Refugee moth­ers at risk

Ev­i­dence shows that the chance of hav­ing post­par­tum de­pres­sion is five times higher in refugee women.

The Coast - - VOICE OF THE CITY - BY SALMA ALMUKHAINI

Her first preg­nancy is a unique ex­pe­ri­ence in any woman’s life. Wel­com­ing a new fam­ily mem­ber could be an ex­cit­ing event, es­pe­cially for a woman be­com­ing a mother for the first time. How­ever, this isn’t al­ways the case for new­comer Syr­ian refugee women re­set­tling in Canada. From Novem­ber 2015 to Jan­uary 2017, 40,000 Syr­ian refugees ar­rived in Canada and one third of them are fe­male and of child­bear­ing age.

As an Ara­bic woman who was raised in the Mid­dle East and ex­pe­ri­enced preg­nancy and child­birth there, I saw that hav­ing strong fam­ily sup­port through­out the preg­nancy and af­ter­ward makes the ex­pe­ri­ence unique and mit­i­gates the psy­cho­log­i­cal stress this ex­pe­ri­ence might cre­ate. Strong fam­ily sup­port has also been found to play a role in de­creas­ing the risk of post­par­tum de­pres­sion, which is one of the com­mon psy­cho­log­i­cal ill­nesses that af­fects women af­ter de­liv­ery world­wide.

Ev­i­dence shows that risk of post­par­tum de­pres­sion in refugee women is five times higher than for Cana­dian-born women. In Syr­ian refugee women, this could be at­trib­uted to many chal­lenges that they often ex­pe­ri­ence be­fore ar­riv­ing and af­ter re­set­tling in Canada. These in­clude so­cial iso­la­tion due to be­ing in a new com­mu­nity, which is cul­tur­ally dif­fer­ent, and the dif­fi­culty in ac­cess­ing and nav­i­gat­ing the com­plex Cana­dian health­care sys­tem. In fact, dif­fi­culty ac­cess­ing gy­ne­co­log­i­cal and ob­stet­ric care is well-re­ported by refugee women in Canada. Cer­tainly, this is ex­ac­er­bated by lan­guage bar­ri­ers that pre­vent these women from ac­cess­ing health care at an early stage, thus leav­ing them iso­lated. Adding to this, loss of fam­ily sup­port and tra­di­tional prac­tices dur­ing the post­par­tum pe­riod iso­late them fur­ther and con­se­quently jeop­ar­dize their men­tal health and leave them more vul­ner­a­ble to de­vel­op­ing a men­tal ill­ness like post­par­tum de­pres­sion. Ev­i­dence sug­gests that risk of men­tal ill­ness might per­sist to the sec­ond gen­er­a­tion of im­mi­grants. There­fore, not ad­dress­ing this is­sue early, start­ing dur­ing preg­nancy, means los­ing a sig­nif­i­cant op­por­tu­nity to de­crease these risks across gen­er­a­tions. A pre­lim­i­nary Cana­dian study on Syr­ian refugee women who have re­cently moved to Canada re­ported that post­par­tum de­pres­sion is com­mon among these women. Ad­di­tion­ally, it re­ported that they might deny their de­pres­sion, and use words like “feel­ing bored” or “tired” to de­scribe their de­pres­sive symp­toms, which, in turn, might mask their de­pres­sion. This was at­trib­uted to the fear of the stigma of hav­ing a men­tal ill­ness and the need for pri­vacy to ex­press their con­cerns, which were high­lighted as the main con­straints when seek­ing help or ac­cess­ing the avail­able ser­vices.

The re­mark­able vul­ner­a­bil­ity that Syr­ian refugee women have dur­ing and af­ter preg­nancy needs to be han­dled care­fully. Health­care providers need to be aware of this hid­den threat and aware that these women might ex­pe­ri­ence de­pres­sion and hes­i­tate to dis­close it ex­plic­itly. Build­ing a re­la­tion­ship of trust and main­tain­ing pri­vacy are vi­tal. In­deed, hav­ing a fam­ily doc­tor or spe­cial­ized mid­wife to mon­i­tor these women closely, both early in preg­nancy and af­ter­ward, may build this re­la­tion­ship of trust and en­sure con­ti­nu­ity of care. As Ahmed et al., (2017) rec­om­mend, it is also im­por­tant to in­crease aware­ness of post­par­tum de­pres­sion among Syr­ian women and their fam­i­lies. This aware­ness needs to be started as early as pos­si­ble dur­ing preg­nancy, and needs to be de­liv­ered in a cul­tur­ally sen­si­tive man­ner, and in Ara­bic, if needed.

The tremen­dous im­pact of so­cial iso­la­tion on women’s men­tal health needs to be ad­dressed. Con­sid­er­ing the con­ser­va­tive na­ture of Ara­bic cul­ture, Syr­ian refugee women need to be sup­ported by other Syr­ian refugee women. Es­tab­lish­ing Syr­ian women sup­port groups, where women feel more com­fort­able dis­cussing women-re­lated is­sues like preg­nancy and birth, is vi­tal. More­over, es­tab­lish­ing a refugee as­so­ci­a­tion—man­aged and op­er­ated by refugees them­selves—could or­ga­nize cul­tur­ally sen­si­tive so­cial ac­tiv­i­ties, make refugees feel more at home and mit­i­gate the so­cial iso­la­tion and sepa­ra­tion that Syr­ian refugees, es­pe­cially women, suf­fer from. Salma Almukhaini, from Oman, is a first-year PhD stu­dent at Dal­housie Uni­ver­sity’s School of Nurs­ing.

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