Swedish maternal health care in a multiethnic society - including the fathers

Abstract: Preventive work in maternal and child health care has a long history in Sweden. Today, Sweden has achieved the lowest maternal and child mortality rates globally based on a maternal health care system regulated by national recommendations; offered to every woman, free of chare, on a continuity basis, by registered midwives at municipal clinics within the community with the purpose of being assessable for all women. Despite the availability of antenatal care, immigrant women living in Sweden often have a different pattern of utilising care and in some cases immigrant women have been shown to be at risk for a negative delivery outcome. The overall aim of this thesis was to investigate differences due to country of birth and utilisation of antenatal care and the experiences of antenatal care, from the perspectives of the both the parents to be. Epidemiological design and explorative qualitative research has been used for the purpose of finding patterns of the utilisation of maternal health care as well as experiences from foreign born men and women concerning maternal health care in general, and maternal health care in the city of Malmö Sweden in particular. Qualitative research has been used to add depth and thereby attain a greater understanding in a social context. In the study population, according to the definitions set in Studies I, IV, the main finding was that 28.3-48.7% of the women had unplanned visits to a midwife and/or to a physician at the delivery ward. Women born in Sweden and in Eastern and Southern Europe had a linear relationship with few planned visits to the midwife at the municipal clinic and more unplanned visits to a midwife at the delivery ward. The women in Study II were positive to the individualised and professional care given at the MHC by empathic and professional midwives. They were positive to the increased involvement of their partner in the area of reproduction and family life since migrating to Sweden. According to the women, this may lead to an increased understanding by the fathers of the woman’s situation during pregnancy, 10 birth and caring for the children as well as it could increase the fathers own emotional as well as practical involvement in their children. The foreign born men, in Study III, were positive towards antenatal care and to be able to take part as support to women at MHC, and during the delivery process. They experienced problems with their situation of being fathers, partners and, as men living in Sweden, due often to their being un-employed and the changed situation that their migration had brought about. The health care system manager need to be aware of the fact that there are groups of women, in a low risk population, who tend to make contact with the maternal care system in a more of less unplanned fashion. By not utilising the planned care offered these women miss an opportunity to meet a midwife who is specialised in preventive care during pregnancy with the focus of treating pregnancy a normal health life event, while at the same time, ensuring the detection of eventual risk factors. A conversation with a midwife in a calm environment is beneficial to the pregnant woman. The immigrant groups need our special attention aimed at making the maternal health care system easily accessible for them, as well as making the maternity staff aware of their own attitudes towards preventive work involving pregnancy in a multiethnic setting. The organisation of care must also, in itself; offer such possibilities for both the staff and the women.