Overcoming communication barriers is the key to reducing the high stillbirth rates in migrant and refugee communities, according to a new report.
The study, published in the Medical Journal of Australia (MJA), outlined the importance of health professionals understanding what matters to migrant and refugee women.
It said this is just as fundamental to ending preventable stillbirths as migrant and refugee women understanding the information they’re provided with.
Lead researcher Professor Jane Yelland, from the Murdoch Children’s Research Institute, said even though 80,000 women of non-English speaking backgrounds give birth in Australia each year, many still report limited access to understandable information.
Migrant and refugee women still experience stillbirth at much higher rates than other women in Australia. Source: AAP
“Clinicians are meant to be telling women about sleeping positions, for example, not to smoke during pregnancy and what to look out for in terms of reduced foetal movement,” she said.
“The latter one is really important because people need to have information that they can understand and then act on.
“You have to be able to understand that information and then know where to go to if you’re concerned and then know that when you go somewhere you’re going to get a response.
“That’s really important and we often hear that people haven’t had access to that information or it hasn’t been provided in a way that they understand.”
'No recognisable improvements'
Professor Yelland said while there are sometimes physical and medical reasons behind high levels of stillbirths among migrant women, there’s often a range of contributing factors.
“The reasons for stillbirth are multifaceted,” she said.
“We can see that stillbirths by the country the women were born in, particularly the maternal region of birth have identified that women from particular regions are at higher risk of stillbirth.
“One explanation for the higher rate of stillbirths among south Asian women - women that were born in India, Pakistan, Sri Lanka, Afghanistan and Bangladesh - those women are at higher risk, and this is related to the difference in gestational length and foetal growth.”
“So there may be biological reasons but there’s likely to be more reasons beyond that, related to migration and access to and the quality of antenatal care.”
More likely than physical reasons for stillbirth are communication barriers.
Migrant and refugee women face additional hardships in accessing antenatal care. Source: AAP
Professor Yelland said women from refugee and migrant backgrounds are missing critical information about their own health and the health of their baby.
“There’s really major challenges for migrant women of a non-English speaking background navigating Australian health care, and that’s been recognised for decades,” Professor Yelland said.
“Unfortunately there’s been no recognisable improvements for migrant women’s experience of maternity care.
“One of the barriers is obvious, and that’s in relation to communication.
“In the context of migration, particularly when people come from a country where English is not the main language in that country, being able to access information in people's own language and communication with service providers is really paramount.
“Language is a barrier in many ways to accessing care and navigating one's way around what is actually a very complex health system.
“What might be less obvious is that access to care is really challenged when care is not responsive to people’s context and needs.
“One thing is finding your way into the system, the other barriers are systemic issues, like not having a professional interpreter when you need one, care in a place that’s difficult to access, or that’s far from home.
“It’s also how, once people are in the system, their experience of care and if they will go back to care.”
'Additional hardships'
For refugees, the barriers are compounded, especially if they’ve experienced torture or trauma.
Melbourne University senior research fellow and report co-author Dr Elisha Riggs said it’s important for health staff to know what to do if someone has experienced trauma.
Breaking down language barriers is the key to reduce high stillbirth rates among migrant and refugee women. Source: AAP
“Individuals of refugee background often have experiences of torture or trauma and can face additional hardships around the time of pregnancy, which is just exacerbated by low levels of English proficiency and low health literacy,” she said.
“Services need to ensure that they’re responsive in providing trauma-informed care, which means really being aware of the refugee experience and how that can impact on a woman and her family at the time of having a baby.”
Dr Riggs said regardless of who the woman is, the most important thing is listening to her needs.
“What really matters to women and communities who are new to Australia is asking them for their opinion about what they would like from health care because that’s the only way we’re going to see any change in ending preventable stillbirth and other poorer outcomes,” she said.
