By: Elham Almoli
Advocating for Pregnant Refugees and Immigrants in Canada
Canada is home to a diverse and vibrant population, with refugees and immigrants making up an important part of our community. A refugee is someone who has been forced to leave their country due to persecution, conflict, or violence. Currently, over 31 million refugees are under the UNHCR mandate and 5.8 million plus many others who are in need of protection. These individuals face numerous challenges, and for pregnant refugees and immigrants, prenatal, interim, and postpartum care presents additional hurdles. Therefore, advocating for these populations and exploring ways to provide necessary support is crucial.
The Multifaceted Challenges in Prenatal, Interim, and Postpartum Care
Language Differences
Language barriers are a significant obstacle for many refugees. English proficiency is sometimes limited, making it difficult for refugees or immigrants to understand medical terms related to pregnancy and childbirth. Studies show that language is the most cited barrier to healthcare for refugees, who struggle to comprehend their health status and the advice given by healthcare providers (Khanlou et al., 2017). This issue is exacerbated when interpretation services are scarce (Stirling Cameron et al., 2021). Therefore, the situation worsens during times of emergencies or when there is increased demand for the healthcare system, such as the COVID-19 pandemic. For instance, some women had to wait up to six hours in emergency departments for telephone interpreters, delaying access to urgent care (Stirling Cameron et al., 2021). As such, to ensure patient-centered care and optimize patients' ability to fully understand and make an informed decision regarding their health and healthcare plan, services that help overcome these language barriers must be present and well supported. Moreover, interpretation services also come at a cost that must be accounted for as part of the healthcare system's spending. It's important to consider that while virtual interpretation services offer convenience, many patients have indicated that they prefer in-person interpreters. The ability to read body language and facial expressions is invaluable in healthcare settings, providing a more comprehensive understanding of patient needs (Stirling Cameron et al., 2021).
Knowing how to navigate the Healthcare System
For many immigrants and refugees, the Canadian healthcare system can be drastically different from where they are coming from, and this can be an additional barrier and stressor for them to navigate. Being aware of this is important to ensure that support groups are addressing these concerns and providing the necessary resources and information for refugees and immigrants to access and learn more about the Canadian healthcare system. This includes general health information like an understanding of how to obtain OHIP and what it covers, healthcare options for patients with refugee status, how to get a family physician, and the available clinics that are familiar with providing healthcare to refugees, such as the Crossroads Clinic at Women’s College Hospital. With regard to pregnant patients, it's important to discuss the differences between midwives, family physicians, and obstetricians.
Mental Health Impacts
Pregnancy and childbirth significantly affect mental health, which is important to keep in mind when supporting refugee or immigrant populations. For example, migrant women are more likely to suffer from prenatal depression compared to non-migrant Canadians (Khanlou et al., 2017). Furthermore, immigrant women experiencing prenatal depression often report somatic symptoms, highlighting the different ways health needs may manifest differently among patient populations (Zelkowitz et al., 2004).
Moreover, refugees face additional stressors, such as migration stress, housing issues, and low income, all contributing to higher depression rates (Zelkowitz et al., 2004). Lack of social support, particularly for refugees separated from their families, is also a significant risk factor as many studies highlight the importance and benefits of having a strong social support system during prenatal, interim, and postnatal care (Khanlou et al., 2017).
Providing Support and Advocacy
Understanding and advocating for the mental health and overall well-being of pregnant refugees and immigrants is essential. Taking the time to understand their backgrounds and values allows us to better support each other as a community and to provide resources that facilitate their transition and welcoming into the country. By addressing language barriers, offering diverse care, and supporting mental health, we can improve the healthcare experience for all patient populations and foster a sense of community and belonging that is supportive and inclusive.
References
Arindambanerjee/Shutterstock, featured in "PWRDF marks World Refugee Day in Canada and abroad." The Primate's World Relief and Development Fund, 19 June 2017, https://pwrdf.org/pwrdf-marks-world-refugee-day-in-canada-and-abroad/.
Khanlou, N., Haque, N., Skinner, A., Mantini, A., & Kurtz Landy, C. (2017). Scoping review on maternal health among immigrant and refugee women in Canada: Prenatal, intrapartum, and postnatal care. Journal of Pregnancy, 2017, 1–14. https://doi.org/10.1155/2017/8783294
Stirling Cameron, E., Ramos, H., Aston, M., Kuri, M., & Jackson, L. (2021). “COVID affected us all:” The birth and postnatal health experiences of resettled Syrian refugee women during COVID-19 in Canada. Reproductive Health, 18(1), 256. https://doi.org/10.1186/s12978-021-01309-2
What is a Refugee? (n.d.). USA UNHCR.
Zelkowitz, P., Schinazi, J., Katofsky, L., Saucier, J. F., Valenzuela, M., Westreich, R., & Dayan, J. (2004). Factors associated with depression in pregnant immigrant women. Transcultural Psychiatry, 41(4), 445–464. https://doi.org/10.1177/1363461504047929
Comments