Caring for pregnant refugee women in a turbulent policy landscape: Perspectives of health care professionals in Calgary, Alberta

Abstract

Background: Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women's trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. Methods: We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. Results: Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient's care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources. Conclusion: Health care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.