Afghan families and health professionals’ access to health information during and after pregnancy



      Having a baby in a new country can be challenging, especially if unable to communicate in a preferred language. The aim of this paper is to explore the provision of health information for Afghan women and men during pregnancy, childbirth and the first year after birth in Melbourne, Australia.


      Community engagement underpinned the study design. Qualitative study with bicultural researchers conducting semi-structured interviews. Interviews and focus groups were also conducted with health professionals.


      Sixteen Afghan women and 14 Afghan men with a baby aged 4–12 months participated. Thirty four health professionals also participated. Verbal information provided by a health professional with an interpreter was the most common way in which information was exchanged, and was generally viewed favourably by Afghan women and men. Families had limited access to an interpreter during labour and some families reported difficulty accessing an interpreter fluent in their dialect. Availability of translated information was inconsistent and health professionals occasionally used pictures to support explanations. Women and men were unsure of the role of health professionals in providing information about issues other than pregnancy and infant wellbeing.


      Both individual and health system issues hinder and enable the availability and use of information. Consistent, understandable and ‘actionable’ information is required to meet the needs of diverse families. Health professionals need to be supported with adequate alternatives to written information and access to appropriate interpreters. Inconsistent provision of information is likely to contribute to low health literacy and poor maternal and child health outcomes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • UNHCR
        Global trends. Forced displacement in 2017.
        United Nations High Commissioner for Refugees, Geneva, Switzerland2018
        • Australian Government Department of Home Affairs
        Discussion paper: Australia’s Humanitarian Program 2018-19.
        Australian Government, Canberra2018
        • Drysdale H.
        • Ranasinha S.
        • Kendall A.
        • Knight M.
        • Wallace E.M.
        Ethnicity and the risk of late-pregnancy stillbirth.
        Med J Aust. 2012; 197: 278-281
        • Small R.
        • Gagnon A.
        • Gissler M.
        • et al.
        Somali women and their pregnancy outcomes postmigration: data from six receiving countries.
        BJOG. 2008; 115: 1630-1640
        • Centre for Maternal and Child Enquiries
        Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008.
        BJOG. 2011; 118: 1-203
        • Heslehurst N.
        • Brown H.
        • Pemu A.
        • Coleman H.
        • Rankin J.
        Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews.
        BMC Med. 2018; 16: 89
        • Ager A.
        • Strang A.
        Understanding integration: a conceptual framework.
        J Refug Stud. 2008; 21: 166-191
        • Department of Health
        Clinical practice guidelines: pregnancy care.
        Australian Government, Department of Health, Canberra2018
        • World Health Organization
        WHO recommendations on antenatal care for a positive pregnancy experience.
        World Health Organization, Switzerland2016
        • National Institute for Health and Clinical Excellence
        Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors.
        National Institute for Health and Clinical Excellence, Manchester, UK2010
        • Berkman N.D.
        • Davis T.C.
        • McCormack L.
        Health literacy: what is it?.
        J Health Commun. 2010; 15: 9-19
        • Nielsen-Bohlman L.
        • Panzer A.
        • Kindig D.
        Health literacy: a prescription to end confusion.
        Institute of Medicine, Washington, DC2004
        • Australian Commission on Safety and Quality in Health Care
        Health literacy: taking action to improve safety and quality.
        ACSQHC, Sydney2014
        • Menendez M.E.
        • van Hoorn B.T.
        • Mackert M.
        • Donovan E.E.
        • Chen N.C.
        • Ring D.
        Patients with limited health literacy ask fewer questions during office visits with hand surgeons.
        Clin Orthop Relat Res. 2017; 475: 1291-1297
        • Cho R.N.
        • Plunkett B.A.
        • Wolf M.S.
        • Simon C.E.
        • Grobman W.A.
        Health literacy and patient understanding of screening tests for aneuploidy and neural tube defects.
        Prenat Diagn. 2007; 27: 463-467
        • Smedberg J.
        • Lupattelli A.
        • Mardby A.C.
        • Nordeng H.
        Characteristics of women who continue smoking during pregnancy: a cross-sectional study of pregnant women and new mothers in 15 European countries.
        BMC Pregnancy Childbirth. 2014; 14: 213
        • Ng E.
        • Omariba D.W.R.
        Immigration, generational status and health literacy in Canada.
        Health Educ J. 2013; 73: 668
        • Paasche-Orlow M.K.
        • Wolf M.S.
        Promoting health literacy research to reduce health disparities.
        J Health Commun. 2010; 15: 34-41
        • World Health Organization
        Health literacy toolkit for low and middle-income countries.
        • Riggs E.
        • Yelland J.
        • Szwarc J.
        • et al.
        Promoting the inclusion of Afghan women and men in research: reflections from research and community partners involved in implementing a ‘proof of concept’ project.
        Int J Equity Health. 2015; 14: 13
        • Department Immigration and Border Protection
        Australia’s refugee and humanitarian programme.
        Australian Government, 2017
        • Green J.
        • Willis K.
        • Hughes E.
        • et al.
        Generating best evidence from qualitative research: the role of data analysis.
        Aust N Z J Public Health. 2007; 31: 545-550
        • QSR International
        NVivo qualitative data analysis software Version 10.
        QSR International Pty Ltd, 2012
        • Yelland J.
        • Riggs E.
        • Wahidi S.
        • et al.
        How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families?.
        BMC Pregnancy Childbirth. 2014; 14: 348
        • Yelland J.
        • Riggs E.
        • Szwarc J.
        • et al.
        Compromised communication: a qualitative study exploring Afghan families and health professionals’ experience of interpreting support in Australian maternity care.
        BMJ Qual Saf. 2016; 25: e1
        • Riggs E.
        • Yelland J.
        • Szwarc J.
        • et al.
        Fatherhood in a new country: a qualitative study exploring the experiences of Afghan men and implications for health services.
        Birth. 2016; 43: 86-92
        • Lee S.K.
        • Sulaiman-Hill C.M.
        • Thompson S.C.
        Providing health information for culturally and linguistically diverse women: priorities and preferences of new migrants and refugees.
        Health Promot J Aust. 2013; 24: 98-103
        • Andrulis D.P.
        • Brach C.
        Integrating literacy, culture, and language to improve health care quality for diverse populations.
        Am J Health Behav. 2007; 31 Suppl 1: S122-33
        • Flores G.
        The impact of medical interpreter services on the quality of health care: a systematic review.
        Med Care Res Rev. 2005; 62: 255-299
        • Victorian Government Department Human Services
        Language services policy.
        Victorian Government, Melbourne2014
        • Brega A.
        • Barnard J.
        • Mabachi N.
        • et al.
        AHRQ health literacy universal precautions toolkit.
        2nd ed. Colorado Health Outcomes Program, 2015
        • Volandes A.E.
        • Paasche-Orlow M.K.
        Health literacy, health inequality and a just healthcare system.
        Am J Bioeth. 2007; 7: 5-10
        • Bryant R.A.
        • Edwards B.
        • Creamer M.
        • et al.
        The effect of post-traumatic stress disorder on refugees’ parenting and their children’s mental health: a cohort study.
        Lancet Public Health. 2018; 3: e249-e258
        • Riggs E.
        • Muyeen S.
        • Brown S.
        • et al.
        Cultural safety and belonging for refugee background women attending group pregnancy care: an Australian qualitative study.
        Birth. 2017; 44: 145-152
        • Correa-Velez I.
        • Ryan J.
        Developing a best practice model of refugee maternity care.
        Women Birth. 2012; 25: 13-22
        • Ekblad S.
        • Linander A.
        • Asplund M.
        An exploration of the connection between two meaning perspectives: an evidence-based approach to health information delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a Swedish context.
        Glob Health Promot. 2012; 19: 1-31