How can care for pregnant women in asylum seekers' centres be improved?

Women living in the asylum seekers' centre in Ter Apel are seven times more likely to lose their baby at birth compared to other women in the North-East Groningen region. This is shown by physician-researcher Anouk Verschuuren's PhD-research. How is this happening? And more importantly: how can it be improved?  
Vrouw bij asielzoekerscentrum in Ter Apel. Foto: Reyer Boxem

In her research, Verschuuren investigated birth care for pregnant women in asylum seekers' centres. 'We actually knew very little about how these women were coping in the Netherlands. What are the birth outcomes? How are these babies coping when compared to other women in the Netherlands?" says Verschuuren. For example, she found that pregnant women in the asylum seekers' centre in Ter Apel lost their babies more frequently than other women in that region.  

 Cultural differences and language barriers   

 One of the things Verschuuren noticed were cultural differences. 'Obstetricians always ask pregnant women if they drink alcohol. There was one woman from Eritrea who indicated that she did not drink alcohol. After further questioning, it turned out that she drank suwa. This is a kind of Eritrean beer that contains alcohol, but this woman did not know that. 'You have to know that as a obstetrician, otherwise you can't ask about it either.' 'Another woman always wore a small cross on a necklace around her neck, which stood for protection. During her delivery, she had a caesarean section and this necklace was taken off her neck. This really made her believe she was dying, as her protection was gone. Because she did not speak the language, she could not express how important that necklace was for her. As a result, she experienced the delivery as traumatic.'   

 Translator phone  

 To bridge the language barrier, midwives can use the translator phone, a number you can call to engage a telephone translator. But in practice, obstetricians do not call enough. 'I think it would be good if we teach healthcare professionals to better deal with cultural differences and to use translators. That is essential for providing good care,' Verschuuren explains.  

 Relocating often  

 Asylum seekers are often forced to move during the asylum procedure. Of all women in asylum seekers' centres who gave birth between 2016 and 2020, 70 per cent moved at least once. 30 per cent changed residence two or more times. Some pregnant women even had to move seven times. 'So then you have to keep getting used to a different environment and place to sleep. That makes it very challenging for the pregnant woman to build a bond with her surroundings and obstetrician. Making it difficult to provide good care. Also, information is often lost in all those transfers.'   

Group care valuable  

'I really think group care could be a valuable way of providing care for these women,' she says. This is a method where the obstetrician treats several women at the same time. 'In collaboration with obstetric practice New Life, we also set up a group care project in Ter Apel during the study. But unfortunately this was temporary,' explains Verschuuren. 'This way, women from the same background can get to know and support each other. The obstetricians who provided group care were very enthusiastic.  They saw that women shared more of their thoughts with each other and that friendships even developed. And we know from international research that social support is very important to reduce stress.'   

Fixed locations for pregnant women  

To achieve this, Verschuuren says all pregnant refugees and asylum seekers should stay in a few fixed locations in the Netherlands, where healthcare professionals are trained to treat these women. 'I know this is not so simple in practice, but it could work so well.'  

Mental health   

'Many women have experienced horrible things like rape and abuse, and they don't have family or friends to talk about it. In maternity care, there is no standard consideration and time for this either.' According to Verschuuren, introducing a mental health questionnaire could help deal with this. Together with obstetricians in Ter Apel she investigated whether pregnant women would like this and find this useful.'All the women we spoke to were very positive about this and said they would use it, provided the information only reaches the healthcare provider.'  

Different view on asylum seekers and refugees  

Making a real difference in maternity care for asylum seekers and refugees requires more than just the commitment of healthcare professionals, Verschuuren states. Poor living conditions in asylum seekers' centres, asylum policy and the Dutch healthcare system also affect the health of pregnant women. 'The Dutch healthcare system is built on the individual's own responsibility, but due to the language barrier and little knowledge of the Dutch system, it is often difficult for asylum seekers and refugees to find their way in healthcare. To really change things, political support is necessary.'