Giving birth is scary for any new mother. But for immigrants who may face prejudice and are not familiar with their new country’s language, hospitals can be particularly daunting places.
The Swedish province of Halland aims to change that by hiring and training birth coaches known as “doulas” from all over the country. Doula and Kulturtolk Halland, a cultural interpreter doula service, provides women who don’t speak Swedish with support and guidance through their entire pregnancy.
The doulas provide support and medical counsel to expectant mothers in 21 different languages.
Doulas support immigrant and minority women who are more likely to experience obstacles when giving birth by giving them agency over their pregnancies, but will their presence be enough to prevent racial discrimination and language barriers?
The challenges of childbirth
Sweden has seen a significant shift in its demographics since 2015, when it admitted more asylum seekers per capita than any other European country.
Its generous migration policy has led to a fast-growing population of foreign-born nationals. Iraqis are now the second-largest nationality group in the country — after Finns — and Syrians come third. And, according to Statistics Sweden, this surge of immigration has led to a 28% increase in the number of non-Swedish nationals giving birth.
These new mothers face significant dangers: according to research by Uppsala University, immigrant women born in low-income countries are nearly seven times more likely to die during childbirth or pregnancy than Swedish-born women. The most common factors for mortality were not seeking medical attention, poor accessibility of services and the lack of quality care.
But this is not an isolated problem. Women of colour and minority groups face significant disparities in health outcomes during and after pregnancy, which leads to higher mortality rates and health complications.
For instance, in the United States, black women are three times more likely to die during childbirth or from health complications during pregnancy than white women. Black women in America face similar barriers such as access to healthcare and poor health literacy — but doulas are helping support black women who may not have the same access to services as white women.
One study published by researchers at the Center for Youth, Family, and Community Partnerships at the University of North Carolina, found that doula-assisted mothers were given more agency over their pregnancies and had better health outcomes than non-doula-assisted mothers. They concluded that women that used doulas were two times less likely to experience a birth complication for either them or their baby.
Although many immigrants to Sweden try to learn the language, high demand and cuts to the system have made it difficult to get a spot in public language schools. And without access to language learning, many immigrants around the world struggle to get the medical resources they need.
One study in the US found that high mortality rates among migrants can be attributed to cultural, predisposed ideas of healthcare, language barriers, lower health literacy and not having knowledge of the healthcare system in the country where they are giving birth.
When immigrants lack language skills, they often struggle to understand instructions from doctors and describe the medical problems they face.
Currently, most Swedish hospitals provide parents with access to an interpreter, who they can choose to have present at the time of birth. But many immigrant women feel uncomfortable with a stranger being present.
Doulas or birth companions are not medically trained but are tasked with providing women with guidance and emotional support throughout their pregnancy.
The doula organisation Doula and Kulturtolk Halland offers educational courses and doula certification once a month to women who speak different languages and come from different backgrounds. Currently, 200 women have received certification.
The organisation also helps the doulas, who are often immigrants themselves, find employment at local agencies and hospitals.
Wendy McWeeny, an advisor to The Community Health Funders Collaborative, said that because doulas work with women throughout their pregnancy and delivery as well as after the birth of the child, they provide continuity of care.
Expectant mothers often see several different doctors throughout their pregnancy. But doulas cultivate a deeper, trusting bond with expectant mothers throughout the long pregnancy process — and are more likely to catch and diagnose a medical issue as it arises, said McWeeny.
McWeeny added that it’s especially important for women of colour and immigrants to have people that will communicate on their behalf — medical professionals may stereotype them based on their nationality and race.
The US Institute of Medicine found that racial and ethnic minority groups receive inferior care. Thanks to discriminatory attitudes, the health problems ethnic minority women mention get overlooked, resulting in missed diagnoses or failed interventions.
To this end, the Doula and Kulturtolk Halland doulas facilitate communication between midwives, who deliver babies at hospitals, and expectant mothers. They also help non-native speakers schedule appointments, allowing them to access better prenatal care.
A recent budget initiative was passed in New Jersey in July 2019 that provides $1 million in doula coverage for New Jersey’s Medicaid program. The aim is to improve health outcomes for women of colour during pregnancy.
“For all women, but especially those who have dealt with implicit or explicit bias, doulas can help support and amplify women’s voices at a time — and in a setting — where it can be hard to be heard. Doulas are an increasingly important intervention as we think about better ways to address the needs of women who have historically been denied a voice,” said McWeeny. — Amelia Axelsen
(Picture Credit: Pixabay)