Views and experiences of South Asian women on maternity care services in Hong Kong : a mixed methods study

Abstract

Compared to native populations, ethnic minority and migrant women face risks of health inequities in maternal healthcare settings, resulting in adverse maternal and perinatal outcomes. The utilization of health services by South Asian female migrants is increasing globally, yet little is known about how they perceive maternity care services in destination countries. Disparities reported among ethnic minorities are not specific experiences to South Asians; indicating a need to explore their specific experiences of unique challenges, needs and barriers. The South Asian population in Hong Kong accounts for 14.5% of total ethnic population. Though several studies exist on South Asian population in general, only one study highlighted dissatisfaction of Pakistani women’s experiences with Hong Kong’s maternity care services. To address this knowledge gap, this thesis aimed to investigate maternal health service in Hong Kong by: 1) examining and synthesizing qualitative evidence available on South Asian women’s views and experiences of maternity care services in destination countries globally; 2) examining South Asian women’s views and experiences of maternity care services in Hong Kong; 3) investigating South Asian women’s experience of respect and autonomy with maternity care services in Hong Kong; and 4) investigating South Asian women’s information needs, barriers and information-seeking behaviours.

I conducted a systematic review of qualitative evidence on South Asian women’s views and experiences with maternity care services in destination countries. Next, both qualitative and quantitative methods were employed in a mixed-method study. Findings of interviews with twenty South Asian women and a cross-sectional survey of 173 South Asian women were reported.

Review results demonstrated that South Asian women have unique experiences in care settings as they place high values on family, tradition and culture, which can interfere with care provisions. Elevated expectations from healthcare professionals due to their positive views of healthcare systems in their residing destination countries indicate a need to strengthen maternal health policies.

Seven overarching themes emerged in the thematic analysis of qualitative data: appreciation of existing maternity care system, ambiguity about care provision, juxtaposition of experiences with their country of origin, discrete interactions at care settings, constrained choices over care center, identifying needs, and the adverse impact of the COVID-19 pandemic on maternity care experiences. South Asian women in Hong Kong had constrained choices in adhering to public services due to expensive private care services. Their perceptions were influenced by comparison to their home countries. In the quantitative study, South Asian women had perceptions of low respect (41.70%) and moderate autonomy (39.30%) toward the maternity service and these perceptions were associated with various demographic and maternal factors. Factors such as labour induction, maternal health complications, absence of antenatal classes, and the choice of a public hospital contributed to their perceptions of low respect and low autonomy. Although the internet was frequently utilized as a source of health information during pregnancy, they still relied on health professionals for the credibility of information. Multi-stranded strategies such as community-based services, increasing cultural competence, addressing unmet needs, increasing the uptake of health information through proactive methods, increasing antenatal appointments at public care settings, and assigning South Asian health professionals to cater to them may help optimize their care perceptions.