| 1. |
- Byrskog, Ulrika, et al.
(författare)
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Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study
- 2015
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.
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| 2. |
- Byrskog, Ulrika, et al.
(författare)
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‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden
- 2016
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 40, s. 10-17
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSomali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care.MethodQualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis.FindingsA balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition.ConclusionsIf confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.
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| 3. |
- Byrskog, Ulrika, 1970-
(författare)
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’Moving On’ and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.
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| 4. |
- Byrskog, Ulrika, 1970-, et al.
(författare)
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Perceptions and experiences of war, violence, migration and reproductive health among Somali refugee women in Sweden
- 2013
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Ingår i: 19th Nordic Midwifery Congress - Nordic and Global Challenges. ; , s. 75-
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Konferensbidrag (refereegranskat)abstract
- Perceptions and experiences of war, violence and migration and related sexual and reproductive health among Somali refugee women in Sweden.Background and objectives: Sweden has during the latest six years experienced a twofold increase of Somali born refugees. Elevated levels of pregnancy related morbidity and perinatal complications are seen among Somali born refugee women. Research has shown links between a mother´s prenatal stress and anxiety and the health of the child the first year. Furthermore, violence towards a mother-to-be has negative health effects and increases the neonatal mortality The specific aim in the current study was to explore perceptions and experiences of war, violence and migration among Somali refugee women in Sweden. This in order to find strategies in caring for birth giving Somali refugee women, with possible experiences of violence, which would benefit the woman and society at large.Material and methods: Qualitative individual audio-recorded interviews were conducted with Somali born refugee women in fertile ages. Interviews were held in three steps: 1) personal narratives by newly arrived Somali born women, 2) perceptions and views out of a depersonalized case and 3) reflections upon emerging themes by female key persons of Somali origin. Thematic analysis according to Clarke and Braun was applied.Preliminary results: The analysis resulted in two main themes: Lives controlled by the presence of violence and Sacrificing for the sake of a future. Access to education, livelihood opportunities and health facilities has been strictly limited by the long-lasting civil war. Escalated violations of sexual and reproductive health and rights were a common triggering factor for finalizing escape. Lives have been extensively marked by family separations. Patience created by war and a pragmatic orientation in life have made survival possible.Conclusions: To be presented at the congressImplications for practice: The results will provide increased evidence based knowledge useful to midwives when caring and supporting birth giving refugee women.
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| 5. |
- Byrskog, Ulrika, et al.
(författare)
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Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden
- 2014
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and
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| 6. |
- Byrskog, Ulrika, 1970-, et al.
(författare)
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Violence, sexual and reproductive health and rights in Somalia : Qualitative interviews with Somali born women in Sweden
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Political violence is a push factors for migration and social determinants of health among migrants. The Somali migration to Sweden has increased threefold during the latest six years, now comprising refugees with more than 20 years of war experiences. Adverse childbearing health and outcomes are reported among Somali born refugees in high income countries. Health is influenced by earlier life experiences and a link between adverse sexual and reproductive health, violence and mental distress is described in research. Therefore, the aim was to explore experiences and perceptions on war, violence and sexual and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews with Somali born refugee women living in Sweden were conducted, based on personal narratives and a hypothetical case. Thematic analysis was applied.Results: Escalating violence and power based restrictions permeated gradually all aspect of life and limited both access to and quality of reproductive health services in pre-migration Somalia. Formal societal support for women exposed to violence was absent. This reinforced shame and stigma connected to war related and community based sexual violence and the silence surrounding sexual and intimate partner violence. Women expressed survival strategies in the context of war based on social networks, pragmatism, strength and faith.Conclusions: Lack of formal structures on community levels has together with collective violence negatively impacted the whole spectra of women’s lives which have undermined the sexual and reproductive and health and rights. Several factors reinforce non-disclosure of violence exposure and can thus hamper health care seeking for violence related illness in the receiving country. Survival strategies shaped by war contain resources for resilience and enhancement of mental, sexual and reproductive health in receiving country.Keywords: Somalia, war, violence, refugee, sexual and reproductive health and rights, qualitative method, thematic analysis
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| 7. |
- Byrskog, Ulrika, 1970-, et al.
(författare)
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Violence, wellbeing, and being approached with questions about violence in maternity care encounters. A qualitative study with Somali-born women in the context of recent migration to Sweden.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter a midwifery care system that includes antenatal care visits where routine questions on violence are asked. The aim of this study is to explore Somali-born women’s views on being approached with questions on violence in Swedish maternity care and how they understand and relate to violence and wellbeing.Method: Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis.Findings: A balancing act between keeping private life private and the new welfare system was identified, where the midwife’s questions on violence were met with hesitance. The midwife was, however, considered a resource in gaining access to support services in the new society. A focus set on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Own experiences of intimate partner violence or non-partner sexual violence were not revealed. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition.Conclusions: For beneficial violence prevention and identification, midwives’ questions on violence need to be justified in relevant ways and embedded in contexts of trustful relationships. Approaches of rationality and “moving on”, without focusing on violence or adversities, indicate strength and access to alternative resources, but need to be balanced against risks for hidden needs in care encounters. Collaborations between Somali communities, maternal health care and social service providers can support families in transition and bridge gaps to formal social and care services.
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| 8. |
- Erlandsson, Kerstin, 1961-, et al.
(författare)
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Evaluating a model for the capacity building of midwifery educators in Bangladesh through a blended, web-based master’s programme
- 2019
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master’s programme in SRHR and the extent to which these were realized after 12 months of part-time study.Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses.Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students’ learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master’s programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students’ learning and how to foster reflective and critical thinking among them.Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.
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| 9. |
- Erlandsson, Kerstin, 1961-, et al.
(författare)
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Evaluation of an online master’s programme in Somaliland : A phenomenographic study on the experience of professional and personal development among midwifery faculty
- 2017
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Ingår i: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 25, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.
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| 10. |
- Klingberg-Allvin, Marie, 1972-, et al.
(författare)
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"Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region
- 2019
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 69, s. 135-142
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.DesignIn this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.Setting and participantsData was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.FindingsFindings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.ConclusionThe flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.
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