It is crucial for refugee service providers to understand the family planning knowledge, attitudes, and practices of refugee women following third country resettlement. Using an ethnographic approach rooted in Reproductive Justice, we conducted six focus groups that included 66 resettled Somali and Congolese women in a western United States (US) metropolitan area. We analyzed data using modified grounded theory. Three themes emerged within the family planning domain: (a) concepts of family, (b) fertility management, and (c) unintended pregnancy. We contextualized these themes within existing frameworks for refugee cultural transition under the analytic paradigms of “pronatalism and stable versus evolving family structure” and “active versus passive engagement with family planning.” Provision of just and equitable family planning care to resettled refugee women requires understanding cultural relativism, social determinants of health, and how lived experiences influence family planning conceptualization. We suggest a counseling approach and provider practice recommendations based on our study findings.
AlpernJ. D.DaveyC. S.SongJ. (2016). Perceived barriers to success for resident physicians interested in immigrant and refugee health. BMC Medical Education, 16, Article 178.
2.
AptekmanM.RashidM.WrightV.DunnS. (2014). Unmet contraceptive needs among refugees. Canadian Family Physician, 60(12), e613–e619.
3.
BairdM. B. (2012). Well-being in refugee women experiencing cultural transition. Advances in Nursing Science, 35, 249–263. doi:10.1097/ANS.0b013e31826260c0
4.
BiroM. A.EastC. (2017). Poorer detection rates of severe fetal growth restriction in women of likely refugee background: A case for re-focusing pregnancy care. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57, 186–192. doi:10.1111/ajo.12593
5.
BrymanA. (2006). Integrating quantitative and qualitative research: How is it done?Qualitative Research, 6, 97–113. doi:10.1177/1468794106058877
6.
BulmanK. H.McCourtC. (2002). Somali refugee women’s experiences of maternity care in west London: A case study. Critical Public Health, 12, 365–380. doi:10.1080/0958159021000029568
7.
Busch-ArmendarizN.WachterK.HeffronL.NsonwuM.SnyderS. (2013). The continuity of risk: A three-city study of Congolese women-at-risk resettled in the U.S. Austin: Institute on Domestic Violence & Sexual Assault, The University of Texas at Austin.
8.
CharlesC.GafniA.WhelanT. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine, 44, 681–692.
9.
CharmazK. (2014). Constructing grounded theory (2nd ed.). London: Sage.
10.
CharmazK. (2015). Teaching theory construction with initial grounded theory tools: A reflection on lessons and learning. Qualitative Health Research, 25, 1610–1622. doi:10.1177/1049732315613982
11.
CoenenM.StammT. A.StuckiG.CiezaA. (2012). Individual interviews and focus groups in patients with rheumatoid arthritis: A comparison of two qualitative methods. Quality of Life Research, 21, 359–370. doi:10.1007/s11136-011-9943-2
12.
CreswellJ. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). Thousand Oaks, CA: Sage.
13.
CreswellJ. W.Plano ClarkV. L. (2011). Designing and conducting mixed methods research (2nd ed.). Los Angeles, CA: Sage.
14.
CrosbyS. S. (2013). Primary care management of non-English-speaking refugees who have experienced trauma: A clinical review. Journal of the American Medical Association, 310, 519–528. doi:10.1001/jama.2013.8788
15.
CulleyL.HudsonN.RapportF. (2007). Using focus groups with minority ethnic communities: Researching infertility in British South Asian communities. Qualitative Health Research, 17, 102–112. doi:10.1177/1049732306296506
16.
DegniF.KoivusiltaL.OjanlatvaA. (2006). Attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland. The European Journal of Contraception and Reproductive Health Care, 11, 190–196. doi:10.1080/13625180600557605
17.
DehlendorfC.LevyK.KelleyA.GrumbachK.SteinauerJ. (2013). Women’s preferences for contraceptive counseling and decision making. Contraception, 88, 250–256. doi:10.1016/j.contraception.2012.10.012
18.
DharC. P.KaflayD.DowshenN.MillerV. A.GinsburgK. R.BargF. K.YunK. (2017). Attitudes and beliefs pertaining to sexual and reproductive health among unmarried, female Bhutanese refugee youth in Philadelphia. Journal of Adolescent Health, 61, 791–794. doi:10.1016/j.jadohealth.2017.06.011
19.
FarquharC. (1999). Are focus groups suitable for “sensitive” topics. In BarbourR. (Ed.), Developing focus group research: Politics, theory and practice (pp. 47–63). Thousand Oaks, CA: Sage.
20.
FettersM. D.CurryL. A.CreswellJ. W. (2013). Achieving integration in mixed methods designs-principles and practices. Health Services Research, 48(6 Pt. 2), 2134–2156. doi:10.1111/1475-6773.12117
21.
GagnonA. J.DoughertyG.PlattR. W.WahoushO.GeorgeA.StangerE.. . . StewartD. E. (2007). Refugee and refugee-claimant women and infants post-birth: Migration histories as a predictor of Canadian health system response to needs. Canadian Journal of Public Health, 98, 287–291.
22.
GuerinP. B.AlloteyP.Hussein ElmiF.BahoS. (2006). Advocacy as a means to an end: Assisting refugee women to take control of their reproductive health needs. Women & Health, 43, 7–25. doi:10.1300/J013v43n04_02
23.
GuestG.NameyE.McKennaK. (2017). How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods, 29, 3–22.
24.
GurnahK.KhoshnoodK.BradleyE.YuanC. (2011). Lost in translation: Reproductive health care experiences of Somali Bantu women in Hartford, Connecticut. Journal of Midwifery & Women’s Health, 56, 340–346. doi:10.1111/j.1542-2011.2011.00028.x
25.
HawkeyA. J.UssherJ. M.PerzJ.MetuselaC. (2017). Experiences and constructions of menarche and menstruation among migrant and refugee women. Qualitative Health Research, 27, 1473–1490. doi:10.1177/1049732316672639
26.
HaworthR. J.MargalitR.RossC.NepalT.SolimanA. S. (2014). Knowledge, attitudes, and practices for cervical cancer screening among the Bhutanese refugee community in Omaha, Nebraska. Journal of Community Health, 39, 872–878. doi:10.1007/s10900-014-9906-y
27.
HenninkM. M.KaiserB. N.WeberM. B. (2019). What influences saturation? Estimating sample sizes in focus group research. Qualitative Health Research, 29, 1483-1496. doi:10.1177/1049732318821692
28.
HerrelN.OlevitchL.DuBoisD. K.TerryP.ThorpD.KindE.SaidA. (2004). Somali refugee women speak out about their needs for care during pregnancy and delivery. Journal of Midwifery & Women’s Health, 49, 345–349. doi:10.1016/j.jmwh.2004.02.008
29.
JacobyS. D.LucarelliM.MusseF.KrishnamurthyA.SalyersV. (2015). A mixed-methods study of immigrant Somali women’s health literacy and perinatal experiences in Maine. Journal of Midwifery & Women’s Health, 60, 593–603. doi:10.1111/jmwh.12332
30.
KeygnaertI.VettenburgN.RoelensK.TemmermanM. (2014). Sexual health is dead in my body: Participatory assessment of sexual health determinants by refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. BMC Public Health, 14, Article 416. doi:10.1186/1471-2458-14-416
31.
KiuraA. W. (2014). Constrained agency on contraceptive use among Somali refugee women in the Kakuma refugee camp in Kenya. Gender, Technology and Development, 18, 147–161.
32.
KruegerR.CaseyM. A. (2009). Focus groups: A practical guide for applied research (4th ed.). Thousand Oaks, CA: Sage.
33.
LaneJ.ColeG. (2013). Pregnancy, prenatal care and delivery perceptions and beliefs of resettled African refugee women in the western U.S. Contraception, 88(2), Article 313.
34.
LazarJ. N.Johnson-AgbakwuC. E.DavisO. I.ShippM. P. (2013). Providers’ perceptions of challenges in obstetrical care for Somali women. Obstetrics and Gynecology International, 2013, Article 149640. doi:10.1155/2013/149640
35.
McMichaelC.GiffordS. (2010). Narratives of sexual health risk and protection amongst young people from refugee backgrounds in Melbourne, Australia. Culture, Health & Sexuality, 12, 263–277. doi:10.1080/13691050903359265
36.
McMorrowS.SaksenaJ. (2017). Voices and views of Congolese refugee women: A qualitative exploration to inform health promotion and reduce inequities. Health Education & Behavior, 44, 769–780. doi:10.1177/1090198117726572
37.
MehtaP. K.SaiaK.ModyD.CrosbyS. S.RajA.MaruS.PiwowarczykL. (2017). Learning from UJAMBO: Perspectives on gynecologic care in African immigrant and refugee women in Boston, Massachusetts. Journal of Immigrant and Minority Health, 20, 380–387. doi:10.1007/s10903-017-0659-4
38.
MeldrumR. M.LiamputtongP.WollersheimD. (2016). Sexual health knowledge and needs: Young Muslim women in Melbourne, Australia. International Journal of Health Services, 46, 124–140. doi:10.1177/0020731415615313
39.
MengeshaB., & 53 current fellows in the Fellowship in Family Planning. (2017). Racial injustice and family planning: An open letter to our community. Contraception, 96, 217–220. doi:10.1016/j.contraception.2017.05.009
40.
MengeshaZ. B.PerzJ.DuneT.UssherJ. (2017). Refugee and migrant women’s engagement with sexual and reproductive health care in Australia: A socio-ecological analysis of health care professional perspectives. PLoS ONE, 12(7), e0181421. doi:10.1371/journal.pone.0181421
41.
MengeshaZ. B.PerzJ.DuneT.UssherJ. (2018). Preparedness of health care professionals for delivering sexual and reproductive health care to refugee and migrant women: A mixed methods study. International Journal of Environmental Research and Public Health, 15(1), 174. doi:10.3390/ijerph15010174
42.
MetuselaC.UssherJ.PerzJ.HawkeyA.MorrowM.NarchalR.. . . MonteiroM. (2017). “In my culture, we don’t know anything about that”: Sexual and reproductive health of migrant and refugee women. International Journal of Behavioral Medicine, 24, 836–845. doi:10.1007/s12529-017-9662-3
43.
MorrisonT. B.WielandM. L.ChaS. S.RahmanA. S.ChaudhryR. (2012). Disparities in preventive health services among Somali immigrants and refugees. Journal of Immigrant and Minority Health, 14, 968–974. doi:10.1007/s10903-012-9632-4
44.
Ngum Chi WattsM. C.LiamputtongP.CarolanM. (2014). Contraception knowledge and attitudes: Truths and myths among African Australian teenage mothers in Greater Melbourne, Australia. Journal of Clinical Nursing, 23, 2131–2141. doi:10.1111/jocn.12335
45.
PavlishC. L.NoorS.BrandtJ. (2010). Somali immigrant women and the American health care system: Discordant beliefs, divergent expectations, and silent worries. Social Science & Medicine, 71, 353–361. doi:10.1016/j.socscimed.2010.04.010
46.
RabenL. A. D.van den MuijsenberghM. (2018). Inequity in contraceptive care between refugees and other migrant women?: A retrospective study in Dutch general practice. Family Practice, 35, 468–474. doi:10.1093/fampra/cmx133
47.
RiggsE.DavisE.GibbsL.BlockK.SzwarcJ.CaseyS.. . . WatersE. (2012). Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers. BMC Health Services Research, 12, Article 117. doi:10.1186/1472-6963-12-117
48.
RogersC.EarnestJ. (2015). Sexual and reproductive health communication among Sudanese and Eritrean women: An exploratory study from Brisbane, Australia. Culture, Health & Sexuality, 17, 223–236. doi:10.1080/13691058.2014.967302
49.
RousseauC. C.RufagariM. C.BagilishyaD.MeashamT. (2004). Remaking family life: Strategies for re-establishing continuity among Congolese refugees during the family reunification process. Social Science & Medicine, 59, 1095–1108. doi:10.1016/j.socscimed.2003.12.011
50.
SchwartzS. J.UngerJ. B.ZamboangaB. L.SzapocznikJ. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65, 237–251. doi:10.1037/a0019330
51.
SmallR.GagnonA.GisslerM.ZeitlinJ.BennisM.GlazierR.. . . VangenS. (2008). Somali women and their pregnancy outcomes postmigration: Data from six receiving countries. BJOG: An International Journal of Obstetrics and Gynaecology, 115, 1630–1640. doi:10.1111/j.1471-0528.2008.01942.x
52.
SperberA. D. (2004). Translation and validation of study instruments for cross-cultural research. Gastroenterology, 126(1 Suppl. 1), S124–S128.
53.
StarrsA. M.EzehA. C.BarkerG.BasuA.BertrandJ. T.BlumR.. . . AshfordL. S. (2018). Accelerate progress-sexual and reproductive health and rights for all: Report of the Guttmacher-Lancet Commission. The Lancet, 391, 2642–2692. doi:10.1016/S0140-6736(18)30293-9
54.
SvenssonP.CarlzenK.AgardhA. (2017). Exposure to culturally sensitive sexual health information and impact on health literacy: A qualitative study among newly arrived refugee women in Sweden. Culture, Health & Sexuality, 19, 752–766. doi:10.1080/13691058.2016.1259503
55.
TorresM. I.CernadaG. P. (2003). Sexual and reproductive health promotion in Latino populations: Parteras, promotoras y poetas: Case studies across the Americas. Amityville, NY: Baywood Publishing.
56.
United Nations High Commissioner for Refugees. (2018). UNHCR global resettlement statistical report. Retrieved from http://www.unhcr.org/52693bd09.html
57.
U.S. Department of State & Bureau of Population, Refugees, and Migration. (2019). Refugee admission by region. Arlington, VA: Worldwide Refugee Admissions Processing System, Refugee Processing Center.
58.
UssherJ. M.PerzJ.MetuselaC.HawkeyA. J.MorrowM.NarchalR.EstoestaJ. (2017). Negotiating discourses of shame, secrecy, and silence: Migrant and refugee women’s experiences of sexual embodiment. Archives of Sexual Behavior, 46, 1901–1921. doi:10.1007/s10508-016-0898-9
59.
VerbiestS.MalinC. K.DrummondsM.KotelchuckM. (2016). Catalyzing a reproductive health and social justice movement. Maternal and Child Health Journal, 20, 741–748. doi:10.1007/s10995-015-1917-5
60.
WilkinsonS. (1999). How useful are focus groups in feminist research? In BarbourR. (Ed.), Developing focus group research: Politics, theory and practice (pp. 64–78). Thousand Oaks, CA: Sage.
61.
WillardC. L.RabinM.LawlessM. (2014). The prevalence of torture and associated symptoms in U.S. Iraqi refugees. Journal of Immigrant and Minority Health, 16, 1069–1076. doi:10.1007/s10903-013-9817-5
62.
WojnarD. M. (2015). Perinatal experiences of Somali couples in the U.S. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 44, 358–369. doi:10.1111/1552-6909.12574
63.
WoodgateR. L.BusoloD. S.CrockettM.DeanR. A.AmaladasM. R.PlourdeP. J. (2017). A qualitative study on African immigrant and refugee families’ experiences of accessing primary health care services in Manitoba, Canada: It’s not easy!International Journal for Equity in Health, 16(1), Article 5. doi:10.1186/s12939-016-0510-x
