Background
Methods
Results and discussion
Study | Study Design | Setting | Description of Intervention | Reported Outcomes of Interest |
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Bilenko et al., 2007 [14] | Retrospective record review of ANC utilisation by pregnant women in two successive pregnancies, before and after the establishment of a local MCH clinic | ISRAEL, Negev Desert | A new maternal and child health clinic in desert areas for semi-nomadic Bedouin extended families living in tribal units, staffed by an Arabic-speaking Bedouin public health nurse | ANC |
Gabrysch et al., 2009 [5] | Pre and post comparative study | PERU, Ayacucho rural Santillana district | A culturally-appropriate childbirth care model developed with Quechua communities and health professionals. Key features included a rope and bench for vertical delivery position, inclusion of family and TBAs, use of the Quechua language and health professionals that were respectful of culture | Skilled birth attendant, Facility birth |
Jan et al., 2004 [15] | One qualitative component and two quantitative components (one economic and one that appeared similar to a retrospective cohort study) | AUSTRALIA, western Sydney | Daruk Aboriginal Medical Service, a community-controlled health service with a midwifery programme staffed by a team including an Aboriginal health worker. Features included regular ANC, transportation and home visits. Cultural awareness sessions were also provided for hospital staff | ANC |
Jewell et al., 2000 [16] | Retrospective comparison of birth certificate data of infants born to project mothers and those born to non-project mothers | USA, Indiana | Minority health coalitions developed projects to increase access to early ANC for minority women through community outreach and addressing cultural factors that affect use of care. Strategies included use of minority professional and paraprofessional staff, social support, advocacy, and referrals for health education and transportation | ANC |
Julnes, 1994 [17] | Retrospective comparison of women in the programme area in the intervention group with women who attended a clinic-based, multi-disciplinary programme and women who had no ANC, using a database constructed from monthly reports of births in the programme area, based on birth certificate information | USA, Norfolk, Virginia | Norfolk Resource Mothers Program - a community outreach programme using resource mothers or lay people, often sharing cultural background with the adolescents, to assist with non-medical dimensions of pregnancy and childcare, including getting ANC and acting as a liaison between the adolescents and public agencies | ANC |
Kildea et al., 2012 [1] | A triangulation mixed method approach including mother and infant audit data, and routinely collected data from hospital databases | AUSTRALIA | Murri clinic – an antenatal clinic established in a tertiary hospital to provide antenatal services to Aboriginal and Torres Strait Islander women. Services include an Indigenous midwife and Indigenous liaison officers who helped families feel welcome, provided support for women in rural and remote areas and served as cultural brokers | ANC |
Marsiglia et al., 2010 [18] | Randomised controlled trial | USA, Phoenix, Arizona | The Familias Sanas intervention was designed to bridge the cultural gap between Latinas and the health care system, and to reinforce among pregnant Latinas the importance of the postpartum visit. The intervention used bilingual, bicultural Prenatal Partners who served as cultural brokers. They showed participants how to navigate the health system and helped them improve communication with health care providers. | Postpartum care |
Mason, 1990 [19] | Case-control | UK, Leicestershire, England | The Asian Mother and Baby Campaign was directed towards Asian women. Link workers, able to speak fluent English and at least one Asian language, worked alongside health professionals in the hospital and community setting as facilitators and interpreters while fulfilling an educative role. | ANC |
McQuestion and Velazquez, 2006 [20] | An endline survey with mothers in the catchment areas of 29 treatment and 29 matched control facilities providing emergency obstetric care (EmOC). The probability of birth at the nearest public EmOC facility was modelled, conditional on whether the mother’s area participated in the programme, among other factors. | PERU, communities in high-risk distritos in 12 of 25 departmentos
| Proyeto 2000 – a project to make emergency obstetric care services culturally acceptable, woman-friendly, and high-quality. Local birthing practices were incorporated into clinical protocols (specific features were not described). Qualitative data collected on mothers’ perceptions and preferences also informed a multimedia Safe Motherhood campaign; TBAs were trained; and facility staff engaged new community health committees. | Facility birth |
Nel et al., 2003 [21] | Descriptive study (pre-post comparison) | AUSTRALIA, remote northern and western Queensland | Following consultations with health providers and Aboriginal communities, the programme included features such as a separate Indigenous medical centre managed by a community board and staffed by Indigenous people, home visits, provision of transportation and the involvement of family in ongoing care | ANC |
NSW Health, 2005 [22] | Comparative study | AUSTRALIA, New South Wales | The NSW Aboriginal Maternal and Infant Health Strategy established community midwife and Aboriginal health worker teams to provide targeted, community-based, culturally-appropriate services for Aboriginal women in each area. State-wide training was introduced for these staff. Community development programmes were included to varying degrees across areas. | ANC |
Panaretto et al., 2005 [23] | Prospective cohort study with a historical control group and a contemporary control group | AUSTRALIA, Townsville, north Queensland | Collaboration with Indigenous communities produced an integrated model of antenatal shared care, delivered from the community-controlled Townsville Aboriginal and Islander Health Service. Strategies included the use of Aboriginal health workers, continuity of care, and a family-friendly environment | ANC, Facility birth |
Panaretto et al., 2007 [24] | Prospective cohort study of women attending the trial maternal child health programme compared with a historical control group | AUSTRALIA, Townsville, north Queensland | See Panaretto et al., 2005 (above) | ANC |
Parsons et al., 1992 [25] | Retrospective study with control group | UK, Hackney, East London | The Multi-Ethnic Women’s Health Project – a health advocacy programme introduced at a hospital to meet the needs of non-English speaking women. Health advocates interpreted and mediated between service users and professionals to ensure an informed choice of health care | ANC, Care-seeking for complications or illness in women and newborns |
Thompson et al., 1998 [26] | Retrospective study with control group | USA, rural Oregon | The Rural Oregon Minority Prenatal Program blended culturally-appropriate care with outreach by using bilingual and bicultural workers with strong links to their Mexican heritage, nursing case management and home visitation to facilitate access to ANC and community services | ANC, Care-seeking for complications or illness in women and newborns |
Stakeholders’ perspectives and experiences of culturally-appropriate maternity care interventions
What factors affect implementation of culturally-appropriate maternity services?
Accessibility
Community participation
Person-centred, respectful care
Cohesiveness along the continuum of care
Conclusion
Studies from systematic review that report overall improvement in care-seeking outcomes | Findings from synthesis of factors influencing implementation | ||
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Study | Setting | Important stakeholder perspectives critical to success | Implementation factors critical to successful outcomes |
Bilenko et al., 2007 [14] | ISRAEL, Negev Desert | Recognition that women are often dependent on family members for transportation and that geographical barriers may further restrict access to medical services; recognition of female illiteracy | Establishment of maternal and child health clinics in desert areas serving a Bedouin Arab population living within 3 km, employment of an Arabic-speaking Bedouin public health nurse, the addition of a local Bedouin woman liaison worker |
Gabrysch et al., 2009 [5] | PERU, Ayacucho rural Santillana district | Recognition of the importance of respecting traditional practices and including family in the birth process; acknowledgement of factors like low education levels, extreme poverty, previous conflict, and widespread female illiteracy; acknowledgement of limited transport options; recognition of inadequate communication between women and providers, either because the providers speak Spanish which is not understood by many or because provider rotation does not allow time to build trust; recognition that health professionals had treated women in unfriendly, brusque, and sometimes discriminatory ways | Hygiene procedures performed by the woman herself or family after explanations, provision of maternity waiting homes, inclusion of family, use of health providers who speak the Quechua language and are friendly and respectful of local culture, permitting women to wear their own clothes, changes to the delivery room setting (e.g. providing rope and bench to allow vertical crouching position, providing normal beds instead of gynaecological bed), integrating traditional Andean elements into the modern medical model (e.g. offering rollete if desired, placenta handed to family for burial), use of a participatory approach to ensure that services meet the local population’s needs |
Jan et al., 2004 [15] | AUSTRALIA, western Sydney | Recognition that women will not return for services if they feel the male doctor is superior; recognition of inadequate communication between women and providers; recognition of the disempowering nature of hospital care for Aboriginal women and the inaccessibility of hospital clinics; acknowledgement that utilisation of services are influenced by factors like poor education, low income, high unemployment, and racial discrimination | Provision of transport service, short waiting times, provision of informal childcare, non-judgemental approach to providing care, cultural awareness sessions with local hospital staff, female general practitioners, Aboriginal health worker, provision of information in a way that suits women’s individual needs, assistance with infant feeding, flexible and proactive approach to seeing the client |
Jewell et al., 2000 [16] | USA, Indiana | Recognition of factors influencing minority women’s poorer utilisation of early ANC than non-minority women (e.g. cultural insensitivity of providers, lack of encouragement to seek care, and the importance of advice from family and friends) | Staff helping women to work through the decision-making process on how to resolve barriers to their cultural beliefs and practices, staff providing advocacy for women if barriers occurred in navigating the health and social service systems, involvement of grassroots community-driven coalitions in the provision of culturally relevant care, provision of social support, provision of transport service, referrals to community services, health education, use of minority professional and paraprofessional staff, project monitoring by the minority health coalition boards, staff engaging in cultural brokering |
Julnes, 1994 [17] | USA, Norfolk, Virginia | Acknowledgement that teenagers targeted by the intervention have limited social and financial support and may experience psychological barriers to ANC | Use of resource mothers (lay visitors) who often grew up in the same cultural milieu as the teenagers they serve (and were often teenage mothers themselves) and may be in a better position to provide empathy and social support, low cost of the intervention, encouragement of teenagers to seek ANC, provision of practical assistance to the teenagers and their families |
Marsiglia et al., 2010 [18] | USA, Phoenix, Arizona | Acknowledgement of Latino spiritual and cultural beliefs related to health; recognition of the importance and influence of social support from family and friends; acknowledgement of cultural and linguistic influences that can become barriers between women and providers | Bilingual and bicultural Prenatal Partners who served as cultural brokers, active client outreach, improved communication between women and providers, patient-driven communication, encouragement of women to be active in their health decisions, education on prenatal care, development of a plan for ANC and postpartum visits |
McQuestion and Velazquez, 2006 [20] | PERU, communities in high-risk distritos in 12 of 25 departmentos
| Acknowledgement that utilisation of services is influenced by factors like poverty, social exclusion, and residing in a remote area; acknowledgement that facilities lack female caregivers; recognition of inadequate communication between women and providers, partly because the providers speak Spanish which is not understood by many; acknowledgement that reports of discrimination and mistreatment by health workers are commonplace | Extension of the Maternal and Child Health Insurance Program to cover most maternal and child health costs, including institutional delivery; emphasis on making services ‘woman-friendly’ (i.e. incorporation of local cultural beliefs and social norms into services, providing accessible and convenient facilities, offering high-quality services, guaranteeing confidentiality, respecting clients’ choices); use of mass media, health education and social mobilisation efforts promoting delivery in the nearest public emergency obstetric care facility |
Nel et al., 2003 [21] | AUSTRALIA, remote northern and western Queensland | Recognition of the importance of extended family, acknowledgement that notes and test results must be shared between the medical centre and hospital facility, acknowledgement of women’s desire for continuity of care | Provision of transport service, ANC outreach visits, consultations with local Indigenous representatives to identify shortcomings and problems with ANC from an Indigenous perspective, inclusion of family at ANC consultations, use of Indigenous staff, patient tracking, seeing patients in a familiar setting, implementation of a shared care policy for doctors in the region |
NSW Health, 2005 [22] | AUSTRALIA, New South Wales | Recognition that transport services are essential for access to health services and that in some places, access to ANC and midwifery services is non-existent; acknowledgement that some women are unable to afford fees for health care; acknowledgement that women value continuity of care and carer; recognition that some women chose not to utilise services due to the bureaucratic nature of mainstream public services (e.g. inflexible appointments, long wait times) | Statewide Training and Support Program for midwives and Aboriginal health workers, employment of an Aboriginal health worker or Aboriginal Health Education Officer, use of community development programs, taking a primary health care approach as opposed to a welfare model of care, basing services in the community where women could access care close to home in a familiar setting |
Panaretto et al., 2005 [23] | AUSTRALIA, Townsville, north Queensland | Acknowledgement that the Australian Indigenous community had little evidence to guide ANC planning | Provision of transport service, family involvement, health care providers taking an integrated team approach, interventions for risk factors (e.g. smoking cessation, breastfeeding, testing for sexually transmitted infections, nutrition) |
Panaretto et al., 2007 [24] | AUSTRALIA, Townsville, north Queensland | Health service providers and the Indigenous community working closely together to improve ANC | Provision of community-based and community-focused ANC, commitment to quality in service delivery, development of a sustainable health infrastructure, collaboration between health service providers and the Indigenous community to develop an integrated model of shared ANC |