Somali Immigrant Women’s Health Seeking and Health Care Utilization

Principal Investigator: Crista Johnson-Agbakwu

Using Community-Based Participatory Research (CBPR), this examination of the health care needs of Somali women has been the largest study conducted to date of African-born immigrants in the United States which has incorporated a community-based, mixed methods approach in examining socio-cultural determinants of health-seeking behavior and health care utilization. Preliminary analyses of 515 surveys revealed a population of recently resettled Somali refugees ranging in age from 18 to 90 years (mean = 36); 83% of whom have undergone a form of FGC. Qualitative interviews indicated most Somali women noting miscommunication, inadequate interpreters, and cultural misunderstanding including stigmatization towards FGC as barriers to care. They also expressed profound fear and distrust of medical interventions (such as cesarean delivery and labor induction), which often led them to refuse recommended treatment, as well as to avoid preventative health screening and other reproductive health services. Likewise, interviews among health care providers also revealed challenges in providing care for this community.

Articles related to refugee women’s health:

Abuldcadir, J., Ahmadu, F. A., Catania, L., Essen, B., Gruenbaum, E., Johnsdotter, S., Johnson, M.C., Johnson-Agbakwu, C., Kratz, C., Sulkin, C. L., McKinley, M., Njambi, W., Shell-Duncan, B., Shweder, R. A. (2012). Seven things to know about female genital surgeries in Africa. Hastings Center Report, 6,19-27.

Fink, G., Helm, T., Belknap. K., & Johnson-Agbakwu, C.E. (in press). Refugee women’s health. In A. Annamalai (Ed.), Textbook of Refugee Health Care, Springer.

Johnson, C. E. (2009). Female genital cutting. In A.T. Goldstein, C.F. Pukall & I. Goldstein (Eds.) Female sexual pain disorders (pp. 235-243), New York:Wiley.

Johnson, C. E., Ali, S. A., & Shipp, M. P-L. (2009). Building community-based participatory research partnerships with a Somali refugee community. American Journal of Preventive Medicine, 37(S), s230-s236. doi: 10.1016/j.amepre.2009.09.036.

Johnson-Agbakwu, C. E., Allen, J., Nizigiyimana, J.F., Ramirez, G., Hollifield, M. (in press). Mental health screening among newly-arrived refugees seeking routine obstetric and gynecologic care. Psychological Services.

Johnson-Agbakwu, C. E., Helm, T., Killawi, A., & Padela, A. I. (in press). Perceptions of obstetrical interventions and female genital cutting: Insights of men in a Somali refugee community. Ethnicity & Health. Advance online publication.

Johnson, C. E., Mues, K. E., Mayne, S. L., & Kiblawi, A. N. (2008). Cervical cancer screening among immigrants and ethnic minorities: A systematic review using the Health Belief Model. Journal of Lower Genital Tract Disease, 12(3), 232-241.

Johnson, C. E., Shipp, M., Ali, S. A., Mues, K. E., Bashir, S. A., & Forman, J. (2008). Barriers to reproductive health care use among Somali immigrants with female genital cutting. Obstet Gynecol111(Supp 4), 56S.

Ibe, C., & Johnson-Agbakwu, C. (2011). Female genital cutting: Addressing the issues of culture and ethics. The Female Patient36, 8, 28-31.

Lazar, J. N., Johnson-Agbakwu, C. E., Davis, O. I., Shipp, M.P.-L. (in press). Challenges in obstetrical care of Somali women: A qualitative study of provider perspectives.Obstetrics and Gynecology International.