Background
Methods
Search methods for identification of studies and screening for inclusion
Population | Population | Population | Exposure | Outcomes / Study Design |
---|---|---|---|---|
Muslim Islam* | Wom?n* Pregnan* Patient* Mother* Childbearing | UK United Kingdom England Scotland Wales Ireland | Maternity adj2 service* Maternity care NHS Perinatal Antenatal Postnatal *birth | Experience* Attitude* Perception* Perspective* View* Opinion* Qualitative Focus group* Interview* |
Inclusion | Exclusion | |
---|---|---|
Participants | Muslim women, regardless of ethnicity, migration status, or country of birth – provided that Muslim is indicated somewhere in the text (e.g. relevant words such as Islam, Muslim, Mosque). | Non-Muslim women or mixed sample where it is not possible to disaggregate the findings according to Muslim/non-Muslim |
Exposure | Maternity services in the UK | |
Outcomes | Women’s experiences, views or accounts of contact with maternity services and healthcare professionals within these services, or of pregnancy / childbearing / motherhood and containing a focus on maternity services | |
Study design | Qualitative research regardless of type (e.g. interpretive descriptive, phenomenology, grounded theory) or mixed-methods research containing qualitative component | Quantitative research or quantitative components of mixed-methods research; surveys that do not provide analysis of open-ended text comments |
Language | Written in English language | |
Publication | Any; including primary studies presented in peer-reviewed journal publications, research reports, doctoral theses | |
Time period | 2001–2019 |
Quality appraisal
Data extraction and thematic synthesis
Results
Results of the search
Characteristics of included studies
Study ID; Aim; Design/ Theoretical perspective | Eligibility criteria | Recruitment | Sample characteristics | Data collection and Data analysis |
---|---|---|---|---|
Study 1: Ali & Burchett, 2004 [25] To raise awareness amongst HCPs and to challenge the racial and religious stereotypes that affect Muslim women’s birth experiences. Interpretive descriptive – theoretical approach unclear | Inclusion: -Given birth within 3 years -Born and raised in UK and those born/raised overseas -Born Muslim or converted to Islam -Regardless of the women wearing the hijab (head scarf) -Regardless of income and ability to speak English | Sampling via the project’s advisory group Recruited across regions in Central and Northern England | n = 43 women from variety of backgrounds including Iraqi, Pakistani, Bangladeshi, European, Indian, Somali and African n = 22 men (partners) n = 8 HCPs | 5 focus groups with Muslim women; Questionnaires with Muslim men; Telephone interviews with HCPs Focus group – framework analysis Open-ended question in questionnaire – content analysis HCPs telephone interviews - both framework and content analysis |
To investigate Muslim women’s motherhood journey and explore the factors that influenced their health needs and decision making when engaging with services. Interpretive descriptive | Inclusion: Phase 1 and 2: First time Muslim pregnant women aged≥18 engaging with maternity services and Muslim mothers who had experienced childbirth in past 3 years. All living and received maternity care in Merseyside, England All English speaking Phase 3: HCPs from a large maternity service in Merseyside | Phase 1 and 2: Purposive sampling from the Muslim community and mailing group (used and created by a number of local Muslim women). Phase 3: Snowball sampling | Phase 1: n = 8 pregnant women Phase 2: n = 24 mothers (Varying in ethnicity, education, occupation, marital status etc.). Phase 3: n = 12 HCPs | Phase 1: 24 one-to-one longitudinal semi-structured interviews Phase 2: 5 focus groups Phase 3: 12 one-to-one interviews Thematic analysis |
Study 3: Alshawish et al., 2013 [28] To investigate the access and use of maternity health services, as well as the barriers and facilitators for Palestinian women. Pragmatic approach, as reported by authors | Inclusion: -Aged ≥18 -Palestinian Muslim -Living in the UK -Had children in one of the Arabic schools in Manchester, England | Purposive sampling is implied and snowball technique; invited through the Arabic school and local mosque | n = 22 Palestinian women living in different areas of Manchester | Face-to-face, semi-structured interviews. Framework analysis |
Study 4: Ellis, 2000 [29] To explore the experience of second generation South Asian Muslim women and to highlight the issues of midwifery practice for this group. Ethnography | Inclusion: -Primiparous -Aged 18–35 -Low risk pregnancy -Second generation and educated in the UK -South Asian Muslim | Purposive sampling is implied | n = 10; no information on ethnic background or other demographics | Semi-structured interviews 1 week after birth. Non-participant observation during labour. Review of birth-plan. Thematic analysis is implied |
Study 5: Bawadi, 2009 [30] To gain insight into the lived experiences of migrant Arab Muslim women during their experiences of childbirth in the UK. Phenomenology - Heideggerian hermeneutic phenomenology | Inclusion: -Pregnant women living in and receiving maternity care in the UK -Aged ≥18 -Migrants in the UK in the past 10 years from Arab countries | Purposive sampling and snowball sampling from Islamic centre, Arabic schools and Muslim women’s societies. | n = 8; varying ages, parity and reason for migration | 22 longitudinal semi-structured interviews carried out in the antenatal, perinatal and postnatal period. Thematic analysis and reports using an adapted version of Interpretive Phenomenological Analysis (IPA) together with hermeneutic principles. |
Study 6: Bharj, 2007 [31] To explore Pakistani Muslim women’s experiences of labour and maternity services to enable the development of responsive and sensitive midwifery care and knowledge. Interpretive ethnographic | Inclusion: -Pakistani Muslim women with no history of either medical or obstetric complexities -Women identified as having healthy babies - Women were excluded if they had experienced previous obstetric care or were multigravida | Recruited from 3 cities in Northern England using the snowballing approach. Purposive sampling and convenience sampling from 9 antenatal classes | n = 27, including 13 primigravidae Pakistani Muslim women, 5 midwives and 9 interpreters | Semi-structured interviews and 3 participant observations during labour. Content analysis (thematic framework approach) |
Quality appraisal
Study ID | 1 | 2 | 3 | 4 | 5 | 6 |
---|---|---|---|---|---|---|
1) Was there a clear statement of the aims of the research? | Yes | Yes | Yes | Yes | Yes | Yes |
2) Is a qualitative methodology appropriate? | Yes | Yes | Yes | Yes | Yes | Yes |
3) Was the research design appropriate to address the aim of the research? | Unclear | Yes | Unclear | Unclear | Yes | Yes |
4) Was the recruitment strategy appropriate to the aims of the research? | Unclear | Yes | Unclear | Unclear | Yes | Yes |
5) Was the data collected in a way that it addressed the research issue? | Unclear | Yes | Yes | Unclear | Yes | Yes |
6) Has the relationship between the researcher and participants been adequately considered? | No | Yes | Yes | Yes | Yes | Yes |
7) Have ethical issues been taken into consideration? | Yes | Yes | Yes | Yes | Yes | Yes |
8) Was the data analysis sufficiently rigorous? | No | Yes | Yes | Yes | Yes | Yes |
9) Is there a clear statement of findings? | Unclear | Yes | Yes | Yes | Yes | Yes |
10) Is the research valuable? | Yes | Yes | Yes | Yes | Yes | Yes |
Thematic synthesis
Theme 1: Islamic practices and individualised care
“ … I don’t like to attend these classes, because it is uncomfortable … as it is women mixed with men. Where is my privacy with these men … ” Zahra [pseudonym] (participant quotation, Study 5, pg.223).
“I forgot to mention some Islamic practices … when I came to tell her that I wanted to add points to my birth plan she looked annoyed and said “we have done this last week … ” Sahar [pseudonym] (participant quotation, Study 2, pg.131).
“ … I was 25 weeks pregnant and I decided not to have an abortion because of religious issues, we believe in destiny and fate” Participant number 5 (participant quotation, Study 3, pg.573)
“ … will they cover me as they do in Jordan? This is an important issue for me...” Rahma [pseudonym] (participant quotation, Study 5, pg.131)
“I think with a Muslim midwife you would feel more comfortable telling her things … you can easily tell a Muslim midwife that you want your child to hear Allah (God) and she would completely understand.” Noor [pseudonym] (participant quotation, Study 2, pg.136)
Theme 2: talk, teach and translate
“I bought magazines and read about birth of baby … When I used to ask my midwife for information, she just didn’t have time to discuss other things” Maheera [pseudonym] (participant quotation, Study 6, pg. 132)
“During my first pregnancy they gave me information. I went every Thursday with my husband. It was useful.” Amina [pseudonym] (participant quotation, Study 5, pg.224)
“ … I could not understand everything they said. I told my husband to translate everything for me but he did not. He was hiding the truth and trying to comfort me” Fatima [pseudonym] (participant quotation, Study 5, pg.193)
“ … women who do not speak English that is an issue in our Asian culture you know interpreting is an issue” Khatiza [pseudonym] (participant quotation, Study 6, pg. 127)
“She prepared me beforehand [for the fact that a] male doctor might examine me, and if this happened, I should not be angry because she gave me the background about the conditions”. Kawther [pseudonym] (participant quotation, Study 5, pg.137)
Theme 3: injustice, inequity and intolerance
“The manner in which she talked to me was very bad … It was clearly because I am a Muslim and wear a veil … ” Rahma [pseudonym] (participant quotation, Study 5, pg.197)
Theme 4: if Allah wills
“It is such a spiritual journey … motherhood journey would make you gain some Iman (faith)” Gp4; P1 (participant quotation, Study 2, pg.109)
“I was reading “Quran [An Islamic sacred book of god, revealed to the prophet] Shareef’ and I got the internal peace and internal strength to cope with the pain.” Lateefa [pseudonym] (participant quotation, Study 6, pg.169)
“Without my faith … I would probably go through depression” Hanan [pseudonym] (participant quotation, Study 2, pg.96)
Theme 5: It’s not all that bad’
“I never felt discriminated against on the grounds of my race. On the contrary, I felt that they respected our religion. In the midwife’s first home visit she said “Al-salaam alykom” in Arabic instead of “hello”.” Amal [pseudonym] (participant quotation, Study 5, pg.197)
“Midwives respected not only women’s faith and culture but their privacy, and as a result woman stated that they had a sense of control over their body and their care.” (Author quotation, Study 6 pg. 165).