Improving maternity care and obstetric outcomes for immigrant women

Rhonda Small in collaboration with the Victorian Perinatal Data Collection Unit and the NSW Midwives’ Data Collection

This project is investigating identified problems of public health importance in relation to obstetric outcomes and experiences of maternity care for immigrant women of non-English speaking backgrounds in Australia. These include a range of unexplained variations by maternal country of birth (e.g. in caesarean section and other obstetric procedures); evidence for higher standardised perinatal mortality ratios among well grown term infants of women born in non English speaking (NES)-countries (suggesting possible cause for concern about the role of communication difficulties in decision-making during labour and birth in these poorer outcomes); and consistently poorer ratings of maternity care by immigrant women from NES-countries. The focus in 2010 has been on investigating changes in outcomes for Vietnamese-born women over time (1983-2007).

FUNDING: NHMRC Career Development Award (2005-2009)

STATUS: one paper published; analyses continuing; further papers in preparation

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Maternity care and health after birth: the experiences of Afghan and Iranian women in Melbourne, Australia

Touran Shafiei, Rhonda Small in collaboration with Helen McLachlan, Division of Nursing and Midwifery, La Trobe University

In order to explore women’s experiences of maternity care and well-being after birth; 47 women from Afghanistan and Iran were recruited at four Melbourne hospitals. Data collection included a brief interview at recruitment; a main telephone interview four months after the birth and an in-depth, face-to-face interview with 14 participants nine to 15 months after the birth. The study findings demonstrated that interactions with staff were the most important factors in women’s experiences of maternity care. A significant number of women reported feeling depressed or very unhappy since the birth and some of them were reluctant to discuss their emotional difficulties with health professionals and did not expect that health professionals would necessarily provide assistance. Women’s comments illustrated that their experiences of emotional distress and help-seeking represent an intensification of their migrant experience, most often in relation to the availability of support when it was needed. Understanding this and paying careful attention to individual needs and preferences are important in providing appropriate maternity and postnatal care for Afghan and Iranian women. The study findings have been disseminated in 2010 via conference presentations and workshops and a paper on maternity care experiences has been submitted.

FUNDING: La Trobe University Postgraduate Research scholarship 2008-2009 Diamond Consortium Seed and Capacity Building Grant 2006-2007

STATUS: PhD awarded in 2010; one paper submitted, others in preparation

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Immigrant and Australian-born women’s experiences of life with a new baby: a comparison

Mridula Bandyopadhyay, Rhonda Small and Lyndsey Watson, in collaboration with Stephanie Brown, Murdoch Childrens Research Institute

Little is known about immigrant mothers’ experiences of life with a new baby, apart from studies on maternal depression. Our objective was to compare the post-childbirth experiences of Australian-born and immigrant mothers from non-English speaking countries. A postal survey of recent mothers at six months postpartum in Victoria (August 2000 to February 2002), enabled comparison of experiences of life with a new baby for two groups of immigrant women: those born overseas in non-English speaking countries who reported speaking English very well (n=460); and those born overseas in non-English-speaking countries who reported speaking English less than very well (n=184) and Australian-born women (n=9,796). Immigrant women were more likely than Australian-born women to be breastfeeding at six months and were equally confident in caring for their baby and talking to health providers. No differences were found in anxiety or relationship problems with partners. However, compared with Australian-born women, immigrant mothers less proficient in English did have a higher prevalence of depression (28.8% vs 15%) and were more likely to report wanting more practical (65.2% vs 55.4%) and emotional (65.2% vs 44.1%) support. They were more likely to have no ‘time out’ from baby care (47% vs 28%) and to report feeling lonely and isolated (39% vs 17%). Immigrant mothers less proficient in English appear to face significant additional challenges post-childbirth. Greater awareness of these challenges may help to improve the responsiveness of health and support services for women after birth. Bandyopadhyay M, Small R, Watson LF, Brown S. Life with a new baby: How do immigrant and Australian-born women’s experiences compare? Australian & New Zealand Journal of Public Health. 2010; 34(4): 412-421

FUNDING: MB supported by COMPASS, NHMRC Capacity Building Grant (2007-2012)

STATUS: Paper published

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South Asian Women’s experiences of living with Gestational Diabetes Mellitus (GDM)

Mridula Bandyopadhyay, Rhonda Small, Mary-Ann Davey, Della Forster in collaboration with Jeremy Oats, Amanda Aylward, The Royal Women’s Hospital

Women from South Asia have a high incidence of gestational diabetes mellitus (GDM) placing them at risk of adverse pregnancy outcomes. Despite the higher rates of GDM in this group, there are no studies of their experiences of living with GDM in Australia or elsewhere. We aimed to explore the experiences and understandings of South Asian women in Melbourne, Australia, after diagnosis with GDM. A qualitative approach was used. Face to face in-depth interviews were conducted with 17 immigrant women from South Asia recently diagnosed with GDM. They were interviewed in the language of their choice at two time points: in pregnancy after GDM diagnosis and at six weeks postpartum. Thematic analysis was conducted to identify common patterns and salient themes within and across narratives, also taking into account any divergent experiences. Before diagnosis of GDM women’s knowledge and awareness of any diabetes was low. Women and their partners were upset by the diagnosis. Dietary advice received was seen to be challenging in the context of culturally different food habits and consequently managing diet after diagnosis proved difficult. Different attitudes to exercise in pregnancy also raised issues for women. Women said they would try their best to maintain lifestyle modifications postnatally, but were uncertain about sustaining these in the long term. South Asian women require culturally appropriate advice regarding strategies to reduce their risk of GDM as early as possible in pregnancy, ideally at the time pregnancy is confirmed.

FUNDING: La Trobe University Faculty of Health Sciences Research Grant 2009

STATUS: One paper in press

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Collaborative Work

Reproductive Outcomes And Migration (ROAM): an international collaboration

Rhonda Small and Mridula Bandyopadhyay, in collaboration with Anita Gagnon, McGill University, Canada, Sophie Alexander (Université Libre de Bruxelles – Belgium), Béatrice Blondell, (INSERM – France), Simone Buitendijk and Dineke Korfker, (TNO Institute – Prevention and Health - Netherlands), Marie Desmeules (Public Health Agency of Canada), Dominico DiLallo (Agency for Public Health of Rome – Italy), Birgitta Essén (Uppsala University – Sweden), Mika Gissler (Institute of Health – Finland), Richard Glazier (Institute for Clinical Evaluative Sciences – Canada), Sylvie Guendelman (University of California, Berkeley – US),Maureen Heaman (University of Manitoba – Canada), Anders Hjern (National Board of Health and Welfare – Sweden), Alison Macfarlane (City University of London – UK), Sarah McDermott (Public Health Agency Canada), Edward Ng (Statistics Canada), Carolyn Roth (University of Keele – UK), Donna Stewart (University Health Network of Toronto – Canada), Babill Stray-Pederson and Siri Vangen (University of Oslo – Norway), Marcelo Urquia (University of Toronto – Canada), Jennifer Zeitlin (INSERM – France and EURO-PERISTAT)

The collaboration aims to undertake comparative work on migrant, refugee and asylum-seeking women’s reproductive health outcomes and their views of maternity care in Europe, North America and Australia. The collaboration began with an initial grant awarded from the Canadian Institutes of Health Research (CIHR) International Opportunity Development Grant Scheme to establish research links between Canada and Australia for comparing reproductive health outcomes of immigrant and refugee women. The first meeting of a wider collaborative network with researchers from the UK, Italy, France, Belgium, and Finland was held at the European Congress of Epidemiology in Porto, Portugal in September 2004. Since then collaborators from a range of other countries have joined the collaborative network and annual meetings have been held. ROAM collaborators met in Amsterdam in November 2010, where completed work was presented and further collaborative research and grant proposals were discussed. Funding was also received in 2010 for a systematic review of caesarean section in immigrant women, led by A/Prof Gagnon.

FUNDING: Canadian Institutes of Health Research International Collaboration grant 2007-2008 and Systematic Review grant 2010; further funding to be sought in 2011

STATUS: four papers published; several in preparation

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