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Giving Birth in a New Land: Strategies for Service Providers Working with Newcomers

I Introduction

The Best Start Resource Centre recently published a manual for service providers who work with newcomers in the field of reproductive health. Giving Birth in a New Land - Strategies for Service Providers Working with Newcomers shares information about the beliefs and practices of newcomer women.

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II Overview

The purpose of this manual is to:

  • Share information about the beliefs and practices of newcomer women.
  • Assist service providers in helping newcomer women and their partners familiarize themselves with Ontario health practices.
  • Suggest ways for service providers to accommodate the needs of newcomer women within their organizational mandate.

This manual was developed in response to some typical issues encountered in the field of reproductive health that are relevant to some newcomer women. For example:

  • Women may want to have a female obstetrician.
  • Women may want to have special foods at the hospital.
  • Men may not wish to attend the birth of their child.
  • The parents or grand-parents may want special ceremonies performed for the baby after birth.
  • Women may expect to have bed rest for one month or 40 days after delivery.

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III Process

The Best Start Resource Centre manual was inspired by another manual developed by the Calgary Health Region - Immigrant and Refugee Women's Cultural Health Practices: A guide for health care professionals (see Reference section). The Best Start Resource Centre wanted to have a manual which reflected more closely the needs of newcomer women in Ontario and provided information about provincial services.

According to Immigration Canada, the term "newcomers" refers to people who have been in Canada less than five years. For the purpose of our work, this period of time may be longer and includes women who are temporary residents, refugees, foreign students, permanent residents and new Canadian citizens.

An Advisory Committee was formed and consultants were hired to research and draft the report. The consultants reviewed the literature for updates and insights and collected relevant statistical data. They interviewed key informants who provide services to newcomer women in the field of reproductive health. They also held focus groups with newcomer women who were pregnant or had recently given birth in Canada. The manual was then drafted and a number of reviewers added to the content.

Our manual includes information about many cultural health practices and recommended care strategies. One of the key decisions was to organize the content by topic, not by cultural background. The manual therefore does not say "Women of Chinese origin will do X." but rather "During the postpartum period, you may encounter behaviour X." This was seen as less stereotypical by the Advisory Committee. This option also encourages the service provider to ask about the clients' practices and beliefs, instead of making assumptions based on cultural background. This became the underlying theme of the manual.

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IV Key Findings

The literature overview has shown us that:

  • There has been limited attention given to the experiences of newcomer women in accessing health services, but this is changing.
  • Most immigrants are in good health but refugees may not be.
  • Immigrant women are more likely than Canadian-born women to have low family incomes, little social support, poor health, possible postpartum depression, learning needs that are unmet in hospital and a need for financial assistance. Health needs are generally met but additional support services may be beneficial.
  • Discrimination exists, especially in some areas.

The statistical information indicated that:

  • The number of newcomers continues to increase in Ontario.
  • Many newcomers are in their reproductive years.
  • Over the next few years, many newcomers will be settling outside the Greater Toronto Area and service providers in smaller cities need to adjust to this trend.

Service providers told us that:

  • There is a need for a resource on this topic.
  • It is as important for service providers to understand cultural practices as it is to help newcomers understand local practices.
  • It is difficult for service providers to work in isolation - institutional policies need to provide support.
  • The delivery room may not provide the best setting for mutual education - it is important to discuss issues ahead of time.

The newcomer women told us that the reproductive services in Ontario are generally very good, particularly programs such as Canadian Prenatal Nutrition Programs funded by the Public Health Agency of Canada, and postpartum groups. However:

  • Access to prenatal care has been difficult for some women. In some cases, they did not have a family doctor and in others, they did not feel they had enough time with their health care provider.
  • Newcomers are not always aware of the existing programs.
  • Women often experience conflict between their extended family wishes and the local practices and feel "caught in the middle".

We also need to keep in mind that specific experiences may not be related to insensitivity or discrimination and may be due to an overloaded health care system or a difficult birthing situation. Canadian-born women may also experience some of these issues.

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V Call to Action

The manual describes a number of organizational challenges and suggests strategies. It includes checklists for organisations and service providers. Some examples of helpful organizational practices include:

  • Training staff about multicultural requirements.
  • Clarifying for the clients the respective roles of public health, hospital, immigration, Children's Aid Society, etc.
  • Acknowledging that many newcomers may be living in a dwelling with multiple families and generations and that suggestions related to cooking and sleeping arrangements need to take this into consideration.
  • Developing a tip sheet for staff with key terms (e.g., "push," "breathe") in various languages.
  • Reviewing policies and procedures on a regular basis to reduce institutional and systemic discrimination.
  • Referring women without formal status in Canada, or who are waiting for Ontario Health Insurance coverage, to the nearest community health centre or midwifery collective.

The manual describes individual challenges and successful strategies to address these issues. It includes information on pregnancy, labour and birth and postpartum care. Specific suggestions related to decision-making, nutrition, mother care, hospital stay, breastfeeding, sexuality, newborn care, postpartum support, etc., are offered.

The manual is interspersed with comments received from newcomer women on the experiences they had when accessing reproductive health services. Many are positive and some point to improvements which could be made.

The key element for service providers to remember is to ask the right questions regarding cultural and personal needs of newcomer women. This will help them prepare the women and their families better for the birth of their child.

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VI Next Steps

The Best Start Resource Centre is presenting the content of the manual in more detail through a half-day workshop at the end of March (please note that registration if full). An additional regional workshop on the topic is planned for late spring 2009 (exact date and location to be determined). Consultations will also be available on this topic.

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VII References

Kongnetiman (2005). Immigrant and Refugee Women's Cultural Health Practices: A guide for health care professionals. Calgary Health Region. (http://www.sacyhn.ca)

Ministère de la Santé de des Services sociaux - Gouvernement du Québec (2007). Naître ici et venir d'ailleurs. (http://publications.msss.gouv.qc.ca)   

Waxler-Morrisson et al (2006). Cross-Cultural Caring, 2nd Edition (http://www.ubcpress.ca)

Best Start Resource Centre (2002). Reducing the Impact: Working with pregnant women who live in difficult life situations. (http://www.beststart.org/resources/anti_poverty) Related publications are also available.