Swedish Maternal Health Care in a Multiethnic Society - Including the Fathers

Preventive work in maternal and child health care has a long history in Sweden.Today, Sweden has achieved the lowest maternal and child mortality rates globallybased on a maternal health care system regulated by national recommendations;offered to every woman, free of chare, on a continuity basis, by registered midwivesat municipal clinics within the community with the purpose of being assessablefor all women. Despite the availability of antenatal care, immigrant womenliving in Sweden often have a different pattern of utilising care and in some casesimmigrant women have been shown to be at risk for a negative delivery outcome.The overall aim of this thesis was to investigate differences due to country ofbirth and utilisation of antenatal care and the experiences of antenatal care, fromthe perspectives of the both the parents to be. Epidemiological design and explorativequalitative research has been used for the purpose of finding patterns of theutilisation of maternal health care as well as experiences from foreign born menand women concerning maternal health care in general, and maternal health carein the city of Malmö Sweden in particular. Qualitative research has been used toadd depth and thereby attain a greater understanding in a social context.In the study population, according to the definitions set in Studies I, IV, the mainfinding was that 28.3-48.7% of the women had unplanned visits to a midwifeand/or to a physician at the delivery ward. Women born in Sweden and in Easternand Southern Europe had a linear relationship with few planned visits to the midwifeat the municipal clinic and more unplanned visits to a midwife at the deliveryward.The women in Study II were positive to the individualised and professional caregiven at the MHC by empathic and professional midwives. They were positive tothe increased involvement of their partner in the area of reproduction and familylife since migrating to Sweden. According to the women, this may lead to an increasedunderstanding by the fathers of the woman’s situation during pregnancy, birth and caring for the children as well as it could increase the fathers own emotionalas well as practical involvement in their children. The foreign born men, inStudy III, were positive towards antenatal care and to be able to take part as supportto women at MHC, and during the delivery process. They experienced problemswith their situation of being fathers, partners and, as men living in Sweden,due often to their being un-employed and the changed situation that their migrationhad brought about.The health care system manager need to be aware of the fact that there aregroups of women, in a low risk population, who tend to make contact with thematernal care system in a more of less unplanned fashion. By not utilising theplanned care offered these women miss an opportunity to meet a midwife who isspecialised in preventive care during pregnancy with the focus of treating pregnancya normal health life event, while at the same time, ensuring the detection ofeventual risk factors. A conversation with a midwife in a calm environment isbeneficial to the pregnant woman. The immigrant groups need our special attentionaimed at making the maternal health care system easily accessible for them, aswell as making the maternity staff aware of their own attitudes towards preventivework involving pregnancy in a multiethnic setting. The organisation of care mustalso, in itself; offer such possibilities for both the staff and the women