Introduction

In the last decade, there has been a significant increase in births to Asian women in New Zealand. Currently, in the Auckland District Health Board region, 29% of births are to Asian women, 25% in Waitemata and 19% in Counties Manukau (Auckland DHB and Waitemata DHB Womens Health Collaboration, 2015). Nationally, 11% of births are to Asian women. As a proportion, Asian births in Auckland are expected to rise to 32% by 2025 in Waitemata and Auckland DHBs and to 22% in Counties Manukau. Language and unfamiliarity with the New Zealand health system mean that Asian migrant women and babies are likely to experience inequalities in health outcomes. The most recent Perinatal and Maternal Mortality Review Committee Report shows that Indian women, along with Maori and Pacific women, experience a higher rate of perinatal death than New Zealand European women. Indian women have a disproportionately high rate of stillbirth and neonatal deaths in the Auckland region (Auckland DHB and Waitemata DHB Womens Health Collaboration, 2015).

Women from culturally and linguistically diverse (CALD) backgrounds prefer to receive maternity care from health professionals from their own ethnic background or, if that is not available , from health professionals who understand their culture and are able to provide culturally (and religiously) sensitive care.. It is important that maternity services are responsive to women from a range of cultural backgrounds and understand CALD women’s pregnancy, birth and postnatal cultural practices so that appropriate assessment, interventions and support are provided for women and their families.

CALD women from refugee backgrounds, arriving in the last three decades, come mainly from the countries of East Africa , Somalia, Eritrea, Ethiopia, South Sudan, Rwanda and Burundi; the Middle East and West Asia, Afghanistan, Iraq, Syria and Iran; as well as Myanmar , Sri Lanka, Bhutan and Colombia (Ministry of Health, 2012). Refugee women have complex health and social needs specifically related to their gender, ethnic, cultural and religious backgrounds and refugee experiences (Ministry of Health, 2012). Seventy-eight percent of refugee women of reproductive age screened by the Refugee Health Screening Service at the Mangere Refugee Reception Centre (MRRC) had vitamin D deficiency or insufficiency (Wishart, Reeve & Grant, 2007). Some communities of origin have a very high prevalence of harmful traditional practices such as FGM (Denholm, 1998). On arrival, the prevalence of HIV in refugee women reflects rates in sub-Saharan African and some areas of South East Asia (AIDS Epidemiology Group, 2011). Post arrival, women have higher rates of pregnancies complicated by diabetes, and lower rates of breastfeeding compared to other New Zealand groups (Perumal, 2011).

Culture plays a major role in the way a woman perceives and prepares for her birthing experience. Each culture has its own values, beliefs and practices related to pregnancy and birth. Some women who come to New Zealand have a pragmatic attitude to traditional practices, and may not be interested in following them here. However, other women may consider it important to adhere to traditional pregnancy and birth practices or to combine traditional and western practices. If health care providers are familiar with different ideas, rituals and behavioural restrictions, and communicate about these with the women they care for, it will be possible for women to have a choice. While health practitioners are not expected to know about the cultural practices relating to pregnancy and birth for all cultural groups, being interested in women’s cultural practices and using an open communication style will be of benefit in cross-cultural interactions with women and their families.

The process of becoming a mother in an adopted land presents specific challenges for migrant mothers in first and second generation women. For migrant women, cultural displacement has an impact on the dilemmas of motherhood (Tummala-Narra, 2004). Additionally, migrant and refugee women face a number of challenging life circumstances which may compromise their mental health, especially during the vulnerable postnatal period. For refugee women, the struggle to “forget” traumatizing experiences and to “make a fresh start” in a new place may lead to higher levels of depression and anxiety than in the general population (Gonidakis, 2012). Difficulties comprehending and adapting to everyday life in New Zealand, a wish to gain acceptance in the host society, the lack of traditional support and conflicting conceptions of motherhood, place women at risk of perinatal depression. LMC and other health practitioner’s awareness of the relationship between migration, the refugee experience and mood disorders and; their efforts to facilitate women's adaptation to the new situation can have a positive impact on the new mother's mental health.

It is highly recommended that maternal health providers working with CALD women consider the following:

• Becoming familiar with the cultural values, beliefs and practices, as well as understanding of the impact of migration and the ‘refugee’ experience, for women during pregnancy, birth and the postnatal period.
• Acknowledging and showing respect for women’s health beliefs, even though they may disagree with traditional practices. It is best to work alongside women to discourage the use of potentially harmful traditional practices while endorsing those which may be of physical or psychological benefit (Toubia, 1999). This approach is most likely to build trust between the LMC and the woman.
• Avoiding assumptions that CALD women have extended family and community support networks. If women do have extended family in New Zealand, be aware that not all families will offer the support that is needed.
• Supporting women unfamiliar with the New Zealand maternity system to network with other migrant women. This is particularly helpful when women have limited English language skills.
• Being mindful of the potential intergenerational issues that can occur between pregnant women and their older family members, and also in the context of interethnic marriages.
• Understanding the influence and role of family members (including grandparents, mothers, and mother-in-laws) during pregnancy, birth, neonatal care, infant feeding, breastfeeding, and postnatal care.
• Developing culturally appropriate approaches when responding to the needs of women from CALD backgrounds