Motherhood in modern society and
the impact on women’s lives
Part E - Multicultural Issues
By Bernadette Gregory
What are the additional multi cultural
issues ?
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Poverty
Geographical location
Housing type
Area of deprivation
People like pets, loud music
Tattoos and ‘hoodies’
Equality issues
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Universal or selective care e.g. screening
Equal access to information and services
Translation and interpreter services
Informed choice and informed consent
Limited resources
Public accountability
Social exclusion
Access to the cultural group
Additional needs of ethnic minority groups
• May be disadvantaged e.g. poverty, geography, area, housing,
educational attainment
• Social isolation
• Unsure how the system works: seek help, referral
• May have complex health needs
• Not an homogenous group- adds to the complexities
• Access to treatment and benefit entitlements
• Different health beliefs and cultural practices
• Different spiritual beliefs and practices
Can you think of examples from clinical practice ?
Examples of additional needs of ethnic
minority groups
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English not their first language
Restricted access to benefits
Cultural needs
Unfamiliarity with maternity services in UK
Female genital mutilation
Arranged marriage
Newly arrived in UK
What are some of the health issues ?
• Psychological – depression, anxiety, panic attacks, fear, PTS
• Mental health issues
• Physical – TB, HIV, parasitic disease, anaemia & other
nutritional deficiencies, genetics
• Hypertension, stroke, type II diabetes
• Incomplete “booking” history or not referred for tests, follow
up appointments so incomplete data eg immunisation follow
up
• Female genital mutilation (FGM)
• Recreational drugs
• Complementary/alternative medicine use
• Multi agency approach to care
Additional needs of asylum seekers and refugees
• Language barriers- translation/interpretation
• Unsure of how the system works – book late or not
at all, miss appointments, miss tests
• May have complex health needs but not an
homogenous group
• Entitled to free medical treatment and benefits
• Additional physical or mental health issues because
of traumatic experiences and/or isolation and
migration
• Different health beliefs and practices
• Different spiritual beliefs and practices
• Racism
(Patel and Kelly, 2006)
Cultural ethnocentrism
Where the indigenous or majority cultural
norms are seen as superior to others
• Can you think of some examples ?
One example could be the prevalence of
Female Genital Mutilation (FGM)
• Actual numbers are unknown
• It is still practised in many countries and within certain
countries it is estimated that between 50 – 98 % of women
may be affected.
• Due to migration, War and famine it is increasingly likely that
UK midwives will care for a woman who has undergone these
procedures
• Over 86 000 first generation immigrant refugees /asylum
seekers and girls who have undergone FGM live in the UK
(Momoh , 2005:73).
• This is likely to be an underestimation
Why is it difficult to estimate numbers?
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Census data unreliable and date easily
Population surveys unreliable
Migration
Asylum seekers/refugee status
Fear of disclosure
Communication barriers
Cultural differences
Different countries/different practices
More common
Less common
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• Uganda
• Nigeria
• Kenya
Egypt
Somalia
Sudan
Ethiopia
Ghana
Mali
Burkina Faso
W.H.O. (2012)
What does the World say about FGM ?
• There are many legislative texts that either directly condemn FGM or are
used as a basis to question or reject the practice
• The Universal Declaration of Human Rights (1948)
• The Convention of the Rights of the Child (1989)
• Resolution by the European Parliament (2001)
• FGM is prohibited in most EU states and in some countries criminal
prosecutions have been sought. Most have a basis in child protection or
protection against personal violence
• Many also have a provision for extra territorial protection
• Many have legislation against individual health professionals
• In UK see FORWARD www.forwarduk.org.uk
Legislation in the UK
The Prohibition of Female Circumcision Act 1985
made it illegal to
“excise, infibulate or otherwise mutilate the whole or any part
of the labia majora or minora or clitoris by another person or
to aid, abet counsel or procure the performance by another
person of any of those acts on that other person’s body”
Fines of £1000 or a term of imprisonment not exceeding 6
months or both
See www.legislation.gov.uk
The Children Act (1989)
• Specifically highlights FGM under section
entitled “Child Protection in Specific
Circumstances”
• Local authorities may exercise their powers if
they believe the child has been/or likely to be
subject to FGM
Female Genital Mutilation Act 2003
• Originated as a Private Members Bill enacted in March 2004
• This legislation was significant in that it introduced the
concept of “extra- territoriality” - girls who are UK nationals
or UK permanent residents cannot be removed from the UK
for purposes of FGM and her parents and others can be
prosecuted for aiding or abetting this procedure
• This protection applies irrespective of the legislation in the
country to which the girl was removed
• This Law strengthens and reinforces the provisions of the
1985 Act
• This Act only applies to England, Wales and Northern Ireland
So a black feminist may think we have a long way to
go yet to achieve equality
Reflective piece:
What would you do to improve NHS and
maternity services to be more inclusive for
Black and Minority ethnic groups (BME)?
References
Momoh, C. (2005) Female genital mutilation
Oxon, Radcliffe
Patel, B. and Kelly, N. (2006) ‘The social care
needs of refuges and asylum seekers’ Social
Care Institute. Bristol, Polity Press.
World Health Organisation (2012)
www.who.int/mediacentre/factsheets/fs241/e
n/