Migrant mothers and health professionals' views and experiences of the Australian perinatal health care system and its influence on their mental health

Abstract

Background: Perinatal depression (PD) is an illness that affects about 20% of women in Australia. Migrant women are particularly vulnerable and at risk of developing PD for many reasons, including a lack of social support, poor language skills, and life stressors such as domestic violence and low socioeconomic conditions. Nevertheless, this study intends to avoid the generalisation of culture and focuses on women's experience as mothers and migrants living in Australia. This research analyses the experiences and social supports for migrant women that shape their perinatal experiences and their perinatal care, and describes strategies adopted to ensure wellbeing in a regional Australian town and a large city. My findings highlight the need for better perinatal care support for this cohort to mitigate the risk of the development of PD.

Method: In this ethnographic project, I studied the experiences of seven migrant women from 2015 to 2018 in Hamilton, Victoria. These women were selected through the local playgroup and also through snowball sampling. Their experiences were compared to ten migrant women in Canberra, ACT, from the same period. All migrant women had lived in Australia for at least two years. Additionally, five health professionals in Hamilton and nine health professionals in Canberra were interviewed. The theoretical approaches of invisible communities, muted groups, and the cultural meaning of suffering and distress framed the work. Interviews with mothers and health care professionals and field notes were analysed using coding of common themes.

Results: As found in other studies, the lack of social support in Australia was the primary complaint of all participants. Participants living in Hamilton reported outstanding perinatal care and highlighted the benefits of having local peer support provided by their local playgroup; only one was diagnosed with PD. In contrast to the experience of women living in Hamilton, participants from Canberra reported dissatisfaction regarding the care they received during labour and in the postnatal period. Of note, five of these women developed PD. Health professionals interviewed in both cities believed that they provided the best evidence-based care despite cultural challenges. They identified that, at times, low health literacy was a barrier to the provision of care. They mitigated this issue through education and medical support. They did not identify significant barriers to delivering perinatal care to migrant women. Nevertheless, there were discrepancies between health professionals' views and those of the women receiving care.

Conclusions: Hamilton had fewer support services and access to perinatal care was limited compared to metropolitan centres. Nonetheless, the interviewed migrant women developed a peer support network through participation in a local playgroup that functioned as the kind of community support migrant mothers longed for and often mourned the lack of. Participants living in Hamilton felt supported by their health professionals and volunteers from their playgroup. Participants in the urban case study expressed dissatisfaction with the quality of perinatal care. They felt that health professionals were not responsive to their cultural needs during the labour and postnatal period, even though Canberra had extensive perinatal support programs available to new mothers. They could not indicate specific community services that were helpful and wished to access long-term. While the explanations for the dissatisfaction in Canberra may be locale-specific, both studies point to the need for communities of support for young mothers rather than focusing on medical programs alone. Show more