Exploring maternity care for asylum seekers and refugees By Lesley Briscoe and Tina Lavender P olitical, religious, demographic or economic factors are the basic reasons which have driven people to migrate (Burnett and Peel, 2001). However, indi- vidual reasons for migration are difficult to elicit. For some, the drive to migrate is powerful and despite barriers created by governments, people remain impelled to gain access to alternative societies. In order to explore aspects of migration, seeking asylum and becoming a refugee, it is important to focus on the level of individuals. Individual displacement may affect women more seriously than men leading to increased isolation, poverty, hostility and racism (Burnett and Peel, 2001). The gravity of this effect is evident by the six times greater chance of maternal mortality which exists for Black African women including asylum seek- ers and newly arrived refugees in the UK (Lewis, 2007). There is a need for health professionals to find ways to lessen the increased risk of mortality with appropriate service provision. However at the time of this study (2002–2003) access to local information about asylum seekers and refu- gees was difficult to obtain, even though this area of the UK remains a main dispersal area. Accessing literature about how women asylum seekers and refugees experienced maternity care in the UK was limited and based on individual ‘snap shot’ interviews (Burnett and Fassil, 2002; McLeish, 2002; Sawtell, 2002). A longitudinal perspective, provided by this study, has helped to contextualize the individual experiences of women during their maternity care. Aim The aim of this study was to explore the experience of mater- nity care by three asylum seekers and one refugee. Methodology Collective case study research was chosen because the multiple cases helped to identify common issues (Stake, 1995) and facilitated the illumination of differences (Fleming, 2003). The use of photographs in this study was as a prompt for conversation, not to be analysed sepa- rately. Photographs have been used successfully in other research studies, for example, Berman and colleagues (2001); Ip (2007) and Lassetter and colleagues, (2007) and is a medium that encourages freedom of expres- sion (Hannah et al, 1995). The intent of the researcher who uses photographs is an important consideration in research because the process of analysis will be affected. In this study photographs were not a portrayal of a ‘quote’ for the image, they were a tool for accessing the women’s perceptions of what was important to them during their maternity experience and this concept may have added to how truth was constructed for the participating women (Pink, 2001). Ethical considerations Following ethical approval from the local research ethics com- mittee, the local Hospital Trust and the University of Central Lancashire, invitation to participate was provided with the help of professional interpreters and pseudonyms were used to protect confidentiality. Data collection Women were approached if the status of asylum seeker or refugee was written in the hospital notes at their booking appointment. Fourteen women were approached and nine women declined to participate. Five women consented; one Lesley Briscoe is Senior Lecturer in Midwifery at Edge Hill University, Ormskirk, Liverpool; Tina Lavender is Professor at Manchester University, Manchester Email: briscoel@edgehill.ac.uk Abstract The aim of this study was to explore and synthesize the experience of maternity care by female asylum seekers and refugees. The approach was a longitudinal exploratory multiple case study that used a series of interviews, photographs taken by the women, field notes and observational methods to contextualize data obtained during 2002 and 2003. Data was collected in the women’s home and a hospital trust. Four women agreed to participate, three women were asylum seekers and one woman was a refugee. Three key themes were generated: the perception of ‘self’; understanding in practice, and the influence of social policy. The women perceived ‘self’ as a response to social interaction. At times, ‘taken for granted’ communication in practice created a barrier to understanding for the women. Social policy related to seeking asylum, dispersement, housing and health directly affecting the lives and subsequent maternity experiences of the women. The theory of symbolic interactionism and transformational educational theory was applied to the findings, highlighting that self-awareness is of paramount importance in care delivery. The strength and resilience of migrating women is acknowledged and should be used as a starting point to develop partnerships in care and to build the woman’s self-esteem during their maternity experiences. INDIVIDUAL CARE BRITISH JOURNAL OF MIDWIFERY, JANUARY 2009, VOL 17, NO 1 17