Refugees, asylum-seekers and undocumented migrants and the experience of parenthood: a synthesis of the qualitative literature

In many countries migrant families with children are a rapidly growing population, with migration for some, sparked by threats of war and violence, political and civil instability, and poverty [1‐3]. Parenthood, whether for first or subsequent children, involves emotional, social and physical changes as well as adaptations of functional roles [4], which continue through childhood from infancy to teen years/young adulthood. While all families may face challenges, migrants may experience compounding difficulties due to the loss of social support networks including their extended family, adjustments necessitated by a new cultural context, experiences of discrimination, declines in social economic status, and reduced access to health and social services [5‐8]. Refugees, asylum-seekers and migrants with undocumented status have particularly challenging migration trajectories. They may have suffered abuse and trauma pre- and during-migration and are more likely compared to other migrants, to be exposed to unfavorable and stressful conditions in the receiving-country, which puts these families at risk of marginalization [5, 8‐12].

There is recognition that migrant families with children often face multiple difficulties and need specialized support [13‐16], however less attention has been given to the unique parenthood contexts presented by having a humanitarian or precarious migration status [17, 18]. Greater understanding of the experiences of refugee, asylum-seeking and undocumented migrant families, especially from their perspective, could inform health and social services, practices and policies. Literature reviews are useful in this regard, especially when the literature is voluminous and complex. There is a large amount of primary research, predominantly qualitative studies, on the parenthood experiences of refugees, asylum-seekers and undocumented migrants and parenthood experiences [19‐25], however no reviews of this body of literature were identified. The purpose of this review was therefore to synthesize the recent qualitative literature and to identify integrative themes describing the parenthood experiences of refugees, asylum-seekers and undocumented migrants.

We used an integrative approach to our synthesis, which involved amalgamating and summarizing data from the qualitative literature [26]. Thematic analysis was used to identify integrative themes that reflected and described the parenthood experiences of refugees, asylum-seekers and undocumented migrants across the research [27‐29].

Figure 1 shows results from the database searches. The searches yielded 6338 citations and 4744 titles and abstracts after duplicates were removed. One-hundred and thirty-eight papers met the inclusion criteria for this integrative synthesis.

Table 4 summarizes the characteristics of included studies. Most of the research was published between 2011 and 2017. All papers were in English and the vast majority of studies were conducted from a social-sciences’ perspective. Almost all studies had been conducted in high-income countries, predominantly the United States (54%; n = 75), followed by European countries (15%; n = 20), Australia (14%; n = 19) and then Canada (12%; n = 17). Only three studies (2%) had been conducted in LMICs (Morocco [34], South Africa [35] and the Dominican Republic [36]).

Migrant groups studied were mostly from Latin America, Sub Saharan Africa and South East Asia. Latin American migrants were primarily undocumented migrants living in the US (37% of studies, n = 51), while Sub-Saharan African and South East Asian (Vietnamese and/or Cambodian) migrants were mainly refugees (35% of studies, n = 48; 10% of studies, n = 14 respectively) living in a range of countries including Australia, the US, European countries and Canada. Only 7% (n = 10) of studies included asylum-seekers. One study focused on undocumented migrants who were sex-trafficked women who migrated to Israel from the former Soviet-Union [37]. The majority of studies (93%; n = 129) included mothers; in 54% (n = 70) of these participants were exclusively mothers. Approximately half of the studies included fathers (47%; n = 65); a small portion of these, 14% (n = 9), focused specifically on fathers. Only 5% (n = 7) of all studies included extended family members. Study populations were most often parents of school-aged children (29%; n = 40) and teenagers/youth (30%; n = 42).

Additional file 1 provides more detailed information about each individual study. Populations were mostly described only by country or region of origin. Just over one-fifth of studies (22%; n = 31) also described their population by ethnicity/religious identity (e.g., Latino, Hmong, Muslim); and fewer, 2% (n = 3) also used race (i.e., Black). The majority of studies (67%; n = 92) included other migrant groups (e.g., economic and family sponsored immigrants) in addition to refugee, asylum-seeking and undocumented migrants. Participants were ‘recent arrivals’ in 28% (n = 38) of studies, usually defined as less than five or 10 years; four studies (3%) purposely focused on more established migrants. Twenty-two percent (n = 30) did not provide any information about length of time since migration. In most studies with both mother and father participants (59%; n = 33 of 56 studies), the number of males was much smaller than the number of females.

A range of qualitative research designs were used including ethnography (27%; n = 37, 2 of these were focused ethnographies), qualitative descriptive (31%; n = 43, 2 of these used interpretive description), grounded theory (18%; n = 25), case study (10%; n = 14), narrative inquiry (7%; n = 10) and phenomenology (7%; n = 10). Five percent of studies (n = 7) were mixed methods research designs. Data were mostly gathered via interviews (86%; n = 119), observation (26%; n = 36) and/or focus groups (25%; n = 34). A handful of studies used other data collection methods such as photovoice, self-filming and journal diaries (11%; n = 15). Language of migrants was an exclusion criterion in 10% (n = 14) of studies. Thirteen papers (9%) overlapped in their data sources and reported duplicate findings [38‐50].

The research primarily focused on migrants’ experiences since arrival in the receiving-country, reflecting on how their migration trajectory had had an impact on their experiences. There were a few exceptions. One study, although conducted in the US, focused on migrants’ experiences raising children in refugee camps in Africa [51]. Another study described the experience of mothers while living in a ‘transit-country’ [34]. A number of studies examined the parenthood experience broadly [20, 24, 25, 34, 36, 37, 41, 47, 48, 50‐64], some were specific to the time around birth [65‐70], and some discussed aspects related to identity and meanings of parenthood in the context of migration [22, 34, 36, 37, 47, 48, 61, 64, 67, 71‐79]. Some studies focused on parenthood experiences under more challenging circumstances including single parenthood [23, 40‐42, 58], teenage pregnancy [69, 80‐83], having an undocumented or mixed status family [21, 84‐96], reunification with children who migrated at a later time [97], and mothering in the context of conjugal violence [98‐100].

Several studies examined specific parenting topics including: navigating the healthcare system [101‐105] or other services [19, 23, 88, 92, 95]; decision-making associated with vaccinations [106], breastfeeding [107‐109], nutrition [110‐113] and oral health [114, 115]; interacting with schools and expectations regarding education [49, 89, 96, 104, 116‐137]; maintaining traditions, beliefs, and languages [45, 74, 78, 84, 138‐145]; raising teenagers [43, 44, 122, 124, 146‐148]; and socializing and disciplining children, including involvement with child protection services [149‐156]. Other studies had broader foci including: acculturation/bi-cultural development and parenting [20, 38, 44, 57, 58, 143, 144, 148, 157, 158]; the effect of migration on relationships between parents and children [19, 20, 38, 39, 60, 62, 147, 148, 159, 160], the extended family [44] and community [41]; strengths and coping to overcome parenting stressors [19, 42, 43, 52, 53, 70, 161, 162]; the effects of trauma on parenthood [22, 40, 51, 106, 159, 160, 163]; the negative impact of immigration and related policies on family life [25, 54, 87, 88, 90, 92, 93, 105, 164]; and dealing with discrimination as a parent [35, 46, 91, 164].

There is an extensive amount of qualitative research on the parenthood experiences of refugees, asylum-seekers and undocumented migrants; this is the first review, however, to synthesize and identify integrative themes from this body of literature. The themes regarding hardship and loss, and building resilience and strength, are consistent with observations made by others regarding the migration experiences of refugees, asylum-seekers and undocumented migrants generally [11, 166, 167], while the third theme on transnationalism highlights additional obligations, challenges and resources that need to be better understood and considered by care and service-providers working with these families. This theme also suggests a lens through which policies and research may be approached.

In the context of parenthood, our review shows that migration and resettlement stresses compound the responsibilities and concerns related to raising and caring for children in a new country and may have deleterious effects on the family [17, 54, 73, 98, 168]. Many experiences identified are common across all types of migrants [15], however results highlighted distinctive challenges related to having a precarious and/or humanitarian status. Furthermore refugees, asylum-seekers and undocumented migrants mostly migrate from LMICs and the cultural, social and religious differences between these countries and high-income countries are great and exacerbate resettlement difficulties, further adding to families’ stress. Despite these additional hardships and losses, the literature also showed that these sub-groups are resilient. Similar to other research on migrants and resilience, family and community support, maintenance of language, religion and culture as well learning new languages and ways of doing, fueled resilience [169]. For refugee, asylum-seeker and undocumented migrant parents, children were also an important source of strength and motivated parents to overcome their difficult circumstances. Together these results reinforce that greater attention is needed to address the unique challenges that refugee, asylum-seeking and undocumented families encounter and that efforts towards supporting families should concentrate on approaches that enhance resilience and strength, especially by bridging language, norms and expectations.

Transnationalism as it relates to migration and families has been a long time focus in the fields of sociology and anthropology [170, 171] while in the health disciplines it has largely been absent. A “transnational perspective” acknowledges that migrants’ experiences extend across countries and that families are affected by their relationships that they maintain with family and friends, their continued economic and political involvement, and their ethnic and cultural attachment to the home country [172]. Work in this area has mainly focused on transnational mothering (parenting children who remain in the home country from a distance) [173, 174], impacts of migration on children and elderly who remain in the home country [175, 176] and economic effects for families and societies via remittances [177]. Little to no research however has directly considered how transnational ties impact parenthood with children in the new country. Our findings build on the research on parenthood and transnationalism [178] and suggest a transnationalism lens is relevant in the healthcare field. Similar to studies on transnational parenting, our results highlight the strong sense of obligation, stress and distress parents experience in parenting from a distance their children who remain in the home country [178]. In addition, our results show how transnational obligations, as well as stresses associated with serial migration and deportation of family members, affect family dynamics and relationships and how parents experience parenthood in the new country. Findings also show how transnational ties may be positive and provide resources and support for migrant families with children. Parents’ health and well-being are therefore inextricably linked to their transnational realities and a receiving-country-centric approach is limited and inadequate for understanding their experiences and addressing their needs. In order to develop more relevant policies and practices, including in healthcare, a transnational lens is needed [171, 179, 180].

Traditional parenting and family support programs tend to emphasize integration and center on resettlement concerns [181, 182]. Using a transnational lens in program and policy development and design would include fostering a transnational identity and sense of belonging. This may be achieved by supporting families to practice their traditions and faiths, and speak and learn (for children) their languages. It would also include encouraging families to maintain their networks and ties to their home country [116, 133]. This would include acknowledging and addressing transnational parenting concerns (supporting family members back home, parenting from a distance, family reunification, deportation of family members) [183], and also recognizing and valuing transnational ties as a resource for families that can be used to foster resilience by building cultural, social and economic capital for parents and children. A transnational approach also involves building trust and resolving cultural frictions by “bridging languages, cultures and norms” between migrant and non-migrant communities. This would consist of creating opportunities for migrants to share their culture and traditions with the receiving-country population [73, 133, 142] as well as ongoing efforts to allow migrants to learn new languages and become more familiar with the way of life in the new country [132]. For the receiving-community it would involve raising their awareness of migrant issues, enhancing their empathy and sense of responsibility for migrants and their families living abroad, and addressing negative discourses [184].

We synthesized a large body of literature and our integrative analysis highlighted differences in parenthood experiences by migration status (refugee vs. undocumented) and also by parent group (mothers vs. fathers). Results from the review suggest that to further understand the experiences of refugee, asylum-seeker and undocumented migrant families, and to better address their needs and enhance resiliency, a transnational lens is needed.