Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context

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Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context

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Publication Article, peer reviewed scientific
Title Conceptualising the prevention of adverse obstetric outcomes among immigrants using the 'three delays' framework in a high-income context
Author(s) Binder, Pauline ; Johnsdotter, Sara ; Essén, Birgitta
Date 2012
English abstract
Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3.
DOI http://dx.doi.org/10.1016/j.socscimed.2012.08.010 (link to publisher's fulltext)
Publisher Elsevier
Host/Issue Social Science and Medicine;11
Volume 75
ISSN 0277-9536
Pages 2028-2036
Language eng (iso)
Subject(s) socio-cultural factors
maternal care encounter
immigrant women
health communication
obstetric intervention
ethnicity
migrant-friendly hospitals
maternity guidelines
Humanities/Social Sciences
Research Subject Categories::MEDICINE
Handle http://hdl.handle.net/2043/14235 (link to this page)

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