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Partnerships for change in refugee child and family health

People of refugee background are ordinary people caught in exceptional circumstances. War and human rights abuse is a commonality for those fleeing from their home and country.  We know that the impact of torture and trauma lasts for years, with impacts that are intergenerational.

As we celebrate Refugee Week and the contribution that refugees make to Australia we reflect on Murdoch Children’s work in seeking to understand how refugee families’ experience health care around the time of having baby – and the innovative work underway to improve the health and health care of these families. This is important as emerging and compelling evidence exists that women of refugee background have poor pregnancy outcomes including stillbirth and neonatal death. Critical to quality improvement in health care is that the client perspective is central – yet the voices of refugee families as consumers of health care has been missing.  

The Healthy Mothers Healthy Families (HMHF) Research Group is breaking new ground in engaging with communities and health care providers to explore their experiences of care around the time of having a baby and develop new ways to address health and health care inequalities for vulnerable families. Several publications by the group indicate that how women access, engage and experience care may be contributing to poorer outcomes. In the journal Midwifery a paper describes findings from two consecutive population-based surveys of recent mothers indicating that migrant women of non-English speaking background are more likely than local born women to rate their maternity care poorly. Migrant women reported that health professionals did not always make an effort to get to know the issues that were important to them, keep them informed about what was happening in labour or take their wishes into account. There was no change in migrant women’s experiences over the eight years between surveys.

Other recent publications report on a study with Afghan women and men who had recently had a baby and with health professionals caring for Afghan and other refugee families. Conducted in partnership with the Victoria Foundation of Survivors of Torture (Foundation House), community engagement was pivotal to the research design and implementation. Over 90 members of the Afghan community participated in a consultation, community and sector advisory groups contributed to the project, 30 Afghan women and men and 34 health professionals were interviewed. The Afghan families were facing significant social and economic hardship during and after pregnancy and whilst appreciative of the health care they received, reported that health services were not meeting their needs in a way that they would have like them to. Families wanted health providers to help with: difficulties associated with settlement in Australia; accessing general health and health care information; having female care providers; and access to accredited interpreters particularly during labour and birth.

In Refugee Week we also celebrate how the voices of  refugee women and their families have paved the way for the formation of a large partnership spanning maternity, maternal and child health services, local and state government, primary care networks and researchers. The Bridging the Gap program comprises multiple quality improvement initiatives to ultimately improve health care and health outcomes for families of refugee background. Implemented in maternity and maternal and child health services in Melbourne’s south east and west, Bridging the Gap projects are co-designed by partners to build sustainable and replicable best practice in caring for refugee and other vulnerable families.

Further reading:

Yelland J, Riggs E, Szwarc J ,Casey S, Duell-Piening P, Chesters D, Wahidi S, Fouladi F, Brown S. Compromised communication: a qualitative study exploring Afghan families and health professionals experience of interpreting support in Australian maternity care. BMJ Quality & Safety In press.

Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, East C, Wallace E, Teale G, Harrison B, Petschel P, Furler J, Goldfeld S, Mensah F, Biro MA, Willey S, Cheng IH, Small R, Brown S. Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implementation Science 2015;10:62.

Yelland J, Riggs E, Small R, Brown S. Maternity services are not meeting the needs of immigrant women in non-English speaking background: results of two consecutive Australian population based studies. Midwifery 2015; 31(7): 664–670.

Riggs E, Yelland J, Szwarc J, Casey S, Chesters D, Duell-Piening P, Wahidi S, Fouladi F, Brown S. Promoting the inclusion of Afghan women and men in research: reflections from research and community partners involved in implementing a 'proof of concept' project. International Journal for Equity in Health 2015; 14:13.

Yelland J, Riggs E, Fouladi F, Wahidi S, Casey S, Szwarc J, Duell-Piening P, Chesters D, Brown S. How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy & Childbirth 2014; 14:348.

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