Abstract
Any major life transition can present incredible challenges and struggles. When parenthood and immigration co-occur, many adjustments are required, and this poses a higher risk to mental well-being. This study examines the impact of the dual transition of parenthood and immigration in the perinatal period on the mental health of Indian immigrants to Australia. This study was conducted in the Western Sydney region using a qualitative design guided by interpretive description and purposive sampling. Thirteen in-depth interviews were conducted with nineteen participants, including six couple interviews, three with women alone, and four with community cultural informants. Data were analyzed using thematic analysis. The overarching theme “Living between two worlds” captured the participants’ journey through immigration and parenthood. Participants’ experiences were reflected in three sub-themes: “feeling different and not belonging,” “losing confidence,” and “feeling liberated,” highlighting the social and emotional impact of these transitions. Understanding the challenges faced during the dual transition and their emotional impact can guide health professionals in providing culturally sensitive perinatal care. The findings draw attention to the depth of emotions that immigrants experience and their impact on daily life during dual transitions. They emphasize the urgent need for change in clinical practice and advocate for a structured yet conversational assessment of the immigration experiences during the psychosocial assessments in the perinatal period. The analysis of the findings presents possible solutions for designing targeted interventions for immigrant populations and will help health professionals better understand and support immigrants. The inclusion of men has elucidated gender-specific stressors and support needs.
Keywords
Introduction
More than 400,000 immigrants arrive in Australia every year (Australian Bureau of Statistics [ABS], 2023), and Indian immigrants constitute the second-largest migrant community (10.3% of the overseas-born population) in Australia after the United Kingdom (ABS, 2023). The median age of Indian immigrants in Australia is 35.9 years (ABS, 2023), suggesting that many may experience new parenthood in the initial years following migration. This intersection of two major life transitions, migration and parenthood, poses unique challenges to the mental health of immigrants, attributable to acculturation stress, lack of traditional support systems, employment struggles, socioeconomic disadvantage, and adaptation to a different healthcare system (Sangalang et al., 2019; Vo et al., 2024). This paper reports the findings of a qualitative study that examined the impact of the dual transitions of parenthood and immigration on Indian immigrants. These findings may guide policymakers and healthcare practitioners in approaches to support Indian immigrants and potentially other immigrant communities and may help improve their mental health outcomes in the perinatal period (the period from conception to the first year after birth).
Background
The transition to parenthood is an incredibly demanding period in the lives of both women and men and is considered a major developmental stage with numerous challenges (Hili et al., 2023). This transition is marked by an intersection of a complex mix of emotions, including happiness, fear, anxiety, and stress (Nomaguchi & Milkie, 2020). Parenting can disrupt existing routines and necessitate significant reorganization and adjustment by parents (Balfour et al., 2018), affecting their emotional and psychological well-being.
The transition to parenthood can be particularly challenging for immigrant women. Studies have demonstrated higher rates of mental illness in the perinatal period, with one in four immigrant women experiencing depression and one in five suffering from anxiety (Anderson et al., 2017; Stevenson et al., 2023). Anderson et al., for example, found that immigrant women in Canada were at higher risk of perinatal depression in comparison to Canadian born counterparts. Risk factors for mental illness in immigrant women include poor social support, being an ethnic minority group in the host country, and low income (Fellmeth et al., 2017; Schmied et al., 2017).
Migration represents a very challenging transition and a period of significant adjustments to a new environment (Tuggle & Crews, 2021). The consequences of migration are complex, often involving changes to an individual’s identity, social interactions, occupational status, and social well-being (Fernando & Patriotta, 2020; Hendriks & Bartram, 2019). Prolonged stress caused by these changes predisposes the immigrant population to increased mental health vulnerabilities (Elshahat & Moffat, 2022). Although immigrants often experience a “healthy immigrant effect” upon arrival, suggesting initial better health, this advantage diminishes over time (Boen & Hummer, 2019; Elshahat et al., 2022; Vang et al., 2017).
As a significant number of the Australian population is of Indian origin, it is crucial to understand how immigration impacts their mental health so that effective support systems and interventions can be developed. Indian immigrants in Australia are mostly skilled migrants, selected for their qualifications and language proficiency (Department of Foreign Affairs and Trade, 2022). However, this population still encounters significant challenges like discrimination and cultural adaptation (Carangio et al., 2021; Gowan & Teal, 2016). These challenges contribute to a sense of difference and exclusion, particularly for women who face the burden of balancing traditional responsibilities with societal expectations. In a systematic review, Karasz et al. (2019) found that South Asian (e.g., Indian) immigrant women suffer from higher rates of mental illness than the native population.
Across Australia, there are established comprehensive policies for assessing and addressing mental health and illness in the perinatal period, which identify risks, offer early intervention, and include psychosocial assessments and depression screenings (Highet & the Expert Working Group and Expert Subcommittees, 2023). There remains a significant gap in understanding how mental health and illness are perceived within culturally diverse communities. Studies show that while screening tools, such as the Edinburgh Postnatal Depression Scale, are routinely used, women from non-English speaking backgrounds often struggle to understand the questions and rarely have access to translated materials or interpreters (Matthey, 2017; Rollans et al., 2013), and healthcare professionals found the practice of administering this scale to immigrants challenging (Skoog et al., 2022). Previous studies also showed that immigrant women were reluctant to talk about mental health or illness, which was due to reasons such as a lack of trust and confidence in the health system, and stigma (Philip et al., 2021, 2024). Researchers are calling for psychosocial assessments that are more appropriate for culturally diverse communities, indicating a need to develop and validate measures for culturally and linguistically diverse populations (Hazell-Raine et al., 2019; Willey et al., 2019).
Migration and parenthood each have their own risks that adversely affect the mental health and well-being of Indian immigrants. However, there are significant gaps in the current literature regarding the dual transition of migration and parenthood among Indian immigrants in Australia. Although existing studies explore the effects of migration and parenthood separately, there is a lack of research on how these two transitions together influence mental health. The combined challenge of adjusting to a new socio-cultural environment while managing the demands of parenthood introduces complex issues that have not been fully investigated. Understanding the complexities of the dual transitions, particularly their effect on mental health, is crucial for developing targeted interventions to support immigrants navigating these dual transitions. Immigration and parenting prompt individuals to reassess their identities as they adapt to new roles and expectations (Gbogbo, 2020). Quality support systems during the dual transition can play a crucial role in developing coping strategies to face these challenges (Bedaso et al., 2021).
This study examined the dual transition of parenthood and immigration in Indian immigrants, which provides valuable insights into the intersection of stressors experienced by this population, to inform culturally sensitive support systems and interventions in maternity care services. This study provides deeper insights into the specific experiences of Indian immigrants, which would be helpful for health professionals and policymakers, including strategies to support the immigrants’ unique challenges, focusing on mental health and well-being.
Methods
Theoretical Framework
The theoretical framework guiding this study is intersectionality, as individuals occupy multiple social locations/identities, which are experienced simultaneously, and identities are not singular, but intersecting (Carbado, 2013; Crenshaw, 2015; Zufferey & Buchanan, 2019). Crenshaw argues that the purpose of intersectionality is not merely to comprehend the social relations of power but to uncover other hidden dynamics with the intent of transforming them (2015). The use of an intersectional framework for the study enables a more comprehensive understanding of the complexity of immigrants’ experiences and opportunities, particularly how the intersections of multiple factors, such as gender, race, cultural background, employment, and financial position (Collins et al., 2021), influence the experiences of immigrant parents. For example, using the intersectional lens, we investigated the meaning of parenthood in Indian immigrants, how it differed in India and Australia, and immigrant experiences such as discrimination, financial position, and the impact on the confidence of the participants as women and as parents.
Design
In this study, we employed a qualitative approach guided by Thorne’s interpretive description (Thorne, 2016). Interpretive researchers aim to explore several perspectives, seeking clarity and understanding of meaning and significance, rather than focusing on causality (Thorne, 2016). This approach was used as interpretive description focuses on generating a detailed and contextual understanding of the phenomena under study. It encourages researchers to explore participants’ lived experiences, making it well-suited to investigate how Indian immigrants experience and manage the dual transitions of immigration and parenthood within a dual socio-cultural context of India and Australia. Applying the theoretical framework of intersectionality, we consider how these transitions intersect and the complex dynamics and aspects that shape immigrants’ mental health experiences. The data for this study were collected from late 2018 to 2019, before the COVID-19 pandemic. An advisory group of Indian health professionals, the Community Stakeholders Group (CSG), was formed and consulted at various stages of the study. The purpose of involving this group was so that they could contribute their expertise in ensuring that the study design and data collection tools were culturally appropriate. For example, this group provided a list of phrases and words used by the Indian community to describe mental health and illness, which were then used to inform data collection during participant interviews. The CSG consisted of eight people, five women and three men, from different parts of India, who were parents of children who varied in age. They came from a variety of professional backgrounds, such as mental health professionals, nurses, social workers, and a university lecturer. The CSG members were able to share their expertise in mental health.
Ethics approval (H12784) was received from the Human Research Ethics Committee at Western Sydney University before commencing the study.
Study Setting and Recruitment
This study was conducted in the western region of Sydney, Australia, as per the Western Sydney Regional Organisation of Councils (WSROC): about 5.4% of the residents in this region were born in India (WSROC, 2021).
Participants were recruited using purposive sampling through a range of community and faith-based groups in Western Sydney. Purposive sampling was used to ensure the recruitment of a diverse participant group that represented the heterogeneity of Indian immigrants in terms of state (region of origin), religion, language, and duration of time living in Australia. Recruitment was also undertaken through word of mouth, advertising through many social media groups, and recommendations to potential participants by prominent community members.
Participants and Inclusion and Exclusion Criteria
There were two distinct groups of participants in this study: the immigrant parents/couples and community cultural informants (CCIs).
Parents/Couples
This study included Indian immigrant couples who were born in India and had migrated to Australia in the last five years. The period of five years was selected as during this early period of immigration, they would still feel strongly connected to their culture and may experience more challenges. The parents/couples were either pregnant or had a baby in the last 6 months before the interview. The exclusion criteria included immigrant couples of Indian ethnic origins but not born in India, for example, Middle Eastern countries or Fiji, as cultural experiences for these immigrants may differ. The participants in the study had to be fluent in English, Hindi, or Malayalam, which were the languages spoken fluently by the first author (BP).
Community Cultural Informants
To enhance our understanding of the experiences of Indian immigrant couples and parents, we purposively recruited a select group of cultural informants (CCI) from the Indian community in Western Sydney. These CCIs were active members of the Indian community and consisted of homemakers, a midwife-specialist, a social worker, and private sector workers. This group had insights into the experiences of new parents, either by firsthand experience or by witnessing family or friends go through new parenthood. The CCIs were recruited in a similar way to the parents/couples. They were a different group from CSG and contributed the data in the study, whereas CSG contributed to the design of the study.
Data Collection
Data were collected through in-depth interviews with parents/couples (both men and women together or separately) and with CCIs. In total, 13 in-depth interviews were conducted with 19 participants. This comprised six interviews with couples, three with women alone, and four with CCIs. Written informed consent was obtained from all participants.
For the participating parents/couples, the research team initially planned to conduct separate individual interviews with each partner to capture their perspectives separately. However, all the men chose to be interviewed in the presence of their partners. Before the interview, a brief demographic questionnaire was administered to the parents/couples to gather information such as age, education, duration of stay in Australia, number of children, and, where applicable, gestation of pregnancy. Given the small number of CCIs and the potentially identifiable nature of the information provided by them, the demographic data were not collected from CCIs. Participants also had the option to be interviewed in English, Hindi, or Malayalam, as the first author (BP) was fluent in these languages. However, all participants chose to use English, except for one couple who opted to use English primarily, with some Malayalam used at times.
For parents/couples, the interviews were conducted in person either at their homes or at a convenient location such as a university library. One interview with the CCI was conducted in person, while other CCIs opted for video calls due to their busy schedules. Each interview lasted for about 45–60 minutes. An interview guide was used, which included the main questions and some probing questions. The same set of questions was posed to both Indian parents and CCIs (Appendix 1).
Other techniques, such as photo-elicitation, free-listing, and pile-sorting of the free list of words/phrases, were also incorporated in the interviews. These methods were used to facilitate deeper discussions on sensitive topics like mental illness, preference for male children, and female feticide. For photo-elicitation, participants either brought their own photos or selected from ones provided by the researchers, and they were asked to briefly discuss their chosen photograph. With the assistance of a CSG, a free list of phrases/words relating to mental health and mental illness was generated. The role of this group was to provide support and reflect on the cultural appropriateness of the research methods and questions. The free list of phrases/words was given to participants who sorted them into categories based on their understanding. Details of these techniques and their application are discussed in a previous publication (Philip et al., 2021). All interviews were recorded with the participants’ consent and transcribed verbatim.
Data Analysis
The data collected from the interviews, photo-elicitation, free-listing, pile-sorting, and field notes were analyzed using reflective thematic analysis. This method, outlined by Braun and Clarke, involves identifying, analyzing, and interpreting patterns of meaning within qualitative data (Clarke et al., 2015). NVivo software was used for data coding and storage. Data from both groups (Indian parents and CCIs) were analyzed independently using reflexive thematic analysis before being integrated to generate common themes. Codes were assigned to capture participants’ ideas, perceptions, and experiences, and broader themes and sub-themes were subsequently established. The first author (BP) was responsible for reviewing and coding all transcripts, while authors 2 (LK), 3 (CT), and 4 (VS) each coded a sample of interview transcripts. The team then discussed and compared these codes. The final themes and sub-themes were examined across data sets through a triangulation process, involving all data sources such as interviews, photo-elicitation, and pile-sorting of free lists. Triangulation in this study was achieved by combining data from various sources (Carter et al., 2014).
Ethical Considerations
Given that the interviews explored mental health and mental illness, there was a risk that the questions and discussions might trigger distressing memories for participants. All participants were provided with information about support and counseling services to address this. Confidentiality was maintained throughout the research, and pseudonyms were used in the analyses and reporting to protect participants’ identities.
Rigor and Reflexivity
The primary author is an Indian immigrant mother with an understanding of the cultural beliefs and practices that influence mental health in the Indian community and has professional experience in mental health services. This background was valuable for the study as it allowed her to communicate in the participants’ primary language, appreciate the sensitive nature of the topic, understand cultural nuances, and be aware of the stigma surrounding mental illness within the Indian community. However, she was also conscious that her personal experiences might influence the interview process and the data analysis. To reduce potential bias and enhance the strength of the study, the research team consulted with the CSG to ensure the use of culturally appropriate terminology and interview questions. A fieldwork journal was maintained, and the research team held regular discussions to refine their approach. Authors 2 (LK), 3 (CT), and 4 (VS), who are the academic supervisors for author 1 (BP), are experienced nurses or midwives, and all are mothers and grandmothers of Caucasian background. They were mindful of the possibility that participants’ viewpoints might differ from their own and ensured that these differences were acknowledged and respected during data collection and analysis.
Results
Characteristics of Participants
A total of 15 Indian parents participated in the study, ranging between 26 and 39 years of age. Most of the participants had postgraduate educational qualifications. Five women participants had a full-time job, one had a part-time job, and one was a homemaker. All men were working at a full-time job. On average, women were living in Australia for a shorter time (1–3 years) than men (4–5 years). The number of children ranged from first-time pregnancy to 4 children. Participants represented 10 different states in India. All four CCIs were women, and no demographic data were collected from this group.
Themes
An overarching theme and three sub-themes were generated through thematic analysis: “Living between two worlds” was the overarching theme that captured the factors that shaped the participants’ journeys through two simultaneous and significant life transitions: immigration and parenthood. The study explored the social and cultural factors that shaped Indian immigrants’ dual transition as immigrants and as parents. Starting a new life as a parent cannot be separated from other factors that influence the lives of new immigrants. The three sub-themes, “feeling different and not belonging”; “losing confidence”; and “feeling liberated,” described the participants’ feelings, contradictions, and conflicts that had to be negotiated across this dual transition, and the impact these transitions had on their mental health (Figure 1). Living Between Two Worlds
Living Between Two Worlds
One of the main challenges with immigration, described by the participants, was that they had to constantly strive to strike a balance between conflicting aspects of two markedly different cultures. They had to try and preserve the home culture, but at the same time try and accept the culture in the host country, which resulted in feelings of being torn between two “worlds,” feelings of being different, and not fully belonging to either culture. They [Australians] are so free and independent and don’t worry about what people think about them. That is what I want to be like, but I grew up so differently, it is difficult for me to do that. All the time I am worried about what will my Indian community think if I dress in a certain way or drink or party etc. I have to be very careful to manage that balance. On the one hand, I want to make friends here and live like an Australian person but at the same time, I don’t want to forget where I came from. It is stressful, this struggle. (Mayuri, mother)
Despite this dissonance, some participants also mentioned discovering new opportunities as a result of immigration and having a sense of freedom and autonomy as a person and parent, which is evident in Anubhuti’s (CCI) statement: “Australia gave me wings …” Some immigrants perceived the coexistence of two cultures as a valuable opportunity. Anamika expressed frustration that some people did not utilize the opportunity afforded to them via immigration: Sometimes it troubles me rather than helping me, seeing people in so much pain still, and stuck with old ideologies and not wanting to grow. And then I sometimes tell people that you should go back. If you don’t want to grow, what are you doing here? (Anamika, mother)
Experiencing parenthood in the initial years of immigration presented a challenging situation for the participants. When asked to describe their experiences with these dual transitions of immigration and parenthood, participants characterized this as a period of considerable stress. Describing the struggles of navigating both immigration and parenting, Anamika (mother) remarked: I had a lot of issues (postnatally), my relationship with my husband went downhill. I don’t know the reason. I think even he was facing a lot of … there was a major change in our life, two life events happened simultaneously.
Similarly, Neha (CCI) elaborated on the two significant life changes: A lot of them (new parents) are already struggling … with low self-confidence, loneliness, homesickness from all you’ve left behind, then you have a baby, and then you find that even with support, it is a delicate time. So, without support it is extremely overwhelming.
The three sub-themes developed from the thematic analysis are now examined in the context of immigrants’ feelings during the concurrent transitions of immigrating and becoming parents.
Feeling Different and Not Belonging
According to the participants, the feeling of not belonging stemmed from significant cultural differences between the Indian and Australian societies. Various aspects of both cultures that contributed to heightened feelings of difference and lack of belonging are described below.
Participants explained that in India, women traditionally have the primary responsibility for household chores. They examined the challenge of conforming to Indian traditional gendered roles in the household and redefined them in the Australian context. They discussed these disparities from two perspectives: firstly, by reflecting on the construct of motherhood in India and, secondly, by exploring traditional gender roles.
Participants conveyed that the expectations from a mother are different in India and Australia. Motherhood is revered in India, and there is an expectation that every woman must become a mother and should sacrifice herself, giving priority to the needs of her children and husband. This is reflected by the participants; for example, Juhi (CCI) remarked: And thereby, when you do become a mother, you know, you’ve ticked that box. There is a lot of selflessness attributed to the mother, or the sacrificial role is glorified.
Influenced by this expectation of selflessness and sacrificial role, women participants had increased responsibilities in the households, and they ended up generally adhering to traditional gender roles, although this added pressure on the women: So, we still are doing a lot of things because they are considered traditionally women’s jobs, but at the same time, we are out earning money and doing a lot of things once not considered women’s jobs. We still have this patriarchal system, where women should act, behave, and talk in a certain way, this is putting a lot of pressure on our women. (Neha, CCI)
After immigration, women participants continued to carry out more household chores than men, but due to the lack of support from extended family and hired help, the expectations for men changed to providing more support in the home. The change in traditional gender roles in families further increased the feeling of being different—in this instance, being different from the home culture: And I think here, maybe there is more of an active role of the father in the whole process [parenthood], as opposed to India, where the father is the second person in every aspect of child-rearing. (Juhi, CCI) My husband is really adjusting to everything, and he is very helpful to me. (Susan, mother)
Participants also described the extended family as a major support network in the perinatal period and when raising a family: There is more help in India, for sure, like grandparents, uncles, and aunts, they are always there. (Sanjesh, father) I feel like there would be more people to help [having extended family available] and then the baby would be happier and playing around with many different people. (Sanjay, father)
Due to immigration, this crucial support in the perinatal period was missed by the participants, and they were unable to continue some of the traditional practices related to this period, like rest, religious rituals, and a special diet. This caused them to feel that they did not belong to either culture: Yeah, to some extent, I know that it will affect me, there are a lot of good things about those [practices], me and my baby both will get benefits from all those things. (Laxmi, mother) This has made it really difficult for me, especially being alone in this country, my parents are in India, and I have very limited support in Australia. This was a planned pregnancy, but still, I am not happy. (Mayuri, mother)
Throughout a person’s life, the sense of belonging emerges from strong, enduring relationships and interactions in educational and professional environments. However, because of immigration, participants found it challenging to establish this sense of belonging through friendships or workplace interactions: Because we came to a new country when we have grown up, it is difficult to have close friendships as in our school days. We have left our close friends behind at home. So, we have some friends here, but not very close friends. (Rupal, mother)
Consequently, immigrants often sought out new social spaces to forge connections, which did not always offer the same depth and quality of support as long-term friendships: I think being able to just talk the same language, understand, you know, is important, which is your frame of reference. So that is important, but in the initial phases, um, just to have that common ground is important. (Juhi, CCI) A lot of them have become friends merely by virtue of the fact that they were born in the same country. So, we understand each other but back in India perhaps they would never have been friends. (Neha, CCI)
In an Australian context, the feelings of being different were reinforced through discrimination. These experiences eroded the self-esteem of the immigrants and cemented the sense of not belonging to the Australian culture: We can’t just say that it’s [discrimination] not there. There’s an undercurrent … Someone has abused me for being Indian on the phone because they could guess it through my accent, or my name, or whatever it is. (Anamika, mother) Yes, discrimination is there and no one can deny it ….. It can make you feel really down, but I’m strong enough to retaliate it and to answer back. (Kripa, mother)
Another factor that contributed to the sense of being different was unfamiliarity with the Australian healthcare system. Many participants and stakeholders in this study were first-generation immigrants and were not fully acquainted with the Australian healthcare system, such as available resources, the process of booking-in to maternity care services, and expectations during the perinatal period. A male participant pointed out that not all healthcare professionals recognize this, sometimes assuming that immigrant couples were already familiar with these processes: There are plenty of systems here to support the people, but when we go to a hospital, they don’t explain things and they assume that people [immigrants] already know this. (Sanjay, father)
Participants did not delve into the specifics of how they navigated these challenges in the healthcare system but recommended solutions such as the midwifery continuity of care model and employing transcultural healthcare workers. They proposed that these initiatives could address issues related to trust and inculcate a sense of belonging.
Losing Confidence
The adaptation processes during the simultaneous transitions of immigration and parenthood frequently led participants to lose confidence in different aspects of their lives, as Neha explains: When you come out of your comfort zone and you come to a country where everything is done differently, people look different, and sound different, you’re already struggling, feeling that “I’m not good enough.” And in how many areas of your life can you feel I’m not good enough without that having some sort of impact on your well-being? (Neha, CCI)
Participants highlighted numerous factors contributing to these conflicts, such as unemployment, under-employment, and challenges in contributing financially to their families. Anamika considered the initial stages of immigration as “traumatic” primarily because of financial instability exacerbated by her inability to work while adjusting to new motherhood simultaneously. This significantly impacted her relationship with her husband, her professional aspirations, and her self-confidence: Only one person was earning, and that was also not enough. There was a time when I started feeling that I was becoming redundant … So, initially, that was very frustrating that it [employment] was not happening. We had major issues with our relationship as well … major fights. (Anamika, mother)
Participants negotiated this by taking up employment that did not align with their qualifications; this may have been by choice, but it caused a lack of self-confidence. Neha recounted how she worked below her ability to alleviate the isolation she faced in the early years following immigration, during which time she also experienced new parenthood. In the absence of her support network of friends and family, this was her way of making connections: I just needed the mental stimulation of going out, meeting other adults, having an adult conversation, and then coming back to baby conversation all day long and changing diapers. Unfortunately, there’s way too much isolation for young mothers, no interaction nor mental stimulation. (Neha, CCI)
Rupal felt that women had to make greater compromises in balancing responsibilities at home and in their professional lives in comparison to their partners, particularly when they have young children: Because due to our responsibilities, we may not be able to achieve our ambition, which will create a lot of stress. We do not have equal responsibilities ……. so, women have to adjust and compromise, so women are more stressed because of it, because our ambitions are put on hold. (Rupal, mother)
Feeling Liberated
Despite the struggles during the early years of immigration and experiencing parenthood simultaneously, participants also described the positive impacts. As mentioned earlier, one participant described a feeling of liberation and freedom: Australia gave me wings. To do what I want without being or feeling apologetic about it, or the guilt that I am upsetting [them]. It was OK to upset them. To make my personality and motherhood shine, Australia gave me wings. (Anubhuti, CCI)
Anubhuti explained that immigration enabled her to select her own approach to parenting, blending aspects of Indian culture that resonated with her alongside positive elements from Australian culture, which she may not have been able to do if she had lived in India: I realized that here, people do not interfere in whatever you want to do, including close family … It’s the simple things like your children having a shower at bedtime and not in the morning, as was the norm when I grew up, I was very clear [to my family] on how I want to parent my children. (Anubhuti, CCI)
Anamika highlighted the advantages of moving to Australia and saw it as an opportunity for her son to experience a more diverse environment with less rigid gender roles. She felt that although she may not directly educate him on equal partnership in relationships, he would absorb and learn from societal norms in Australia. I’m a mother of a son. If I had been in India, I think I would have been very stressed because he would learn the same ways of patriarchy and I could not have done a lot. I’m glad I’m here because I’ve broken that cycle. Here, he can see other things, and he can learn. (Anamika, mother)
The majority of female participants in this study alluded to this sense of freedom following immigration, some from the patriarchal norms they were expected to adhere to in India, some from the fear of societal judgment, and others from scrutiny of their parenting practices, particularly from their in-laws.
Discussion
The findings of this study demonstrate the challenges immigrant parents face when navigating the dual transitions of immigration and parenthood and how these simultaneous life changes influence their social and cultural realities as well as their health outcomes. While existing research has explored the transition to parenthood and immigration as separate phenomena, there is a notable gap in understanding the combined impact of these transitions on the mental health of immigrants. This study contributes to filling that gap by examining the intersecting challenges of these dual transitions.
The thematic analysis revealed that the participants experienced a sense of living between two worlds or in a liminal space, marked by the challenge of reconciling their lifelong identities with the demands and expectations of their new life as residents in Australia and as parents. The sub-themes emphasized the emotional dimensions of the immigrant experience, including feeling different from others, having a sense of not belonging, and losing self-confidence, yet simultaneously gaining a sense of freedom for some. This illustrated the multi-layered nature of their experiences.
Nancy Schlossberg’s transition theory presents a valuable framework for understanding the nature and impact of the dual transition described by participants in this study. Schlossberg describes three parts of the transition process: approaching change, taking stock, and taking charge (Schlossberg, 2007), and suggests that to assess an adult’s capacity to transition, it is essential to consider four major categories: situation, support, self, and strategies. How an individual will cope with transition can be predicted by assessing the balance of resources and deficits in these four categories (Barclay, 2017). The interaction and manifestation of these four factors can explain why different individuals react differently to the same type of transition (Schlossberg, 2007). These categories offer a way to conceptualize and understand the dual transition of immigration and becoming a parent. The findings of this study are discussed here under these categories.
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Economic immigrants, including Indian immigrants in Australia who are mostly skilled migrants, also navigate a complex liminal space balancing their home culture with the new norms of the host country, but their experiences in the liminal space remain underexplored, particularly when it comes to managing two concurrent life transitions. However, Kilkey and Palenga-Mollenbeck note that structural factors such as employment situation and public support influenced the adjustments made after immigration (Kilkey & Palenga-Möllenbeck, 2016).
Several studies (Kim, 2018; Lee et al., 2018) show that the combined effect of multiple life transitions on mental health can be more harmful than a single life transition. Kim suggests that one of the major risk factors for parenting stress is acculturative stress (2018), and Lee et al. postulated that acculturative stress increased when coupled with the demands of parenting (2018). Some participants in this study faced conflict due to differing parenting expectations from their family and host culture, which is consistent with the findings of Williams et al., who suggested that stress related to acculturation is associated with higher family conflict (Williams et al., 2017). This study has focused on the dual transitions of parenthood and immigration; however, it is important to recognize that these are not the only significant transitions shaping the experiences of immigrants. For South Asian women, marriage itself may constitute a form of migration, involving moving from their natal home to their husband’s household (Sharma, 2016). Hence, the burden of adjustment may be higher for women immigrants, as they have already made another significant transition, emphasizing that multiple intersecting transitions can leave them more vulnerable to mental health concerns.
While exploring perinatal mental health, as reported in a previous paper (Philip et al., 2021, 2024), these participants noted the centrality of motherhood in immigrant families’ lives, the importance of having a baby, and the importance given to a male child in the Indian community. Studies show that having a baby soon after arrival in a new country significantly affects the career prospects of immigrant women (Sharma, 2016), and the effect on employment can impact their mental health (Shankar et al., 2024). However, the timing, for example, of having a baby soon after marriage or immigration, was not raised by these participants, although it may have influenced their experiences.
It is well-documented that the role of “
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While some participants reported negative experiences related to the dual transition, others described feeling “liberated.” Very few studies explore the positive effects of immigration. O’Reilly and Benson (2016) discussed the positive impact of migration; however, it was in the context of lifestyle migration and not economic migration (O’Reilly & Benson, 2016). Similarly, Geurts and Lubbers (2023) discussed the positive impacts of immigration, but their focus was on participants’ overall evaluations of their experiences and not the impact on their mental health (Geurts & Lubbers, 2023). It is difficult to estimate if any of the negative experiences faced by the participants had a more significant effect on mental health than the others. The findings of this study showed that the experiences associated with the transition to parenting in the context of new immigration happened in the absence of positive contributory factors, such as social support. Even as participants felt liberated in the host country, their experiences of losing confidence and feeling alienated increased the potential for mental health concerns.
Participants have described some “
Analyzing the dual transitions of immigration and parenthood through the lens of Schlossberg’s theory, situation, support, self, and strategies—and examining the intersectionality of these four factors—offers a better understanding of immigrants’ lived experiences. It underlines how the interplay between these elements shapes their navigation of the liminal space and its impact on their mental health and well-being.
Strengths and Limitations
The use of codesign with a CSG is one of the greatest strengths of this study. The CSG was consulted at different stages of the study to ensure the cultural appropriateness of the methods used. Multiple methods were also used for data collection within the interviews, which proved effective in participant engagement by providing participants with stimuli during the in-depth interviews. The sample was a strong representation of the Indian community, as the participants belonged to 10 different states of India and followed two major religions of India, namely, Hinduism and Christianity.
Another important strength of this study was the inclusion of men, which provided a unique and valuable perspective. By including men’s perspectives, this study sheds light on gender-specific stressors, coping methods, and support needs. Even though we aimed to include more men in the study, only six men participated, and all six men wanted to be interviewed with their wives. We acknowledge that this may have influenced the narratives of the participants, and individual interviews might have given different results. Recognizing the emotional and psychological impact on both parents can contribute to a holistic approach in perinatal care.
However, the sample mostly consisted of skilled immigrants, and all participants were university graduates or postgraduates, which may not represent the broader Indian immigrant population. Even though we had planned to conduct interviews for men and women separately, all participants wanted to be interviewed as a couple. This could have influenced the narratives, as men and women may have different perceptions of mental health and illness and may experience different impacts of immigration and parenthood. The sample had a higher number of female participants and thus may not fully represent the experiences of men.
Previous authors have highlighted the impact that marriage has on the lives of immigrant women in a new country, so there are possibly other transitions other than immigration and parenting, such as marriage and having a baby early in marriage, which may have also impacted their experiences.
As the data for this study were collected before the COVID-19 pandemic, the findings did not reflect additional stressors related to the pandemic that could have impacted the immigrants, for example, an inability to be with extended family at the time of grief and loss.
Recommendations for Further Research
The findings of this study illustrate how the effects of immigration can impact the transition to parenthood in the early years after immigration. Further research should consider incorporating these findings to explore further how these dual transitions impact the mental health of immigrants. Future research should consider that immigrants might be experiencing multiple transitions, such as marriage, and should explore how these intersecting transitions affect their mental health and well-being during the perinatal period. Additionally, there is a need to explore best healthcare practices when conducting psychosocial assessments on immigrant women to provide more effective assessment and screening by exploring the intersectionality of their experience, particularly as immigrant women continue to underreport mental health concerns (Philip et al., 2021).
Implications for Practice
Midwives and other healthcare professionals should be aware that people are inherently multi-positioned, shaped by cultural differences, nationality, and identity. Acknowledging the intersections of Schlossberg’s four factors—situation, support, self, and strategies—in the experiences of immigrant parents is an important starting point for improving practice in the assessment, exploration of needs, and referrals for immigrant women. The findings of this study provide significant insights for the Australian healthcare services by providing a nuanced understanding of these differences and challenges the immigrants face due to dual transitions. It is also recommended that maternity and mental health support services integrate strategies addressing cultural stress and parenting demands, since the intersection of both transitions results in higher vulnerabilities related to mental health (Sangalang et al., 2019).
For example, developing multicultural awareness and creating spaces and support programs for immigrant parents to share their experiences with others of similar experiences may alleviate the sense of “not belonging.” The involvement of new immigrant parents in parent groups and playgroups will contribute to giving them a feeling of shared experience. Most importantly, peer support and engaging them in leadership roles or community service may reduce feelings of isolation, raise their self-confidence, and build a sense of community and belonging (Lai et al., 2020; Page-Reeves et al., 2021).
The dual transition of immigration and parenthood can affect self-esteem and confidence. A strength-based approach in the provision of maternity care for new immigrant parents is very important for rebuilding their confidence. However, this needs to be located within the intersectionality of their situation, together with other support systems they have, such as employment and social networks. Providing information to new immigrant parents about Australian maternity health care, available support, and resources can help them navigate the dual transitions effectively. Healthcare professionals should be trained to recognize and build on the strengths of immigrant parents, such as their collectivist parenting style, resilience, skills, and abilities, rather than focusing solely on the negative impacts of immigration. Training should equip healthcare professionals with cultural competence, helping them understand the challenges faced by immigrant parents within an intersectional context of shifting gender roles, employment changes, and cultural differences.
The results of this study highlighted that for some participants, immigration also offered a sense of liberation, uncovering the transformative potential of navigating these dual transitions. Healthcare professionals can empower immigrants by calling their attention to the transformative and liberating aspects of immigration. By focusing on these positive aspects, clinicians can help immigrants to embrace their new identities. The facilitation of programs that will support positive community integration can allow new immigrant parents to reclaim their agency, redefine their identities, and promote their well-being. It is important to realize that the Western framework for understanding mental health may not apply to the perspectives of Indian immigrants who ascribe meaning to mental health and illness through different conceptual lenses (Philip et al., 2024).
Conclusion
The findings of this study show that while the dual transitions of immigration and parenthood come with challenges, they also offer opportunities for growth and adaptation. It is essential to acknowledge that the feeling of living between two worlds, during these two important life transitions, can lead to a loss of confidence and feelings of not belonging. Healthcare professionals can address these complexities by recognizing the diverse needs of immigrants and creating environments that promote positive integration, and foster support and empowerment. It is essential to understand that individuals possess multiple intersecting identities, and the interplay of various factors shapes their experiences. An individual’s ability to navigate dual transitions may depend on the balance of resources and deficits within the four categories of situation, support, self, and strategies they use. Understanding these interactions allows for a more comprehensive approach to care, making it easier to identify, discuss, and address the challenges they face. This approach will not only enhance the quality of maternity care but also strengthen the resilience and adaptation of immigrant families.
Footnotes
Acknowledgements
We would like to thank the participants in this study, including the immigrant Indian parents, the Community Stakeholders Group (CSG), and community cultural informants (CCIs), who were very generous in sharing their time, experiences, and insights with us. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. We thank Anubhuti Rose Anthony for creating the image for this paper.
Ethical Considerations
All data utilized in the current manuscript are lawfully acquired. Ethics approval was obtained from the human ethics committee at Western Sydney University (H12784) before the data collection began. All participants gave written informed consent before enrolling in the study; the consent was obtained in person by the primary investigator Bridgit Philip.
Author Contributions
Bridgit Philip: Conceptualization (lead), data curation, formal analysis, investigation, methodology, visualization, and writing—original draft preparation (lead), review, and editing. Lynn Kemp: Conceptualization (supporting), supervision, and writing—review and editing (equal). Christine Taylor: Conceptualization (supporting), supervision, and writing—review and editing (equal). Virginia Schmied: Conceptualization (supporting), methodology, supervision, and writing—original draft preparation (supporting), review, and editing (equal).
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.