Setting the stage: reviewing current knowledge on the health of New Zealand immigrants—an integrative review

The growth of migrant communities continues to rise globally, creating unique and complex health challenges. Literature on immigrant health in New Zealand (NZ) remains scant. This integrative literature review was conducted drawing on peer-reviewed research articles on immigrant health in NZ published between 2012 and 2018. The objectives were to: (i) provide a critical overview of immigrant health in NZ; (ii) identify general trends in health research conducted in NZ on immigrants; (iii) compare, contrast, and evaluate the quality of the information; (iv) develop a summary of research results and; (v) identify priorities and recommendations for future research. A search yielded more than 130 articles with 28 articles constituting the foundation of the review. This review is timely following the rapid increase in the scale, speed, and spread of immigration and its potential for changing NZ’s national health patterns and priorities. This integrative review led to the four primary conclusions. Firstly, migration in NZ is a gendered phenomenon, as there has been more women and girls arriving as migrants in NZ and being at risk of poor health in comparison with their male counterparts. Secondly, studies on infectious diseases take precedence over other health problems. Thirdly, research methodologies used to collect data may not be relevant to the cultural and traditional customs of the migrant populations. Furthermore, a number of research findings implemented have failed to meet the needs of NZ migrants. Lastly, policy initiatives are inclined more towards supporting health practitioners and lack a migrant centred approach

Women's experience and perception of maternal health care and emergency services in rural Zimbabwe

Approximately, 3000 women die every year in Zimbabwe during pregnancy, child birth or postpartum. According to the Zimbabwe Demographic Health survey (2011/12), maternal mortality has worsened from 720 deaths per 100, 000 to 950 between 2007 and 2012. Most of what needs to be done is known. Past efforts have managed to sustain high levels of antenatal care (ANC) visits among pregnant women and skilled birth deliveries yet maternal mortality estimates remain high. While quality of care in maternal health services is needed for progress towards reducing maternal mortality, women’s perspectives for policy and action in maternal health seem to be the missing link. The study examined women’s perceptions and experience of maternal health care services and to what extent such understanding can be used to explore strategies to improve the quality of maternal health and obstetric care in rural Mutare. A feminist interpretive paradigm was employed in the study. A critical qualitative research methodology, using guided in-depth interviews and focus group discussions collected data from 25 women using antenatal, postpartum care services and maternity waiting homes at the time of the research. All focus group discussions and interviews were recorded, translated and transcribed. Transcripts were coded and analysed thematically. Four broad themes were identified: 1) women’s experience of maternal health care; 2) quality of maternal health care; 3) women’s knowledge of maternal health care; 4) priorities areas of improvement. In summary, women’s knowledge of maternal health care services was low. Women understood that quality of care; barriers to maternal health care; lack of awareness of dangerous signs in pregnancy; and gender inequality had contributed to poor maternal health in the district. Women’s stories and experiences suggest that behind issues of inadequate maternal health care are the shadows of many other urgent development issues - gender inequality; poverty and unemployment; inadequate education and public health spending and above all, lack of skilled birth attendants and enabling environments. Women’s empowerment through basic education and employment was identified as keys to improve maternal health and quality of care in this district

Women\u27s experiences of disrespectful and abusive maternal health care in a low resource rural setting in eastern Zimbabwe

Background: There has been an increase in recent publications, in high and medium resource settings, documenting women\u27s dissatisfaction with the quality of maternity care they receive. Their discontent is mostly related to their midwives\u27 disrespectful or negative attitudes. Objective: To explore women\u27s experiences and perceptions of disrespect and abuse from their maternity care providers in a low resource rural setting in Zimbabwe. Design: A critical, qualitative research methodology, using in-depth interviews and two focus group discussions, was employed to capture rural women\u27s experiences during antenatal care, postpartum care, and the use of maternity waiting homes\u27 services. Setting: Three rural health centres in Mutare district, Manicaland Province in eastern Zimbabwe. Participants: A total of 20 purposively sampled women, 16-30 years of age, who were accessing various stages of maternal health services, were recruited from three conveniently selected rural health centres. Eight women participated in the in-depth interviews. A further eight women were discussants in the first focus group, and a further four women participated in the second focus group. Findings: Multifaceted and interconnected factors contribute to midwives\u27 attitudes and behaviours towards their clients. Midwives\u27 subjective perceptions, women\u27s social status, and health system constraints (i.e., availability of trained midwives and quality of midwifery training) in rural and poorly resourced community, often result in inappropriate services, negative attitudes, abusive treatment, and disrespectful behaviour towards women. Poor treatment in maternity care directly contribute to adverse health outcomes and women\u27s satisfaction with services. Conclusion and implications for practice: Women\u27s social status, level of education and age, were perceived to influence the quality of care or treatment they received. Improving women\u27s experience of maternal care requires targeted interventions at the interpersonal level between a woman and her health care providers, as well as at the level of the health care facility and the health system. The results of this study challenge all tiers of health personnel including policy makers, in low resource settings to reappraise the present situation thereby challenging these established behaviours, to ensure that the continuum of maternity care is respectfully and socio-culturally delivered