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Perceptual Differences in Pregnancy Medical Care: An Initial Study into the Differences Between Asylum Seekers and Dutch Women

Laura Schackmann[1], Medical Sciences, University College Roosevelt

Abstract

Aim

To carry out an analysis of the perceptions of asylum seekers and Dutch women in pregnancies/deliveries within the Netherlands.

Methods

Firstly, a literature review was completed. Search engines PsychINFO, Google Scholar and PubMed were used. Next, six cultural interviews were conducted, with two experts and four women who had delivered in the Netherlands.

Results

In this investigation the obstetric care system in the Netherlands and Dutch cultural background was described. Additionally, the perceptions of asylum seekers, Dutch women and healthcare providers towards obstetric care in the Netherlands were described. Lastly, the obstacles that asylum seekers may face in relation to pregnancy/delivery care were further explored. Due to the challenges faced by asylum seekers, their perceptions of desired and received obstetric care in the Netherlands were different from the care as perceived by Dutch women.

Conclusion

Overall, it can be suggested that asylum-seeking pregnant women should receive the same type of obstetric care as Dutch women; however, through their perception of the obstetric care system and the challenges they face, there are indications that they may receive less care and feel less satisfied with the experience. To increase overall satisfaction, obstetric care in the Netherlands should be better tailored and more sensitive to the cultural and individual contexts and upbringings of the clients, specially when dealing with asylum seekers and refugees.

Keywords: Asylum seekers, Dutch women, obstetrics, cultural change/challenges, perceptual differences, pregnancy/delivery.

Dedication

I would like to dedicate this article to the asylum seeker I interviewed. I was very much touched by her story, and I would like to be her light by voicing her experience.

Introduction

Increasing migration has implications on both providing and receiving healthcare in new living situations (Small et al., 2014). The lack of understanding of healthcare systems, communication barriers, and a sense of discrimination may bring distress to immigrants (Small et al., 2014). As a result, this may lead to uncertainty and instability for asylum-seeking pregnant women accessing obstetric care in their new settlements.

Turmoil in countries affected by war has forced asylum seekers to emigrate due often to unsafe situations in their home country. As asylum seekers enter the EU, some come to the Netherlands. Due to forced migration, asylum seekers often experience uncertainty and distress also in their host countries.

Some asylum-seeking women become pregnant and deliver in the Netherlands. According to Burnett and Peel (2001), women need to be offered obstetric care and family planning options tailored to their cultural and religious backgrounds. Additionally, language barriers, communication difficulties and cultural norms should be taken into account.

The aim of this research is to carry out a comparative analysis in the ways pregnant asylum seekers experience pregnancies/deliveries as opposed to the Dutch pregnant women within the Dutch health care system. Firstly, a literature review was completed. Then, cultural interviews were conducted to understand the experiences of pregnant Dutch and asylum-seeking women in the Netherlands.

The research question is: What are the perceptions concerning obstetric care in regards to pregnant asylum seekers as opposed to Dutch pregnant women in the Netherlands? The hypothesis for this research is: The lack of understanding of Dutch cultural norms, unfamiliarity with the Dutch health care system, communication barriers, and resources for medical assessment are difficulties that may occur more often during medical care for pregnant asylum-seeking women than for Dutch women.

Method

Search strategy and selection criteria

Peer-reviewed articles and studies that discuss pregnant asylum-seeking and Dutch women, healthcare professionals, medical care regarding pregnancies/deliveries, and challenges related to the context were used. These search results were only selected if the language of the text was in English or Dutch. This article uses publications that were published in the last 15 years (2001–16).

Interviews

A study by Sevinç Kılıç, Ajghif, Öztürk, and Karadağ (2016) was used to base the questions for the cultural interviews with the healthcare professional specialising in Dutch obstetric care. The interview with an expert in medical care for asylum seekers was taken, by permission, from a radio, NPO R1, interview.

The remaining interviews with women with pregnancy/delivery experience were created based on the Modified Cultural Formulations of Diagnosis (Drožđek, 2007), which is referred to the English version of the Diagnostic and Statistical Manual of Mental Disroders (DSM-IV) (APA,1994).

Literature

Obstetrics care system in the Netherlands

According to Truijens, Pommer, Heimel, Verhoeven, Oei and Pop (2014), the Dutch obstetric care system provides the choice for low-risk pregnant women to have a home or hospital birth setting supervised by an independent community midwife. There are three main possibilities in regards to obstetric care: firstly, midwife-led only; secondly, supervision by the midwife but is followed by a referral to an obstetrician; lastly, for high-risk patients, obstetrician-led care only. Overall, satisfaction may decrease if there is a break in continuity of care (Truijens et al., 2014).

The Netherlands is known for its obstetric care system as almost one-third of births occur at home (De Vries, et al., 2009). According to Ascoly, Van Halsema and Keysers (2001), the midwife is present in about 50 per cent of the pregnancies. The midwife has many responsibilities, including prescribing drugs, performing surgical interventions, etc. Additionally, the midwife has the power to refer the patient or admit her to a hospital if needed. After the delivery, there is quite extensive postpartum care.

The following gives an overview of the pregnancy care scheme in the Netherlands.

  • First check-up: week eight to ten
  • Ultrasound: week ten to twelve
  • Second check-up: week fourteen to sixteen
  • 16th–24th week: every four weeks
  • 24th–30th week: every three weeks
  • 30th–36th week: every two weeks
  • 36th–42nd week: every week

(Verloskundigen, 2016)

Cultural foundation of obstetric care system in the Netherlands

The obstetric care system reflects a sense of charm or, in Dutch, gezelligheid (De Vries et al., 2009). The Dutch are persistent in keeping this ideology of home births, even though all around the world, the idea of birth has become industrialised and modernised in hospital settings.

In respect to the ideology of family within the Dutch culture, the Dutch were the first among modern society to experience the 'nuclearisation' of family in the late seventeenth century (De Vries et al., 2009). The evidence that reflects this idea of family is that within the Dutch language, this is the only Germanic language, with a specific word for nuclear family (in Dutch gezin).

The key idea of femininity also reflects the combination of home and family. Femininity is reflected historically speaking to the high fertility rate and low rates of participation in paid employment (De Vries et al., 2009). These components, that encompassed family, created and maintained the strong belief for home births. Furthermore, cultural ideas on thriftiness, solidarity and heroes support the preference for home births. The Dutch do not often seek medical solutions and are overall known for their low use of medications (De Vries et al., 2009). Likewise, the Dutch people are likely to downplay the hero in comparison to, for example US obstetricians, where they are inclined to support the hero. This refers to the idea that US obstetricians are more prone to interfere 'by rescuing a labouring woman from protracted pain and life-threatening complications with surgery' (De Vries et al., 2009: 18).

Lastly, in regards to solidarity, healthcare in the Netherlands is socialised. The idea of one's own healthcare is seen in relation to the healthcare of others. According to De Vries and colleagues (2009), a labouring woman will limit herself to a midwife because otherwise she will drive up her healthcare needs and reduce access to others.

Perception of Dutch women on the obstetrics care system in the Netherlands

In the Netherlands women who experience obstetric care are generally satisfied. A study by Johnson, Callister, Freeborn, Beckstrand and Huender (2007) explored the experiences of childbirth in Dutch women who had given birth at home. In a qualitative study (n=14), the results suggested that different factors such as midwives, family support, and home birth made the perception of birth a positive experience among Dutch women (Johnson et al., 2007).

The midwives who provide care for pregnant women are much appreciated. Pregnant women appreciate their support, good instruction and way of inspiring feelings of trust. This study concluded that Dutch women have increased satisfaction with their childbirth with little to no medical intervention, but with an increased amount of emotional support.

There are also Dutch women who do not partake in home births. These women generally give birth in a hospital or clinic setting because they believe giving birth at home is messy, not all supplies are present in case of an emergency, or they simply have to go to the hospital due to complications (De Vries et al., 2007). Women are not choosing the hospital because of the coziness, but rather for convenience and perception of risk.

To compare the women who have obstetrician-led and had midwife-led care; there are different levels of satisfaction regarding their pregnancy and delivery. A study by Truijens and co-researchers (2014) suggested that of the two questionnaire-based studies, study one (n=300) and study two (n=289), there were higher scores relating to 'personal treatment' and 'educational information' for both during pregnancy and delivery among low-risk women who received midwife-led care. With regard to delivery, women who gave birth with their well-trusted midwife and women who received obstetrician-led care from the beginning of the pregnancy had the highest scores. This study concluded that satisfaction was highest for women who had only received either midwife- or obstetrician-led care.

Obstetric care system available to asylum seekers in the Netherlands

In an ideal situation, all women would have equal access to obstetric care; however, the supply and the demand for care is not equally distributed. In a study by Posthumus, Borsboom, Poeran, Steegers, and Bonsel (2016), they explored the dynamics of obstetric care utilisation through obstetric interventions. In the analysis of singleton pregnancies (n=1,532,411) between 2000 and 2008, maternal characteristics in assumed low-risk pregnancies were investigated. The results suggested that generally for the women who were non-Western, there was considerably lower probability for obstetric intervention. The conclusion of that study suggested that there are inequalities in the obstetric care system, particularly for the less privileged.

Perception of healthcare professionals working with pregnant asylum seekers in the Netherlands

According to Ascoly and co-workers (2001), there are three main constraints: language, difficulty in request and time that medical staff with pregnant asylum seekers generally experience. Due to language barriers, translators are often needed, which requires more time and attention. Additionally, due to the complexity of the pregnancy and other asylum-seeking circumstances, their requests may be too far-fetched. Furthermore, medical providers generally lack information on the patients' background and due to language barriers this can cause difficulties in their communication. Overall, lack of understanding from both sides of the physician–patient relationship, in addition to lack of time, may cause obstacles in providing care.

In the study by Kurth, Jaeger, Zemp, Tschudin and Bischoff (2010), it was mentioned that working with asylum-seeking patients had considerable emotional and social challenges. Often the interpreters had emotional challenges translating some of the traumatic events the asylum seekers experienced before or during their journey to their host country. Additionally, the legal difficulties encountered when working with asylum seekers was perceived as one of the main challenges by medical care providers.

Finally, in a qualitative study by Boerleider, Francke, Manniën, Wiegers, and Devillé, (2013), the experiences midwives had regarding working with non-Western women living in the Netherlands was investigated. The main findings from interviewing (n=13) midwives and holding focus group with (n=8) midwives were that they had mixed feelings. The midwives expressed this type of work to be both demanding and rewarding. Some of the main difficulties were: communication barriers, suboptimal health literacy, socioeconomic problems, lack of knowledge of the obstetric care system in the Netherlands, family pressure, as well as high demands such as physician preferences (Boerleider et al., 2013). In conclusion, care for non-Western women was perceived to be difficult by midwifes, which suggested that these difficulties should be incorporated in midwifery and training programmes.

Perception of asylum seekers with regard to pregnancy and delivery in the Netherlands

Receiving obstetric care as an asylum seeker in the Netherlands

Receiving obstetric care as an asylum seeker in the Netherlands is perceived to be difficult. According to Ascoly and colleagues (2001), asylum seekers are a particularly vulnerable population. The conditions of poverty, stress and insecurity lead to this vulnerability.

As an asylum seeker receiving obstetric care with little understanding of the healthcare system, being in a stressful situation, and uncertain whether she may stay in the Netherlands, may be reflected in these disproportionately high numbers for abortions. According to the central agency for the reception of asylum seekers, 14.1 of every 1000 pregnant asylum seekers have an abortion as opposed to 8.6 of every 1000 pregnant Dutch women, annually, in the Netherlands (Goosen, Uitenbroek, Wijsen and Stronks, 2009)

Other than the mental state of the asylum seeker, the Dutch obstetric care system as a whole should be considered. The cultural formation of the obstetric care system allows for this system to be unknown and strange to asylum seekers. This may lead to being pregnant as an asylum seeker unfavourable.

Information provided

Overall there is a lack of information provided to asylum-seeking pregnant women and this restriction may remain a difficulty during and after the pregnancy. According to Ascoly and co-researchers (2001), the Asylum Seeker Centres across the Netherlands try to provide information. However, during and after pregnancy, asylum seekers feel that there is a lack of information.

Impact of culture on communication and support

Cultural differences with regard to pregnancy may have an influence on both communication and support. In the study by Ascoly et al. (2001), it was stated that women from non-Western cultures are often dependent on translators. But in such cultures, where strict gender roles are prevalent, pregnancy-related topics are mostly not spoken about in mixed company. Thus sensitive topics such as rape are not discussed, as the woman may be reluctant to mention it in the presence of a male figure.

Link between communication and isolation

Linking the difficulties of communication with the language barriers, they are often the result of isolation. Ascoly et al. (2001) mentioned that pregnant asylum seekers who do not speak Dutch and who are dependent on male translators might feel isolated. This creates a type of vicious cycle given that these women want to become integrated, but also constantly have the thought of not being able to stay in the Netherlands.

Results

In total, six interviews were conducted and a short summary of each interview may be found in Table 1 and Table 2.

Interviewee Profession Position/organisation Type of work
1 Public health doctor Chair of NVTG (Dutch organisation of tropical medicine and international health) Translates experience of different countries and organisations into a broader framework, specifically research/advertising
2 Care co-ordinator in post-delivery care N/A Intakes with clients, face-to-face and telephonically, and organises information sessions for pregnant women

Table 1: Interviewes summary: experts in the field

Interviewee Age of Interviewee Nationality Years in the Netherlands Partner Family Support Number of pregnancies Type of delivery
3 23 Angolan 3 Yes No 2 C-section
4 33 Dutch (originally Angolan) 12 Yes Yes 2 C-section
5 51 Dutch and American 36 (several international moves) Yes Yes 4 Vaginal
6 32 Dutch Most of life Yes Yes 2 Vaginal

Table 2: Interviews summary: women who delivered in the Netherlands

Medical care

Procedure

The interviewees gave information about the Dutch care system. In the Netherlands, starting in week six, a pregnant woman goes to a midwife or obstetrician. Throughout pregnancy, there are certain check-ups. After the delivery, the midwife visits the patient four times and after six weeks, the patient has a post-delivery check-up (Interviewee 2, lines 16–28).

For asylum seekers, the process of seeking obstetric care is not the same. Firstly, the interviewed asylum seeker told the Central Organisation for Reception of Asylum Seekers (COA), then went to a general practitioner (GP) at the medical centre of the asylum seeker centre (GCA). After four months she was asked to come back and, following this, she was sent to a midwife outside of the GCA.

Communication/ language barriers

Among the four women interviewed, there were different reactions regarding communication. Overall, the women who spoke Dutch had no communication issues. However, the woman who was an asylum seeker had considerable communication problems. According to the expert on medical care for asylum seekers, she mentioned that after arriving in a new country usually they find it difficult to express their complications and they have problems with language. When there are complicated stories, the process of receiving help can take a long time (Interviewee 1, lines 31–44).

Information provided

Comparing the pregnancy and delivery description of the four interviewees, there are differences regarding information provided. The two native women did not require much information, as they were familiar with the care system. Furthermore the Dutch woman from Angola felt that she received enough information regarding her complications (Interviewee 4, lines 218–22). Lastly, the asylum seeker felt that she lacked information (Interviewee 3, lines 214–15).

Limitations for asylum seekers

According to the public health doctor, asylum seekers have less access to care even though they have desire for care (Interviewee 1, lines 8–16). When asylum seekers are settled, seeking medical care is complicated and questions are often unanswered. (Interviewee 1, lines 20–31).

Cultural differences

According to the public health doctor, as a medical professional working with asylum seekers, s/he should have an understanding and acceptance for other cultures. In the Netherlands, there is quite an equal relationship between doctor and patient, whereas for foreigners this may be difficult due to the language barriers and inability to understand or ask questions (Interviewee 1, lines 50–63).

Between the Dutch and Angolan cultures, there are differences among medical care. According to the Dutch woman from Angola:

Money is a big key in terms of medical care in Angola.
(Interviewee 4, line 217)
If you have money, you can go to a hospital otherwise you deliver at home. In that case, you ask someone who may know something about deliveries to help you.
(Interviewee 3, lines 203–10)
Relations with healthcare professionals

The native Dutch women and the Dutch woman from Angola had good relations with healthcare professionals. In contrast, the asylum seeker stated that the medical staff were quite neutral in their attitude. They were friendly and did their tasks, but they did not have much influence on the situation that she was an asylum seeker (Interviewee 3, lines 121–24).

Pregnancies and delivery

Pregnancy circumstances

Among the four interviewed women, their reactions towards their pregnancy circumstances were different. For the interviewed asylum seeker, the circumstances of both her pregnancies as an asylum seeker did not go well. Both pregnancies were traumatic in their own way.

During her first pregnancy, she was eight months pregnant when she was arrested by the foreign police and put in jail. She felt like she was a criminal, but she did not do anything wrong. This was a traumatising experience, causing her to pass out from the shock, waking in jail (Interviewee 3, lines 30–61).

Her second pregnancy was not much better. She had high levels of stress related to the Immigration and Naturalisation service process and the instability of her asylum situation, which led to little energy to proceed with her pregnancy. Due to the lack of energy they started delivery early, and she had a C-section. During her C-section, the doctors did not give her enough anaesthetic; she mentioned, 'they simply didn't do much because more anaesthetics would cost more money' (Interviewee 3, lines 30–61).

For the Angolan Dutch woman, during her first pregnancy, she noticed she was three months into the pregnancy. She experienced both pregnancies differently. She had much more pain in her second pregnancy and it was more emotional, scary and difficult. (Interviewee 4, lines 47–70).

Both native Dutch women experienced their pregnancies and deliveries differently. The two native Dutch women had planned pregnancies and were generally happy with the way they proceeded.

Delivery circumstances

For the asylum seeker interviewed, neither her pregnancy nor her delivery went smoothly. At the eight-month point during her pregnancy, in jail, she was experiencing many complications, but did not expect to be in labour. She noticed that water was leaking, which she mistakenly thought was urine. The police did not want to accept that she was in labour. After fighting to get in contact with a doctor, they did some tests and it wad noticed that her water had broken. This was very stressful as she was worried about the health of her baby (Interviewee 3, lines 30–61).

Furthermore, the Angolan Dutch woman had quite some complications and therefore had a hospital-setting delivery. After the stressful encounter of the complications during her second pregnancy, she was already admitted to the hospital a few days prior delivery as a consequence of her complications. She explained the delivery procedure and the difficulties she encountered:

My delivery was stressful […] I became shocked because of the extreme loss of blood. I was thinking: what are they going to do me? What will they do with the baby? I believe there was an angel above […] the blood clots became smaller and less […] And [then they] released me and I went home.
(Interviewee 4, lines 72–129).

The two native women both experienced their deliveries differently. One had a home birth and the other a hospital birth. The first native interviewed said:

I like the coziness of having a home delivery. Everything is at your own disposal […] I see childbirth more of a natural process, which should be guided by the body.
(Interviewee 5, lines 34–52)

Furthermore, the second native experienced her delivery as 'painful but special' (Interview 6, line 39). She had a hospital-setting birth due to her low pain tolerance (Interviewee 6, lines 39–44).

Family relations during pregnancy and delivery

Each of the women interviewed had different family relations and expectations of support. Firstly the asylum seeker suggested she received support from her boyfriend, as she had no family in the Netherlands. The Angolan Dutch woman mentioned that her family was very important to her. Her boyfriend treated her well and she had close contact with her mother and siblings. Lastly the two native Dutch women explained their family relations, support provided by them, and that they relied strongly on their husbands and family.

Discussion

Obstetrics care system in the Netherlands

In an ideal situation, all women would receive the same care in the Netherlands; however, this is not the case, as suggested by this research. In the study by Posthumus and colleagues (2016), they suggested that there are inequalities in the obstetric care system. Based on the interview with an asylum seeker, this idea was confirmed. Other than her limited care, her overall experience was not pleasant either. For instance, she felt that during her second delivery, the doctors did not give her enough anaesthetic so she could feel what they were doing. It could be possible that she was unaware of the C-section procedure and may have quickly assumed that she was being discriminated towards by not receiving enough anaesthetic.

Additionally, she believed they simply did not give much because more anaesthetic would cost more money (Interviewee 3, lines 30–61). In general a doctor works in the best interest of his/her patients, but due to legal difficulties this may be a challenge for medical care providers to even provide optimal or adequate care. According to Kurth et al. (2010), it is suggested that medical care providers have to be restrictive at times as it may put a risk on their own ethical and/or legal obligations.

Cultural differences

The cultural formation of the maternal care system and the underlying philosophy in the Netherlands allows for this to be a strange system for asylum seekers. There are significant differences in medical care between Dutch and Angolan cultures. According to the Dutch woman from Angola: 'Money is a big key in terms of medical care in Angola' (Interviewee 4, line 217). She implied that medical care, in Angola, revolves around whether you have money or not. This often leads pregnant women to ask someone who may know something about deliveries to help with her delivery given that no other resources are present.

That description may also suggest the difference in planned on non-planned pregnancies. The two native Dutch women had planned pregnancies whereas the two women from Angola did not. It may suggest that for the women with asylum-seeking history, it may be quite a shock when receiving medical care in the Netherlands. This may reflect the delay in starting prenatal care or the unfamiliarity of C-sections. Despite cultural differences, a key element that appeared in all four women was the importance and close bonds with family and significant others.

Perception of Dutch women of the obstetrics care system in the Netherlands

In the Netherlands, women who experienced obstetric care were generally satisfied. The study by Johnson et al. (2007) concluded that Dutch women have increased satisfaction with their childbirth with little to no medical intervention, but with an increased amount of emotional support. The native Dutch woman who experienced a home delivery could further elaborate on this idea. She mentioned that she liked the coziness of a home delivery and how she saw childbirth as a natural process. (Interviewee 5, lines 34–52). Her views on little intervention was confirmed in a study by De Vries et al. (2009), as they suggested that the Dutch are known for their low use of medications.

There are also Dutch women who do not partake in home births (De Vries et al., 2007). This idea can be further confirmed by a personal account of a native Dutch woman interviewed who had a hospital-setting birth due to her low pain tolerance (Interviewee 6, lines 39–44).

It is important to mention that each woman interviewed experienced her pregnancy and delivery differently due to potential complications, or simply pain tolerance, beliefs and preferences. Research often claims that, in the Netherlands, women who experience obstetric care are satisfied overall. However, the care given and received to native women may differ from that of asylum seekers.

Perception of healthcare professionals working with pregnant asylum seekers in the Netherlands

Healthcare professionals often find that working with asylum seekers is rewarding, but also demanding. According to Ascoly and others (2001), there are three main constraints: time, language and difficulty in requests. The public health doctor interviewed mentioned that one should have a feel and acceptance for other cultures. However, touching on the cultural differences in the Netherlands, the lack of cultural understanding of, for instance, prescribing medication not being very common, may lead to an asylum-seeker patient feeling as if she has not been taken seriously (as she was not prescribed medications) (Ascoly et al., 2001).

Care for non-Western women was perceived to be difficult by midwifes and therefore it was suggested that these difficulties should be incorporated in midwifery education and training programmes. The public health doctor further confirmed this idea; that different cultural background should be included in education and recap courses (Interviewee 1, lines 111–14).

Patient–physician relationship

Among the native Dutch women and the Dutch woman from Angola, the relations with the healthcare providers who were involved in their pregnancy and delivery were positive. The general response regarding relationships with physicians was that the midwife or obstetrician was knowledgeable, friendly, competent, and was willing and able to help with all questions (Interviewee 6, lines 67–72).

In contrast, the asylum seeker felt that the medical staff were friendly and did their tasks, but they did not have much influence in the situation that she was an asylum seeker (Interviewee 3, lines 121–24). A reason for this difference may be suggested through the lack of understanding from both sides of the physician–patient relationship, in combination with lack of time, which may eventually limit a strong physician–patient bond.

Difficulties asylum seekers may face

Receiving obstetric care as an asylum seeker in the Netherlands tends to be perceived as difficult. This is seen through first-hand experience by the asylum seeker interviewed. During her second pregnancy she had continuous stress, which led to little energy to proceed with the pregnancy (Interviewee 3, lines 30–61). To alleviate some of this stress, certain resources should be made available such as: providing relaxation methods, talking to a psychologist, or seeking support from other women who either speak the language and/or have experienced a similar situation.

Communication and language barriers

Overall the Dutch native women, and the Dutch woman of Angolan descent, who speaks Dutch, referred to positive experiences with communication with healthcare providers. In the contrary, the asylum seeker from Angola indicated quite some communication problems. Cultural differences with regard to pregnancy can have an influence on both communication and support provided. In the study by Ascoly et al. (2001), they further confirmed that communication issues often concern women from non-Western cultures, as they may depend on translators.

Due to the complexity of the pregnancy, but also other circumstances that revolve around asylum seekers, their requests may be too difficult to address (Ascoly et al., 2001). This tied into the comment by public health doctor, who mentioned that after arriving in their new country, asylum seekers find it difficult to express their complications and they may have problems with the language. Additionally, when there are complicated stories, this process of receiving help can take longer (Interviewee 1, lines 31–44).

Information provided

The three Dutch women felt as if they were provided with enough information. In contrast, the asylum seeker felt that she did not receive enough information. The reason why she felt this way may either be due to misunderstandings and lack of understanding of the language or simply the information was not offered/provided. However, there are two sides to each argument: medical providers frequently lack information on the patients' background and language barriers may cause difficulties (Ascoly et al., 2001).

Conclusion

Implications

This research was conducted over a limited time frame. As there were only a few interviewees, these results should not be generalised. Furthermore, interviews are subjective to the interviewees' own experiences and thus this research should be approached as an impression of the topic.

Final conclusion

This research is a comparative analysis of the ways pregnant asylum seekers experience pregnancies/deliveries as opposed to the Dutch pregnant women. By producing a literature review and conducting cultural interviews, an ideal situation where all women receive the same type of care was not shown to exist. Due to the various challenges asylum seekers face, the perceptions of obstetric care requested and received in the Netherlands is different to the care offered to Dutch women. Due to challenges such as lack of understanding of cultural norms, unfamiliarity with the healthcare system, communication barriers, and resources available for medical assessment, an asylum seeker's impression of available and received care is not perceived as positive as that of Dutch women.

Recommendations

In order to increase the overall satisfaction of obstetric care for asylum seekers, women should be offered care tailored and sensitive to their culture and religious backgrounds (Burnett and Peel, 2001). For better satisfaction of care in the Netherlands, information should be provided to asylum seekers such as: contact information for translators, general overview of cultural norms, brief explanation of obstetric care, and possible support channels to contact. Additionally, time should be taken when medically assessing for a better understanding of the patient.


Acknowledgements

I would like to thank my academic supervisor, Dr E. Wiese, for her support and guidance throughout the research process. I would also like to thank all the participants for sharing their expertise and experiences that formed the basis of this investigation.

List of tables

Table 1: Interviewes summary: experts in the field

Table 2: Interviews summary: women who delivered in the Netherlands

Notes

[1] Laura Schackmann is taking part in the Global Health Research Masters at the Vrije Universiteit in Amsterdam, Netherlands.

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To cite this paper please use the following details: Schackmann, L. (2017), 'Perceptual Differences in Pregnancy Medical Care: An Initial Study into the Differences Between Asylum Seekers and Dutch Women', Reinvention: an International Journal of Undergraduate Research, Volume 10 Issue 2: Featuring the Eramus+ BLASTER Project, https://warwick.ac.uk/fac/cross_fac/iatl/reinvention/archive/volume10issue2/blaster/schackmann. Date accessed [insert date]. If you cite this article or use it in any teaching or other related activities please let us know by e-mailing us at Reinventionjournal at warwick dot ac dot uk.