Response strategies in forced migration: Women refugees’ narratives of health, identity and mothering

University of Minnesota Ph.D. dissertation. June 2016. Major: Nursing. Advisor: Cheryl Robertson. 1 computer file (PDF); x, 200 pages.The year this dissertation was submitted there were more individuals forcibly displaced around the world than at any other point in history. Research describing the vulnerabilities, human rights violations, and challenges individuals, families, and communities encounter across the spectrum of migration is readily accessible. Less available are studies that document the strengths-focused response strategies women refugees engage to navigate systems and experiences associated with displacement. This research, developed with the purpose to answer questions residing in this gap, is a series of ethnographic case studies documenting experiences of resilience, identity construction, and mothering among Karen refugee women from Burma. I define a response strategy as a tool engaged by an individual or community to navigate forced migration and promote the resilience of interpersonal connections, and cope individually and collectively with the challenges inherent to cultural transformation. Through this conceptual model I explore the experiences of women refugees from Burma living in refugee camps on the Thai-Burma border and post-resettlement in the United States. Discourse, positional identity and hybridity frame, from a theoretical perspective, the tension inherent to the transformation of systems and structures. In particular, in this research I engage hybridity theory and the space of cultural difference to articulate the intersection of this transformation with the migration narratives of Karen women. The total study period was eleven months and characterized by two distinct phases of data collection. In the first phase I spent three weeks in two refugee camps along the Thai-Burma border conducting participant observation and informal interviews with Karen refugee women. In the refugee camps I partnered with the American Refugee Committee (ARC). The maternal-child health focus of ARC programs in the camps along the Thai-Burma border is highly regarded. In the second phase of data collection and analysis, I recruited and interviewed repeatedly a cohort of twelve Karen women post-resettlement in the United States over a seven-month period. An essential community partner in this phase of research was the Karen Organization of Minnesota (KOM). The KOM was the first Karen run organization in the United States advocating and supporting the experiences of refugees from Burma in resettlement. I formally approached the analysis of each phase of data collection using Spradley’s levels of analysis, a classical method of analysis in ethnographic research. In working through the four levels of Spradley’s analysis I reconstructed, from the narratives of refugee women, processes integral in self-understanding, identity, and the negotiation of factors associated with migration. This method of analysis supported an intricate approach to the data. I was able to establish broader categories of meaning, such as response strategies that support the health of individuals, families, and communities. Spradley’s analysis was also a mechanism through which I captured finer characteristics in the data, such as contrasts and silences. In the analysis I also drew from Critical Discourse Analysis and Grounded Theory to elicit patterns and politics embedded in language that influenced position, as well as to identify spaces between language where participants actively shifted meaning. Findings suggest that the response strategies women engaged as they navigated migration, the unique space of the refugee camp, and mothering post-resettlement facilitated the negotiation of the social, cultural, political, and legal structures they encountered. I assert that within the transformational spaces that refugee women constructed, the processes of coping and becoming reflected the relationship between structure and agency. Within these intersections a woman could express her resistance to a system that in its design represented a majority she was not a part of. As Karen refugee women moved to redesign their position within these systems, a shift in cultural norms resulted, inclusive of those that influence or define the role of women. To filter support through these spaces in ways that preserve them, also preserves the balance that women have constructed through the transitions and unknowns of migration. As public health practitioners, engaging in a caring response to refugee experiences, we need to seek out these spaces and find ways to funnel support through them without taking them over. Understanding ways refugees negotiate transition is not a phenomenon unique to the Karen. This is a facet of migration for all migrant groups, those with legal status such as refugees, and those without