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Klingberg-Allvin, M., Hatakka, M., Erlandsson, K., Osman, F., Byrskog, U. & Egal, J. (2019). "Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region. Midwifery, 69, 135-142
Open this publication in new window or tab >>"Change-makers in midwifery care": Exploring the differences between expectations and outcomes - a qualitative study of a midwifery net-based education programme in the Somali region
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2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 135-142Article in journal (Refereed) Published
Abstract [en]

The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

Design

In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

Setting and participants

Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

Findings

Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

Conclusion

The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

Keywords
Net-based education, Quality midwifery education, Midwifery care, Somaliland, Capability approach, Choice framework
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29004 (URN)10.1016/j.midw.2018.11.007 (DOI)000454129800018 ()30503998 (PubMedID)2-s2.0-85057779256 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-01-10Bibliographically approved
Byrskog, U., Hussein, I. H., Yusuf, F. M., Egal, J. A. & Erlandsson, K. (2018). The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women's views, knowledge and opinions. Sexual & Reproductive HealthCare, 16, 39-44
Open this publication in new window or tab >>The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women's views, knowledge and opinions
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 39-44Article in journal (Refereed) Published
Abstract [en]

Objective

The aim of the study is to elucidate young women’s perceptions of the situation for female survivors of non-partner sexual violence in Somaliland.

Methods

Young Somali women with diverse backgrounds (n = 25) shared views, knowledge and opinions about non partner sexual violence in focus group discussions held in urban settings. Data was analysed using content analysis.

Results

A main category “Bound by culture and community perceptions” with four subcategories comprises the informants’ perceptions of non-partner sexual violence among young women in Somaliland. Illuminated is the importance of protecting oneself and the family dignity, a fear of being rejected and mistrusted, how the juridical system exists in the shadow of tradition and potential keys to healthcare support.

Conclusion

The study raises awareness of the dilemmas which may be faced by young women subjected to non-partner sexual violence and healthcare providers in the intersection between state and traditional norms. Education is a key when it comes to a young woman considering the use of the services available in a society where traditional problem-solving is relied on parallel to state-based support. State-based functions, communities and families need to work together to provide comprehensive support to young female survivors of non-partner sexual violence in Somaliland.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Content analysis; Healthcare; Non-partner sexual violence; Perceptions; Somalia; Somaliland; Young women
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27313 (URN)10.1016/j.srhc.2018.01.006 (DOI)000440877700007 ()2-s2.0-85041821320 (Scopus ID)
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-08-23Bibliographically approved
Bogren, M., Erlandsson, K. & Byrskog, U. (2018). What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students. BMC Health Services Research, 18(1), Article ID 639.
Open this publication in new window or tab >>What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students
2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 639Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With professional midwives being introduced in Bangladesh in 2013, the aim of this study was to describe midwifery students perceptions on midwives' realities in Bangladesh, based on their own experiences.

METHOD: Data were collected through 14 focus group discussions that included a total of 67 third-year diploma midwifery students at public nursing institutes/colleges in different parts of Bangladesh. Data were analyzed deductively using an analytical framework identifying social, professional and economical barriers to the provision of quality care by midwifery personnel.

RESULTS: The social barriers preventing midwifery quality care falls outside the parameters of Bangladeshi cultural norms that have been shaped by beliefs associated with religion, society, and gender norms. This puts midwives in a vulnerable position due to cultural prejudice. Professional barriers include heavy workloads with a shortage of staff who were not utilized to their full capacity within the health system. The reason for this was a lack of recognition in the medical hierarchy, leaving midwives with low levels of autonomy. Economical barriers were reflected by lack of supplies and hospital beds, midwives earning only low and/or irregular salaries, a lack of opportunities for recreation, and personal insecurity related to lack of housing and transportation.

CONCLUSION: Without adequate support for midwives, to strengthen their self-confidence through education and through continuous professional and economic development, little can be achieved in terms of improving quality care of women during the period around early and late pregnancy including childbirth.The findings can be used for discussions aimed to mobilize a midwifery workforce across the continuum of care to deliver quality reproductive health care services. No matter how much adequate support is provided to midwives, to strengthen their self-confidence through education, continuous professional and economic development, addressing the social barriers is a prerequisite for provision of quality care.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28364 (URN)10.1186/s12913-018-3447-5 (DOI)000441829700002 ()30111324 (PubMedID)2-s2.0-85051661540 (Scopus ID)
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2018-09-03Bibliographically approved
Faysal Badal, N., Alo Yusuf, U., Egal, J., Pedersen, C., Erlandsson, K., Osman, F. & Byrskog, U. (2018). With knowledge and support women can attend antenatal care: the views of women in IDP camps in Somaliland. African Journal of Midwifery and Womens' Health, 12(3)
Open this publication in new window or tab >>With knowledge and support women can attend antenatal care: the views of women in IDP camps in Somaliland
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2018 (English)In: African Journal of Midwifery and Womens' Health, ISSN 1759-7374, Vol. 12, no 3Article in journal (Refereed) Published
Abstract [en]

In Somaliland, women’s perceptions of barriers to accessing antenatal care is sparsely described, particularly with regard to marginalized women. The aim was to investigate perceptions of barriers to accessing antenatal care from the perspective of pregnant women living in Internal Displaced Persons camps. Individual semi-structured interviews with fifteen women were conducted and analysed using content analysis. The overriding theme was “With knowledge and support, women can attend antenatal care”.  The findings highlighted that to obtain antenatal care, it is crucial for women to have knowledge and trust regarding antenatal services, a supporting environment, and ways to overcome practical barriers, such as patient fees and long waiting hours. If women and families received relevant information about the structure and benefits of ANC, they would probably prioritize ANC, given that the care is tailored to each woman’s needs. For this, community awareness and trust between women, families and ANC providers are central.

Keywords
Antenatal care, Content analysis, Somaliland
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26593 (URN)10.12968/ajmw.2018.12.3.138 (DOI)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-11-13Bibliographically approved
Erlandsson, K., Osman, F., Hatakka, M., Egal, J. A., Byrskog, U., Pedersen, C. & Klingberg-Allvin, M. (2017). Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty. Nurse Education in Practice, 25, 96-103
Open this publication in new window or tab >>Evaluation of an online master’s programme in Somaliland. A phenomenographic study on the experience of professional and personal development among midwifery faculty
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2017 (English)In: Nurse Education in Practice, ISSN 1471-5953, E-ISSN 1873-5223, Vol. 25, p. 96-103Article in journal (Refereed) Published
Abstract [en]

To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Online education, Net-based education, Midwifery education, Human rights
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25050 (URN)10.1016/j.nepr.2017.05.007 (DOI)28575755 (PubMedID)2-s2.0-85019746618 (Scopus ID)
Note

Open Access APC beslut 15/2017

Available from: 2017-05-29 Created: 2017-05-29 Last updated: 2017-06-21Bibliographically approved
Mohamoud Osman, H., Ali Egal, J., Kiruja, J., Osman, F., Byrskog, U. & Erlandsson, K. (2017). Women’s experiences of stillbirth in Somaliland: A phenomenological description. Sexual & Reproductive HealthCare, 11(1), 107-111
Open this publication in new window or tab >>Women’s experiences of stillbirth in Somaliland: A phenomenological description
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2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, no 1, p. 107-111Article in journal (Refereed) Published
Abstract [en]

Background: Low- and middle-income countries in Africa have the highest rates of stillbirths in the world today: as such, the stories of the grief of these women who have had a stillbirth in these settings need to be told and the silence on stillbirth needs to be broken. In an attempt to fill this gap, the aim of this study was to describe the experiences of Muslim Somali mothers who have lost their babies at birth.

Method: Qualitative interviews with ten Somali women one to six months after they experienced a stillbirth. Data were analyzed using Giorgi's method of phenomenological description.

Results: In the analysis, four descriptive structures emerged: “a feeling of alienation”; “altered stability in life”; “immediate pain when the sight of the dead baby turns into a precious memory”; and “a wave of despair eases”. Together, these supported the essence: “Balancing feelings of anxiety, fear and worries for one's own health and life by accepting Allah's will and putting one's trust in him”.

Conclusions: This study makes an important contribution to our knowledge about how stillbirth is experienced by women in Somaliland. This information can be useful when health care providers communicate the experiences of stillbirth to women of Muslim faith who have experienced an intrauterine fatal death (IUFD) resulting in a stillbirth. 

Keywords
Phenomenology; Qualitative research; Somaliland; Stillbirth
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-23882 (URN)10.1016/j.srhc.2016.12.002 (DOI)000394066700018 ()28159120 (PubMedID)2-s2.0-85008890148 (Scopus ID)
Available from: 2016-12-30 Created: 2016-12-30 Last updated: 2017-11-29Bibliographically approved
Byrskog, U., Essén, B., Olsson, P. & Klingberg-Allvin, M. (2016). ‘Moving on’: Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden. Midwifery, 40, 10-17
Open this publication in new window or tab >>‘Moving on’: Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden
2016 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 10-17Article in journal (Refereed) Published
Abstract [en]

Background

Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care.

Method

Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis.

Findings

A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition.

Conclusions

If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Somali women, Maternity care, Migrants, Qualitative, Thematic analysis, Violence, Wellbeing, Sweden
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-21488 (URN)10.1016/j.midw.2016.05.009 (DOI)000382308900003 ()27428093 (PubMedID)
Available from: 2016-05-25 Created: 2016-05-25 Last updated: 2017-11-30Bibliographically approved
Byrskog, U., Olsson, P., Essén, B. & Klingberg-Allvin, M. (2015). Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study. BMC Pregnancy and Childbirth, 15(1)
Open this publication in new window or tab >>Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study
2015 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Violence, Somali born women, Antenatal care midwife, Communication, Trustful relationships, Networking, Person-centered, Qualitative method
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-17302 (URN)10.1186/s12884-015-0429-z (DOI)25591791 (PubMedID)
External cooperation:
Available from: 2015-04-20 Created: 2015-04-20 Last updated: 2017-12-04Bibliographically approved
Byrskog, U. (2015). 'Moving On' and Transitional Bridges: Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>'Moving On' and Transitional Bridges: Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. p. 92
Series
Digital Comprehensive Summaries of Uppsala Dissertations from teh Faculty of Medicine, ISSN 1651-6206 ; 1127
Keywords
Somali-born women, violence, transition, migration, childbearing, midwife, maternal health, perinatal health, wellbeing, qualitative, case-control
National Category
Health Sciences
Research subject
Health and Welfare, Kvinnor och mäns erfarenheter och upplevelser av könsrelaterat våld i väpnade konflikter
Identifiers
urn:nbn:se:du-20502 (URN)978-91-554-9302-8 (ISBN)
External cooperation:
Public defence
2015-10-01, Universitetshuset Sal IX, Uppsala, 11:08 (English)
Opponent
Supervisors
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2016-08-29Bibliographically approved
Byrskog, U., Essén, B., Olsson, P. & Klingberg-Allvin, M. (2014). Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden. BMC Public Health, 14, Article ID 892.
Open this publication in new window or tab >>Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden
2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 892Article in journal (Refereed) Published
Abstract [en]

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.

Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.

Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.

Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

Keywords
Somali-born women, maternity care, qualitative, thematic analysis, violence, wellbeing, Sweden
National Category
Health Sciences
Research subject
Health and Welfare, Kvinnor och mäns erfarenheter och upplevelser av könsrelaterat våld i väpnade konflikter
Identifiers
urn:nbn:se:du-20501 (URN)10.1186/1471-2458-14-892 (DOI)
External cooperation:
Available from: 2015-12-22 Created: 2015-12-22 Last updated: 2017-12-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1713-6014

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