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An ethnographic investigation of maternity healthcare experience of immigrants in rural and urban Alberta, Canada

Higginbottom, Gina M.A.; Safipour, Jalal; Yohani, Sophie; O'Brien, Beverley; Mumtaz, Zubia; Paton, Patricia; Chiu, Yvonne; Barolia, Rubina

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Gina M.A. Higginbottom

Jalal Safipour

Sophie Yohani

Beverley O'Brien

Zubia Mumtaz

Patricia Paton

Yvonne Chiu

Rubina Barolia


Background: Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada.

Methods: The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over 2.5 years using focus groups and in-depth semistructured interviews with immigrant women (n = 34), healthcare providers (n = 29), and social service providers (n = 23) in a Canadian province. Purposive samples of each subgroup were generated, and recruitment and data collection – including interpretation and verification of translations – were facilitated through the hiring of community researchers and collaborations with key informants.

Results: The findings indicate that (a) communication difficulties, (b) lack of information, (c) lack of social support (isolation), (d) cultural beliefs, e) inadequate healthcare services, and (f) cost of medicine/services represent potential barriers to the access to and navigation of maternity services by immigrant women in Canada. Having successfully accessed and navigated services, immigrant women often face additional challenges that influence their level of satisfaction and quality of care, such as lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping, and culture shock.

Conclusions: Although health service organizations and policies strive for universality and equality in service provision, personal and organizational barriers can limit care access, adequacy, and acceptability for immigrant women. A holistic healthcare approach must include health informational packages available in different languages/media. Health care professionals who care for diverse populations must be provided with training in cultural competence, and monitoring and evaluation programs to ameliorate personal and systemic discrimination.

Journal Article Type Article
Acceptance Date Dec 3, 2015
Online Publication Date Jan 27, 2016
Publication Date Jan 27, 2016
Deposit Date Jul 22, 2016
Publicly Available Date Jul 22, 2016
Journal BMC Pregnancy and Childbirth
Electronic ISSN 1471-2393
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 16
Issue 20
Keywords Diversity Ethnographic study Healthcare access Maternity care Immigrant woman Canada
Public URL
Publisher URL
Additional Information Findings from a large mixed-methodological study funded by a regional grant. Co-authored with colleagues at the University of Alberta, Canada, Linnaeus University, Sweden and the Aga Khan University Pakistan.

I supervised as PhD students Dr Safipour and Dr Barolia and later Dr Safipour as a Postdoctoral Fellow.

Regional funding was obtained for this study for which I was PI. The object of the regional funding was to lay the foundations for the acquisition of national funding which was realized in a subsequent CIHR grant.


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