INTRODUCTION

In recent years, international migration has grown rapidly (Arcaya et al., 2015). Between 2000 and 2017, the migrant population increased by 85 million. In 2017, more than 90 million international migrants were residing in the World Health Organization (WHO) European region and 49% of these migrants were women, many of childbearing age (DeGrandeet et al. 2014, International Organization for Migration 2017- 2018, WHO 2018, Heslehurst et al 2018).

On average, the fertility rate in the migration population is relatively higher than in the native population. Pregnancy is a period of increased vulnerability for migrant women. Vulnerable pregnant women face barriers to accessing health care. Late access and poor-quality maternity care can lead to adverse perinatal outcomes. Several studies and many official reports have demonstrated an increased maternal and neonatal mortality risk among migrant women (DeGrande et al 2014, Heslehurst et al 2018, ORAMMA 2017, Fair et al 2020, van den Akker et al 2016, Balaam et al 2013).

Although the healthy population of each country usually migrates, over time, the health of immigrants gradually deteriorates. Immigrants are physically and mentally burdened due to socio-economic problems, social exclusion, chronic stress, miserable living conditions, difficulty accessing health care, language restrictions, etc. Especially for migrant women, the provision of prenatal care is suboptimal care, and the mental health of women is burdened. This means that migrant women need to be more vigilant during pregnancy and to significantly increase the health promotion and prevention of these groups of migrants (Heslehurst et al 2018, van den Akker et al 2016, Pedersen et al 2014, Urquia et al 2015).

In the European Union, there is a consensus and commitment to ensuring the availability, accessibility, affordability and quality of essential health services for migrants; European countries have a shared responsibility to address inequalities and to provide high-quality healthcare that meets the needs of migrant women who give birth. However, in the Member States of the European Union (EU), services provided to migrants are not the same and in some countries, inequalities have not been eliminated (Arcaya et al 2015, Fair et al 2020, Balaam et al 2013).

This study aimed to provide up-to-date evidence on migrant women’s experiences of pregnancy, childbirth, and maternity care in their destination country within Europe.

RESULTS

DISCUSSION

As to the results of the interviews to the five (5) women, according to the themes that they were analyzed, these are mentioned as follows.

In response to theme 1 about their overall experience with ORAMMA-based care, the women stated that the MPS was waiting for them at the hospital and that they went together to the midwives. They were made to feel very welcome by the people there. They had a lot of fun pretending to speak Arabic at times. They completed all of their examinations in one day and could send them to another center every day as well. They explained to them what these examinations were about each time and let them decide whether or not to take them. They were all pleasant, and the environment was friendly.

In response to theme 2, the women stated that they felt very comfortable with the midwifery-led continuity care model because (the midwives) were women. It was critical that they were all female because they could ask questions that they would be embarrassed to ask in front of a male doctor. When they were about to have an ultrasound scan, (the midwife) gave them an apron to wear and closed the examination room door. They felt as if they were conversing with a friend. They were very attentive to them. Finally, they appreciated that they paid special attention to pregnant women and cared for them more than they should.

In response to theme 3 about their experiences with MPSs, the women expressed gratitude that (the MPS) waited for them at the hospital every time they had an appointment. Furthermore, it is critical for them (the refugees) to have someone translate for every service they use. They look up to him as if he were king. Otherwise, they will perish. The MPS was superior to everyone else; she knew everything there was to know about pregnancy and where they needed to go for the medical test. Every appointment had the same person; they knew her, and this made them (referring to their husbands) feel at ease discussing our concerns. Everything is different in Greece than it is in Syria. The pregnant woman must do a lot of medical test and ultrasound in specific dates. Finally, they said that they had someone who understood them, standing next to them all the time. They could also share all their thoughts. They were discussing altogether (with the midwives) like friends about our babies and how to take care of their baby.

As to the theme 4 about their empowerment for healthseeking- assessing maternity services, the women said that they understood very well, so much so that they think they can visit the hospital alone. They are talking to everyone. They explain to them, they help them understand how important it is. They may have some trouble with all the services and medical tests, but it is more important to give birth to a healthy baby and be well themselves too. Sometimes they go together with their sister to the hospital. They give birth in the same hospital as them. They know the place there, and they help her to understand how the system works. Finally, they say that they had a wonderful time with the midwife.

The struggles of immigrant women with barriers to communication and language are issues that migrant women constantly face. Immigrant women report a poor understanding of medical terminology and yet there is insufficient use of interpreters in the healthcare system (Fair et al 2020, Lionis et al 2018).

Poor communication and the provision of insufficient information impact women’s ability to choose appropriate care options and provide informed consent. An inability to converse in the local language also means women find it difficult to establish a relationship with their care provider and this impact women accessing care. HCPs can help women to overcome language barriers by providing appropriate information, engaging professional interpreters more frequently and ensuring they give women the opportunity to ask the questions that they have (ORAMMA 2017, Fair et al 2021, Papadaki et al 2020).

According to studies, the lack of understanding between migrants and HCs about traditional customs and their expectations for maternity care affected their access to health services. The issues clearly point to a need for HCPs to receive education and training in culturally competent care to identify women’s expectations of care better and how to understand and appropriately respond to women’s needs related to their cultural background, to ensure effective maternity care and reduce barriers to accessing care (ORAMMA 2017, Fair et al 2021, Papadaki et al 2020).

An issue that emerged particularly strongly in this study is that to meet the unique needs of many immigrant women, there is a need for care that goes beyond traditional models. In addition, other studies have highlighted the unstable or inadequate living conditions of migrant women, their financial difficulties and the enormous burden of loneliness and the lack of a family network around them (Heslehurst et al 2018, Balaam et al 2021, Soltani et al, 2020).

Some migrant women described exemplary care, receiving treatment that was empathetic, caring, culturally sensitive and compassionate. However other migrants reported discrimination prevalent in the HCPs that they encountered. Care is seen to be impacted where women do not feel well treated or feel discriminated against, while unrushed, kind, empathetic HCPs are appreciated. Our findings suggest that continuity of care increases migrant women’s satisfaction with maternity care. This is in line with the Cochrane review which has found increased satisfaction reported by women receiving continuity by a known midwife, as well as reduced rates of preterm birth and perinatal death (Pedersen et al, 2014).

To address the social determinants of health and avoid discriminating against migrant women, it calls for personcentred, high-quality, continuity of care that incorporates aspects of cultural competency and trauma-aware care. The evidence within this review, alongside other evidence, led to the development of the ORAMMA integrated perinatal care model (ORAMMA 2017, ORAMMA 2017).

The women who received care under the ORAMMA program were very satisfied with the provision of antenatal care, they felt very comfortable with the providers talking, communicating and understanding the reason for their care. Finally, empowering them to become familiar with the healthcare system has proven useful for women.

A very important limitation of the qualitative study is that the sample is relatively small. The specific population is very difficult to locate due to the mobility of the population in different parts of Greece and Europe, so it is difficult to be included in the research. Also, these women find it very difficult to trust the structures and the purpose of this study easily. Through this study, important conclusions and useful benefits emerge from implementing the ORAMA project.

Finally, in the future, it would be useful for intercultural mediators to be women with special education in obstetric care. HCPs to be trained and experienced in the culture of the specific population but also to know the obstetric care they have in their country.

CONCLUSION

Regarding the conclusion of the above study, it is important for immigrant women to feel understood. Professional interpreters should listen to women and build a friendly relationship of trust with women. HCs should incorporate traditional or cultural practices related to the perinatal period and provide care for women. Therefore, the provision of the ORAMMA program to migrant and refugee women is vital.