Maternal multimorbidity - experiences of women seeking asylum during pregnancy and after childbirth: a qualitative study

Abstract Background: Many women seeking asylum during pregnancy and after childbirth have ill-health but detection and assessment of all physical, psychological, and social health needs (maternal multimorbidity) are often difficult as part of routine maternity care. Healthcare providers are key for the early identification and management of vulner- able pregnant women who have additional physical, psychological, and social health needs. We sought to explore the impact of the asylum-seeking process, understanding of wellbeing, expressed health needs (in terms of maternal multimorbidity), and the experiences of maternity care of women seeking asylum during pregnancy and after child- birth in Liverpool, United Kingdom. Enabling factors and barriers to access woman-centred care were also explored. Methods Key informant interviews (n = 10) and one focus group discussion (n = 4) were conducted with women attending a non-profit charitable pregnancy support group. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes. Results The asylum-seeking process negatively impacted women making them feel anxious and depressed with lit- tle control or choice over their future. Women reported feeling stressed regarding poor standard of accommoda- tion, low income, dispersal and the uncertainty of their asylum application outcome. Wellbeing during pregnancy and after childbirth was understood to be multifactorial and women understood that their physical health needs were interlinked and negatively impacted by complex psychological and social factors. Women reported that their expectations of maternity services were often exceeded, but information giving, and the use of language interpreters needed to be improved. Women expressed the need for more psychological and social support throughout preg- nancy and after childbirth. Conclusions A multidisciplinary team, with links and effective referral pathways to maternal mental health and social services, are necessary for women seeking asylum, to ensure a more integrated, comprehensive assessment of mater- nal multimorbidity and to provide maternity care in a way that meets all health needs. Keywords Maternal multimorbidity, Asylum seeker, Pregnancy, Antenatal care, Maternal mental health, Social wellbein