Pregnancy and Maternity Health of Immigrant Women in Portugal

1
Pregnancy and Maternity Health of Immigrant Women
in Portugal
Sónia F. Dias1 Cristianne F. Rocha2
1 Institute of Hygiene and Tropical Medicine, New
University of Lisbon, Portugal 2 Universidade
Luterana do Brasil, Porto Alegre, Brasil
12th World Congress on Public Health 30th April
2009
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Background

• Immigrant women in Portugal are at high risk for
  negative sexual and reproductive health outcomes
  and underutilize healthcare services .
• Research has based mainly on epidemiological
  data qualitative research methods allow to
  deeply understand migrants' perspectives on
  reproductive health.
• Focus groups provide insights into not only
  individual behavior but also the social, cultural
  and political factors which influence
  reproductive health.

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Objectives

• Understand immigrant women perceptions,
  attitudes and needs on issues related to
  reproductive health, as pregnancy and maternity
  health.
• Understand how immigration experiences influence
  reproductive health.
• Identify factors related to access and
  utilization of reproductive health services.

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Methods and participants

• 8 Focus groups were conducted in 2008
• Purposeful sample
• 64 low income immigrant women
• from Brazil and Portuguese Speaking African
  Countries
• aged 18-45 years
• living in Lisbon
• Discussions were audio recorded and transcribed
• Thematic decomposition was adopted to structure
  the analysis
• Content analysis was used

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Results Reproductive health
Differences between African and Brazilian women
related to cultural beliefs and norms that play
an important role in the adoption of practices
related to pregnancy and maternity health.
Family planning mainly associated to maternity I
did family planning when the baby was born, the
doctor said to me to do it, so I went but only
one time. (African) Beliefs associated with
inefficiency of contraceptive methods (African
participants) I have never took the pill. And if
I take and get pregnant? I used to use the pill
and was always getting pregnant.
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Results Reproductive health
Experiences and fears related to delivery
In the hospital I see so many women suffering, my
fear is that I wont have a normal delivery and
will have some kind of problem. (Brazilian)
I had some problems with one pregnancy ()
because the doctor was very late for delivery ()
he was the only doctor available. (Brazilian)
Different experiences related to
maternity Brazilian women describe their
experiences of maternity in Portugal as more
difficult than in Brazil ... I had some
difficulties during pregnancy, I had fever and I
even had to donate milk. I asked the nurse if
there was any milk bank here in Portugal, she
didnt know , I got scared about that.
(Brazilian) African women report more
difficulties in the country of origin than in
Portugal in my country its completely
different from here. Treatments are different ()
there are equipments here, to have a normal
delivery, that dont exist in my country.
(African)
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Results Reproductive health
The desire of having children is influenced by
the cultural context of the country of origin
many people want to have more children and
try to have, but there are many difficulties ()
its difficult not having the family with us.
(Brazilian) .. even if we wanted to, we
cant make it. Here, these four children are
enough. (African)
Difficulties faced in host country influence
pregnancy and decision making about having
children Im a single parent so I dont
want to have more children. (African) We
have to pay for a baby-sitter, almost our whole
wage () if we have children , we have to
handle with it. (African) the unintended
pregnancy is a main concern because nowadays its
very difficult to support so many children.
(African)
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Results Immigration experiences
There is an interception of personal, economic,
social, and cultural factors that characterize
diverse immigration' experiences which have
implications to reproductive health.
Arrival and adaptation experiences To come to
this country and have to live in a tent () I
suffered a lot. I almost died () coming here was
a sorrowful decision. (African) Then I arrived
here and found another kind of war, more
difficulties. (African)
Difficulties in managing family life and working
conditions I had 3 children to care and Im
alone. There were days that I had to leave them
locked at home to go to work, because I didnt
have money to pay for a baby-sitter (African)
Here, no one helps (African)
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Results Immigration experiences
Lack of support Isolation and disruption of
social relations (...) When you are an immigrant
you are away from relatives and people to help
you. You feel lonely (Brazilian) Isolation
experience during pregnancy and postpartum The
decision of having children becomes more
difficult and sometimes pregnancy interruption
turns to be the only alternative. A child isnt
a problem but makes it more difficult () the
person has to make the decision (Brazilian) Here
its very difficult, so sometimes consciously we
have to remove the baby. (African) Frequently
women dont have support from relatives and/or
partners to continue the pregnancy.
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Results Immigration experiences
Data from women's discourse reveal that
frequently they face situations of human rights
violation, discrimination, social inequalities
and exclusion.

• Discrimination
• I suffered because of my color specially when I
  looked for a job. (Brazilian)
• I know a woman that used to say that who steals
  husbands and who prostitutes is Brazilian.
  (Brazilian)

• Violence
• I was walking with my boyfriend and many were
  making fun of me, saying that he was sleeping
  with others () that hurts. (African)
• I have a neighbour, her husband beats her, there
  is a lot of domestic violence. (African)
• My husband used to beat me () and he used to put
  my family against me () they believed him.
  (African)

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Results Access and utilization of health care
services
Utilization of reproductive health services
related to pregnancy and maternity care
those who already have children, I believed they
use more, but those who didnt have only go to
health services when they need. (African)
I only go when Im pregnant. (African) Reduced
utilization of prenatal care I only knew
I was pregnant at the fifth or sixth month.
(African)
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Results Access and utilization of health care
services
Distrust and perception of low quality of health
services there is a big room full with
women, theres no privacy. But worst than that is
that they are screaming. Then the doctor came,
opened our friends legs and did the delivery
right there. (Brazilian) a friend of
mine wasnt feeling well, every day she would go
there and they would send her home it took too
much time and the baby was born with a
deficiency. (Brazilian) everyone asks
why do Portuguese people dont have babies? The
stories we listen, in XXI century, the way they
have their babies here, makes women wanting to
have no more children again. (Brazilian)
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Results Access and utilization of health care
services
The results showed that women faced several
barriers to health care services due to
structural, administrative, social, economic and
cultural bafflers.
Lack of migrant-oriented health
services. Insufficient training for health
professionals in caring for those from different
cultural backgrounds. Lack of sensitivity of
health providers.
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Results Health care services

• Discrimination
• (...) the Nurse said Damn! You were so well in
  your country, and you came to have your baby
  here. I found that comment very inconvenient.
  (Brazilian)
• When its a disease you are vulnerable and
  suffer, and this discrimination brings more
  suffering (Brazilian)
• I think there should be more respect because we
  are ill and in the hospital () I think that they
  dont worry about us being alone (Brazilian)
• When I was giving birth I said Im immigrant but
  Im an human being and she told me You
  immigrants must be in your countries. And you
  have to shut up. (Brazilian)

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Conclusions

• Strong relation between condition of being
  immigrant (and socially disadvantaged) and
  difficulties in pregnancy and maternity health.
• Dynamic process between the challenges migrant
  women face moving to a different society and
  cultural expectations that determine perceptions,
  attitudes and consequently choices that can make
  them more vulnerable.
• Be sensitive to these questions and develop new
  approaches to deal with reproductive health
  issues and implications for pregnancy and
  maternity health in these groups.

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Conclusions

• Health providers must be sensitive to deal with
• different cultural and value systems that have
  impact on decision-making related to reproductive
  health
• factors that increase vulnerability of immigrant
  women in reproductive health, specially during
  pregnancy and maternity.

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Thank you

• smfdias_at_yahoo.com