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Prevalence and Risk Factors Among Refugee and Immigrant Women

Introduction

Immigrants are the ones who come to the country to live permanently. Immigrants are always being motivated in leaving their own space, their former countries of citizenship, and their regular habitual residences. This is due to certain reasons like lack of proper access to local resources along with the desire towards the economic prosperity and also engaging towards paid work so that they can lead a standard life (Lansakara, Brown and Gartland, 2009)

Some of the important reasons for the citizens to migrate in Australia due to certain factors like free or the subsidized rate of healthcare system along with quality education and also the suitable weather and climate. The country, Australia, also acts as a pathway to citizenship. The biggest advantage in this is that in Australia, the immigrants can be able to get dual citizenship and the children born after that can also male application for citizenship even if their parents do not get qualified. Postnatal depression could create a negative impact on the quality of relationships between the child and the mother. This can also affect the relationship between the grandmother and the grandchildren as per the discovery of the new research. Some studies highlight that the immigrant women who came to Australia have been experienced themselves with struggle, anxiety, and also the language problem at the time of the postnatal period. Hence it has been found that the women are finding it hard in coping up with the family as well as the social networks(Bandyopadhyay, Small, Watson, and Brown, 2010)

According to the Department of Health in Australia, the immigrant women after coming to Australia have suffered from different problems that involve cultural diversities, resettlement problems among the migrants, and the refugees through which their ental health has been placed at risk. This involves grief, anxiety, and the continuous loss where family and friends have left them behind. According to the Mental Health Policy of Australia, the immigrant women in Australia have experienced themselves with certain traumas like different cultural backgrounds, lack of recognition in the professional qualifications, etc. The existence of personal along with the depression history in the family enhances the postpartum depression. It has been found that women having a more anxious personality can quickly develop postpartum depression (Løvlie and Madar, 2016)

Discussion

According to Falah-Hassani, Shiri, Vigod, and Dennis (2015), the mental health disorders at the time of the perinatal period I common after conducting the study in the USA where around the 12-month prevalence of around 25.3 percent have been found for the pregnant women and around 27.5 percent in case of the postpartum women. This kind of problem is common for those women who belong from low and middle-income countries and also from socioeconomic groups. Here the migrants refer to those people who stay outside of their own birth country like that of refugees, asylum seekers, and also the economic migrants. As per the World Health Organization, around 10 percent of pregnant women in the global context and also 13 percent of the women who have just given birth to the child have been experienced with a mental disorder that is depression. Common Perinatal Mental Disorders are highly prevalent among the lower and middle-income group countries. Around 15.6 percent of the women in the lower-middle-income countries experienced a mental disorder of around 20 percent after the childbirth. The postpartum depression which is known as the non-psychotic depressive disorder as being classified by the Diagnostic and Statistical Manual of Mental Disorders gradually started within 4 weeks of childbirth. The social factors that involved in this postpartum depression are stressful events of life along with prenatal anxiety.

A recent review that has been made by Fung and Dennis (2010), indicates that telephone-based peer support along with interpersonal psychotherapy reduces the women number suffering from postpartum depression. For example, Syria one of the Middle East countries has experienced a humanitarian crisis in recent years those which is not having postpartum depression. However, as per the World Health Organisation records, the Syrian people’s mental health is getting declined daily and they always face major health challenges involving the low uptakes of the postnatal care.

Postnatal depression or the mood disorder generally occurs among women up to 1 year after the childbirth which gets characterized through certain feelings of loss or saddening situations and sometimes, it is also the loss of self-esteem and dignity. One of the risk factors associated with the postnatal depression is that the women in this stage particularly suffered from the cultural ambiguities and the ethical issues. Some of the authors like Tobin, Di Napoli, and Wood-Gauthier (2014) have argued that individuals always bind through the rules of culture which helps in shaping and influencing the behavior. The rate of prevalence in the context of postnatal depression generally varies between cultures and its occurrence is around three times in the developing societies as compared to the developed ones.

The literature on the risk factors regarding the mental health illness highlights aspects like certain perceptions and the attitudes towards depression in different cultural contexts. One of the risky factors in this kind of postnatal depression among the refugee and immigrant women is their lack of openness and transparencies in the communication where they can be able to reflect their sufferings and pains to some other carers due to the existence of fear and self-respect. It was most common among some of the black Caribbean women who often find difficulties in talking about their perinatal depression where they were having the feeling of underreporting their psychological feelings. As per Tobin, Di Napoli, and Wood-Gauthier (2014), the literature highlights the part of the professional professionals, there exist certain factors among the professionals which include lack of awareness, late in the diagnosis, and the presence of excessive medicalization of symptoms. The presence of risk factors that are responsible for postnatal depression among the immigrant or the refugee women is the social exclusion, relationship complexities, and also the existence of the deprivation.

In many situations, it has also been found that the women outside Australia shortly after giving birth to their child were less likely to report regarding their pain to the outsiders and always tell that their pain after the birth is manageable and they are not much concerned enough in this. However, some of the research studies show that women are often gone through painful stitches after giving birth to a newborn baby. However, they were seemed to be helpless and ashamed in sharing this due to the presence of the language barriers especially the lack of English fluency among the immigrant or the refugee women. It is also considered as one of the limitations (Collins, Zimmerman and Howard, 2010)

Culture plays important role in the way where the women perceive and preparing themselves for the birth of their child. Each of the cultures is having its distinct values, practices as well as beliefs which are linked with the pregnancy and the birth. Most of the women who are coming from culturally and linguistically diverse backgrounds outside Australia adheres to certain traditional pregnancy and birth practices. As per Husain et al., (2012), at the time of the pregnancy, women from different cultures prohibit themselves from eating certain foods. In addition to this, at the time of labor, women from different cultures avoid moving too much and lying down. However, in the modern era, before and after birth, women freely moves around and also attend official works and at the same time also the personal works.

Hence as per Falah-Hassani, Shiri, Vigod and Dennis, (2015), if the healthcare professionals are aware of this fact that women who are undergoing through the postnatal depression and familiarize themselves with different rituals, cultures as well as behavioral restriction, then women coming from culturally and linguistically backward class could have the choice in reflecting their sufferings which they have undergone at the time of the labor pain and also after that. It should be known to the healthcare professionals to realize the differences in maternity care in the overseas. The women coming from culturally backward classes might feel vulnerable and also anxious regarding their health and also the health of their unborn child. This creates automatic anxiety and stress among them due to a lack of proper information. In most of the backward countries, normal delivery occurs which creates mental and physical pressure on both the child and the mother. However, these women have adapted themselves well in this kind of situation. Hence after migrating to Australia, they often deny better medical treatment like, at the time of normal delivery, the requirement of de-infibulation an afterbirth vulvae restructuring procedures is important for performing the surgeries.

In the modern context, C-section surgeries are safe for women. However, most of the women deny this kind of surgery where they often think that they might lose their child. In most cases, it has been recommended by the healthcare professionals to the women who are going through the postnatal depression after the childbirth, to take adequate rest. However, in many situations, the research shows that women regularly perform their regular household chores even though how many days they had been elapsed since birth. The traditional culture of birth highlights that after marriage, the mother in law in the family expects that the women will be having the child within some months. If that did not happen, then often mother in law considers the women as alien and often faces mental traumas from the family. In this aspect, the support from the husband is highly necessary where in many cases, this is also absent which often makes the women suffered from mental traumas and in most of the time often gets saddened.

The gap can be found at the time of interviewing the participants who have undergone through the postnatal depression. In most of the situations, it has been found that the participants are not sporting enough in reflecting their sufferings and also the mental stress and the anxieties they have been gone through. At the time of researching with the participants who have gone through the postnatal depression, the researchers are often faced with cross-cultural complexities and language barriers(Husain et al., 2012). Hence it can be found that there had occurred a lack of communication between the researchers and the participants which had which ultimately seek for professional bits of help.

According to Fung and Dennis, (2010), the clinical implications highlight to incorporate the bio-psychosocial model of the health services at the tie of working with the postnatal refugee or immigrant women. Secondly, the clinical practitioners should also need to understand the family background of the women from where she actually belongs and accordingly should treat her based on her cultures and religious beliefs. Hence it is also important to understand family politics that is how the extended family display and wield power is affecting the mental status of the immigrant or the refugee women. Collins, Zimmerman, and Howard, (2010) stated that health professionals at the same time should also be aware of the intercultural communications that need to be managed with the women at the time of their postnatal period.

Hence as a whole, both the compassion as well as care should be managed through which the turmoil can be avoided and the transparencies can also be uplifted. Hence it can also be stated by Løvlie and Madar (2016), that improvement of the experience among the women at the time of the postnatal depressive period is one of the important aspects to be taken care of. Under this, the healthcare practitioners need to be thoughtful and practical enough in undertaking the individualistic approach where the women entitlement towards the postnatal care along with the options to access it can be easily explained. Here the woman’s support network also needs to be made stronger through which the appropriate care can be delivered and the women can also get encouraged in discussing anything which is bothering her for the last few months after the childbirth. The practitioners in this situation should keep in mind that women’s respect at the time of interviewing them.

Conclusion

As being demonstrated through the entire study, it has been found that the refugee or immigrant women’s postnatal suffering just after birth is not new. However, there exist certain medical interventions through which their sufferings can be easily dealt with effectively. In this context, the in-laws should be supportive of the women and should not always pressurize the women to conceive after being married. The same kind of acknowledgment and understanding should also be present among healthcare professionals. In short, the presence of intercultural communication between the immigrant women and the nurses or the doctors is highly essential to know the actual sufferings and the ain of women at the time of going through the labor stage and also after giving birth. The contemporary social sciences should be acknowledged by the healthcare professionals at the time of dealing with women suffering from postnatal depression and should be following the individualistic approach. Along with this, they also should be aware of the presence of the multicultural activities within society.

References

Bandyopadhyay, M., Small, R., Watson, L. and Brown, S., 2010. Life with a new baby: How do immigrant and Australian-born women's experiences compare?. Australian and New Zealand Journal of Public Health, 34(4), pp.412-421.

Collins, C., Zimmerman, C. and Howard, L., 2010. Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Archives of Women's Mental Health, 14(1), pp.3-11.

Falah-Hassani, K., Shiri, R., Vigod, S. and Dennis, C., 2015. Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. Journal of Psychiatric Research, 70, pp.67-82.

Fung, K. and Dennis, C., 2010. Postpartum depression among immigrant women. Current Opinion in Psychiatry, 23(4), pp.342-348.

Husain, N., Cruickshank, K., Husain, M., Khan, S., Tomenson, B. and Rahman, A., 2012. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: A cohort study. Journal of Affective Disorders, 140(3), pp.268-276.

Lansakara, N., Brown, S. and Gartland, D., 2009. Birth Outcomes, Postpartum Health and Primary Care Contacts of Immigrant Mothers in an Australian Nulliparous Pregnancy Cohort Study. Maternal and Child Health Journal, 14(5), pp.807-816.

Løvlie, A. and Madar, A., 2016. Postpartum Depression Among Somali Women in Norway. Journal of Immigrant and Minority Health, 19(3), pp.638-644.

Tobin, C., Di Napoli, P. and Wood-Gauthier, M., 2014. Recognition of Risk Factors for Postpartum Depression in Refugee and Immigrant Women: Are Current Screening Practices Adequate?. Journal of Immigrant and Minority Health, 17(4), pp.1019-1024.

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