Pernilla Ny Swedish Maternal Health Care in a Multiethnic Society - including the Fathers

................................................................................. 9 ORIGINAL PAPERS I-IV ................................................................ 11 ABBREVIATIONS ........................................................................ 12 DEFINITIONS OF TERMS ............................................................. 13 PREUNDERSTANDING ................................................................. 14 INTRODUCTION ........................................................................ 16 BACKGROUND .......................................................................... 18 The purpose of Maternal health care ....................................................... 18 Maternal health care worldwide ....................................................20 Maternal health care in Europe ......................................................21 Maternal health care in Sweden ....................................................22 Women’s experiences of maternal health care .................................23 Migration ............................................................................................ 24 Migration to Sweden and Malmö ...................................................24 Migration and healthcare in Sweden ..............................................25 Acculturation ...............................................................................26 Transition, in the perspective of maternal health care ................................ 26 The encounter with the midwife ......................................................27 Being a mother and father in a new country ....................................28 AIMS ....................................................................................... 31 METHODS ................................................................................ 32 Design ................................................................................................ 32 Setting ................................................................................................ 34 Data collection ..................................................................................... 35 Retrospective community based register study ..................................35 Study I, IV ...................................................................................35 Focus group discussion, individual interviews and cross cultural research ............................................................36 Studies II, III .................................................................................36 Participants .......................................................................................... 37 Study I, IV: ..................................................................................37 Study II: ......................................................................................39 Study III: ......................................................................................39 Definitions and variable description ........................................................ 41 Low-risk pregnancies.....................................................................41 Country of birth ...........................................................................41 Background factors .......................................................................42 Planned care ...............................................................................42 Unplanned care ...........................................................................43 Lowerand higher utilisation of MHC ..............................................45 Mode of delivery..........................................................................45 Analysis .............................................................................................. 46 Statistical analysis ........................................................................46 Content analysis ...........................................................................46 Ethical considerations ........................................................................... 47 RESULT ..................................................................................... 48 Studies I, IV ......................................................................................... 48 Backgrounds factors .....................................................................49 Care utilisation ............................................................................49 Unplanned care ...........................................................................50 Reasons for seeking unplanned care ...............................................50 Delivery outcome .........................................................................51 Studies II, III ......................................................................................... 51 Maternal health care ....................................................................52 The men’s involvement ..................................................................53 Being parents in Sweden ...............................................................55 DISCUSSION ............................................................................. 57 Criticism of methods ............................................................................. 57 Studies I, IV: ................................................................................57 Studies II, III .................................................................................59 Result discussion ................................................................................... 62 Health care utilisation-behaviour ....................................................63 Individualised care by professional caregivers in a multi-ethnic context .................................................................68 Stable motherhood and unstable fatherhood, ...................................69 within the area of reproductive health .............................................69 CONCLUSIONS ......................................................................... 74 FURTHER RESEARCH ................................................................... 75 CLINICAL IMPLICATIONS ............................................................. 77 Populärvetenskaplig sammanfattning ...................................................... 78 ACKNOWLEDGEMENT ............................................................... 80 REFERENCES ............................................................................. 83