Maternal Multi-morbidity - Experiences of Women Seeking Asylum During Pregnancy and After Childbirth: a Qualitative Study

Background: Many women seeking asylum during pregnancy and after childbirth experience significant ill-health, but detection and assessment is often difficult as part of routine maternity care. Healthcare providers are key for the early identification and management of vulnerable pregnant women who have additional psychological and social health needs. We sought to explore the experiences and health needs of women seeking asylum during pregnancy and after childbirth in Liverpool, United Kingdom. Enabling factors and barriers to access women-centred care were also explored. Methods: Key informant interviews (n=10) and one focus group discussion (n=4) were conducted with women attending a pregnancy support group. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes. Results: Women seeking asylum understand wellbeing during and after pregnancy is multifactorial and that physical health is interlinked with psychological and social factors. Many women reported that their expectations of maternity services were exceeded, but information giving, and the use of language interpreters needed to be improved. Women explained that they need more comprehensive and timely psychological and social support. The asylum-seeking process itself resulted in women feeling anxious and/or depressed with little control or choice over their future. Women were stressed regarding poor standard of accommodation, low income, dispersal and the uncertainty of their asylum application outcome. Conclusions: A multidisciplinary framework and team support, with effective referral pathways to collaborate with maternal mental health and social services, are necessary as part of routine maternity care to ensure a more comprehensive and holistic approach that addresses the needs of asylum-seeking women.