Equity and Access to Healthcare Services: A qualitative analysis of the maternity care experiences of Arab migrant women in Scotland

Abstract

Background: Globally, migration has surged over the past two decades, with the UK emerging as the fifth top destination, hosting over 9.5 million foreign born residents (IOM, 2021). There has been a gradual increase in the number of new female migrants in the country. These trends emphasise the importance of meeting the maternity care access needs of new migrants, ensuring equitable access to services, and adapting these services to diverse cultures. This study’s initial scoping review mapped the literature about maternity care access experiences among newly arrived migrants in EU/EFTA countries. It identified limited studies about newly arrived migrant women in Scotland, a country experiencing population growth due to migration. Among migrant group that received little attention despite their numbers are newly arrived migrant women from Arab countries.

Aim: To explore and describe the maternity care access experiences of newly arrived Arab migrant women who have given birth in Scotland, and for whom English is not their first language.

Methods: A Qualitative Descriptive study was conducted using the Levesque et al. (2013) 5As access to healthcare framework. Twenty participants from various Arab countries and with different migration statuses were selected from Scotland’s four largest cities through purposive sampling strategy. In-depth semi-structured telephone interviews were conducted, focusing on their experiences. Thematic Analysis (TA) was employed to analyse the interviews.

Findings: Participants reported varied experiences at different stages of maternity care, with more challenges than facilitators in accessing care. An overarching theme ‘Expectation and reality’ and four other themes were identified from the data. These are: 1) Perceived availability and appropriateness of maternity care; 2) Motivators and inhibitors when seeking maternity care; 3) Communication; and 4) Encounters with healthcare professionals.

Discussion and Conclusion: The study highlights lack of familiarity and discrepancies between expected and actual care experiences, affecting experiences and perceptions of maternity services. Participants faced several challenges at both service and organisational levels, leading to criticism and resistance behaviours such as appointment avoidance and exaggerating conditions. The study shows how initial self-directed barriers could transform into motivators, and vice versa, which influenced participants’ decisions to seek, accept, or avoid care. It also identifies substantial communication barriers due to language difficulties and the inadequacy of interpretation services. This, along with a lack of tailored informational materials, significantly affected access to and understanding of maternity care services. Positive interactions with healthcare professionals fostered feelings of equality and welcome, while negative encounters often resulted in perceptions of discrimination. Recommendations include improving information provision and adopting women-centred, culturally sensitive practices to enhance maternity care for migrant women.