When I can be my whole authentic self, I feel safe and know that I belong: a photovoice study exploring what culturally safe pregnancy care is to Karen women of refugee background in Victoria, Australia

ABSTRACT

Objectives

Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background.

Design

A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S’gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups.

Results

Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong.

Conclusion

When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.

KEYWORDS:

• Cultural safety
• pregnancy care
• health equity
• refugee health
• photovoice
• reflexive thematic analysis
• Karen women
• community–based participatory research

Sustainable Development Goals:

• SDG 3: Good health and well-being
• SDG 10: Reduced inequalities

Acknowledgements

This study was made possible by the support and strength of the participants, and community advisors Hsar Thaw, Sukanya, and Christina. We would also like to thank the Refugee and Migrant Health Research Program, Intergenerational Health at the Murdoch Children’s Research Institute, the Stronger Futures Centre of Research Excellence, Foundation House, Australian Catholic University, Australian College of Midwives, and photographer Kim Landy for their support of the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors disclose receipt of the following financial support for the research, authorship, and or publication of this article: RC was supported by the Australian Catholic University’s Faculty of Health Sciences Funding Support for Honours by Coursework with Minor Thesis; and the Victoria Branch Australian College of Midwives’ Margaret Mabbitt Scholarship. SB is supported by an Australian National Health and Medical Research Council Leadership Fellow Investigator Grant (#2018144). LB is supported by an Australian National Health and Medical Research Council Centre of Research Excellence Grant (#1198270). Research conducted at MCRI is also supported by the Victorian Government Operational Research Infrastructure Support Scheme.