A new report on Minnesota Somali women reveals the challenges women in the community face in dealing with Western medical practices during pregnancy and childbirth.
Complications between the Somali community and Western doctors are fueled by cultural differences between the two societies, but the “Cultural Traditions and the Reproductive Health of Somali Women” study could help to bridge that gap.
“We wanted to shed light on the concerns Somali women have regarding Western health care practices,” said Fartun Weli, executive director of the Minnesota-based Somali advocacy group Isuroon, which sponsored the report. “When we have a study focusing on such issues, then health professionals will not have an excuse not to fix the problems our community is facing.”
Deeply rooted cultural and religious traditions influence Somalis’ ideas about marriage, family and the maternity process. Minnesota health providers, however, aren’t providing the estimated 70,000 Somali-American population in Minnesota with a culturally acceptable environment, according to the report.
Traditionally, the success of a Somali woman is often linked to a marriage leading to the births of many children. On average, women in Somalia bear seven children during their lifetime, the study stated.
While Somali women understand the importance of a health provider, they strongly prefer a female provider to a male, the study stated. It’s not culturally or religiously accepted for women to expose their genitals to men other than their husbands. It doesn’t matter what the conditions are.
Last year, Nancy Deyo, a senior advisor for the Women’s Refugee Commission, who researched and authored the report, gathered a focus group consisting of 25 Somali women, 12 Somali men and health professionals in Minneapolis.
The group reported that Somali women feel providers rush to do unnecessary Cesarean sections, also known as C-sections.
For Western providers, C-sections become indispensible when a woman in labor encounters health problems, her vagina is too small for the baby to pass, the child is weirdly positioned or signs of distress in the baby arise.
For the Somali community, the report stated, a C-section is seen as a dangerous practice, which will cause women to never have a natural birth again. Others see the surgery as Western providers’ way to thwart Somali women from having more babies, the study stated.
Somali women are accustomed to situations where health providers in Somalia gave them more time and support in manipulating the child’s position to enable a successful birth. Such a process can last three to four days, the report said.
A community member in the study expressed his frustration toward the C-sections this way:
In Somalia, almost all births are natural, but we see here up to 70 percent of births by surgery. Because of this high number, we think the doctors want to make money from the surgeries; they make less if the child was born naturally. They also want mothers to have fewer children. This is why we fear C-sections.
The study also revealed that Somalis object to inducing labor, a Western medical practice to begin the birthing process. The community is “anti-intervention,” the report said, adding that Somali women believe God determines the right moment for babies to come out.
The women also fear the inducing method because they believe that it “burns the womb,” meaning the womb breaks and women won’t be able to reproduce, which is considered a catastrophe in the Somali culture, according to the study.
Discrimination by providers
Some women shared with the study that they were discriminated against because they’re immigrants. They said that nurses didn’t give them the attention and care they needed during agonizing labor pain. The women reported that the nurses stood outside, chatting and laughing, while they were in severe pain.
One woman told researchers:
In the U.S., as long as you’re an immigrant, doctors do not give you proper care. I was pregnant and my child had his umbilical cord wrapped around his neck. When I had the ultrasound the doctors told me there is something wrong with your baby, but they did not fix it. When the baby came out he was strangled with the umbilical cord. I did not sue them because I trust Allah will take care of us, but my baby has a disability from that birth.
Others said doctors don’t take the time to educate patients about options pertaining to childbirth. For instance, if a Somali woman objects when a doctor suggests a C-section, the doctor tells them to go find another doctor. Consequently, the women feel abandoned.
“We want our doctors to consult with families,” a man told the researchers who conducted study. “Even if surgery is the best alternative, we want to know our options and have a discussion about it.”
The report recommended that health care workers educate Somali mothers on C-sections and why they’re required. In order to prevent messages lost in the translation, the report recommended that any education be provided in the Somali language.
It was also recommended that Western health providers embrace culturally fitting childbearing options if they don’t cause health problems to the mother and her unborn baby.
The report suggested that in order to improve the relationship between Somali patients and caretakers, Western health providers should “better understand Somali culture and belief systems related to reproductive health care.”
Reporting for this article supported in part by Bush Foundation.