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Cited by 61Migration, Health and TraumaGlobal Maternal and Child HealthMigration, Identity, and Health

Conceptualising the prevention of adverse obstetric outcomes among immigrants using the ‘three delays’ framework in a high-income context

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Binder, Pauline, Johnsdotter, Sara, Essén, Birgitta·2012·Social Science & Medicine
DOI 10.1016/j.socscimed.2012.08.010
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Abstract

Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3.

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  • Broken trust between women and providers has contributed to the first delay in sub-Saharan Africa.

    “Similarly, broken trust between women and providers has contributed to the first delay in sub-Saharan Africa, and subsequently, women’s rationalizations during non-emergency settings to avoid care in the future (Binder et al., Citation2012).”

    From Recommendations to improve maternal mortality among Rohingya women in Bangladeshi refugee camps (2025) · cites this paper as Binder et al., 2012

    The Findings and ‘Governance of care quality: optimal reciprocity’ sections (page numbers not supplied) link broken trust to Phase 1 care-seeking and describe how non-emergency encounters can shape later care decisions. But these findings concern African immigrant women receiving care in the UK; the paper does not establish that broken trust contributed to the first delay in sub-Saharan Africa. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Language barriers are commonly cited as a third delay among populations that have moved to a new setting.

    “Similarly, language barriers are commonly cited as a third delay among populations that have moved to a new setting (Binder et al., Citation2012).”

    From Recommendations to improve maternal mortality among Rohingya women in Bangladeshi refugee camps (2025) · cites this paper as Binder et al., 2012

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Authors
Binder, P., Johnsdotter, S., & Essén, B.
Affiliations
Uppsala University Hospital (SE)
Corresponding author
Binder, Pauline
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2012-12
Volume
75
Issue
11
Pages
2028-2036
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2012.08.010
OpenAlex
W2060211676
Cited by
61
References
52
Citations by year
2026: 2 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 9 · 2019: 7 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 7 · 2014: 6 · 2013: 2
FWCI
5.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Social Science & Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Malmö University Publications (Malmö University) (submittedVersion)
Funders
  • The Swedish Council for Working Life and Social Research
  • Faculty of Medicine at Uppsala University, Sweden
Topics
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Sociology and Political Science › Migration, Identity, and Health
Keywords
maternal migration, immigrant women, adverse obstetric outcomes, care-seeking behavior, facility accessibility, trust in healthcare providers, language barriers, interpreters, treatment refusal, high-income settings, London
MeSH terms
Adolescent, Adult, Africa, Cultural Characteristics, Female, Health Services Accessibility, Humans, London, Maternal Health Services, Middle Aged, Patient Acceptance of Health Care, Pregnancy, Pregnancy Complications, Risk Factors, Socioeconomic Factors, Practice Guidelines as Topic, Qualitative Research, Emigrants and Immigrants, Young Adult, Time-to-Treatment

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