One Somali woman described being in labor for three or four days. She eventually went to the hospital. But the doctor told her she needed surgery to deliver the baby, and her family took her home because they didn’t want a C-section. She eventually gave birth to a dead baby.
Another woman described being held for 21 days at the clinic of an Ethiopian refugee camp. Her strength depleted to such an extent that they transferred her to the hospital, where they asked her whether she wanted to save her own life or the life of the child. The woman chose to save the child’s live. But the lights went out just before surgery, and the doctors aborted the baby and took him out of her dead. Of the 13 women and the babies being born there that night, she and one infant were the only ones who survived.
Those are just two of the stories that Nancy Deyo told Wednesday at a conference on Somali women’s health, coordinated by Somali women's health education and advocacy group Isuroon.
Deyo, senior advisor at the Women's Refugee Commission, heard the stories while conducting putting together a report on cultural traditions and the Somali women’s reproductive health.
During her research, she spoke with a total of 50 people—Somali women, Somali men, religious leaders and healthcare providers at three local hospitals and clinics. Many of the interviewees were from Hopkins' Somali community. One group of women had given birth in both the United States and Somalia or refugee camps.
Somali women’s health is a particularly important issue. Back in Somalia, about one in 12 women die in childbirth.
Yet western healthcare can be alienating for many mothers. The report paints a picture of very different expectations for reproductive medicine than those found in western culture. It also recommends ways local providers can adapt their care to Somali culture since giving birth in an unfamiliar western hospital can be frightening to expectant mothers.
“The stories of medicine in the United States can be every bit as scary as the stories of Somalia and the camps are to us all,” Deyo said.
Below are few examples of how Somali healthcare culture differs. See the table below for a full breakdown.
Click on the PDF to the right of this article to read the executive summary of the report.
Medical model and prenatal care
Western medicine places a heavy emphasis on preventative care—screening, testing and health management. In Somalia, people typically only go to the doctor once problems emerge and only return if things get worse. There is little to no prenatal care. Some Somali mothers visit their doctors at 20 or more weeks for an ultrasound and then don’t return until they’re in labor.
- Key quote: “I’ve had eight children and everything was fine. I know my baby is healthy because it is moving. Why do I have to be measured every two weeks?” one woman said.
The Somali women reported that they preferred midwives over physicians. They also strongly prefer female providers.
- Key quote: “We thought when we brought in two Somali male residents that it would make a difference—they speak the language, they understand what Somali women have gone through—but they still get rejected,” a healthcare provider at a Minneapolis clinic said.
The Somali women expressed a strong preference for natural childbirth and aversion to inducing labor, leading to longer pregnancies. One man blamed the inducing of labor for his wife’s back problems, while several women said they had refused to induce because they thought it “burns the womb,” meaning they couldn’t have any more children.
- Key quote: “Somali women are always my late delivery ladies,” one midwife said. “Somali women believe that God determines when the baby is ready to be born. I have seen women go to 43 weeks and the baby dies. But Somali women have this amazing willingness to accept what God has given them and they are at peace with it.”
Both Somali women and men said C-sections are only acceptable in their culture if the mother’s or child’s life were in danger and objected to the high rates of C-section they saw in the United States. Some thought doctors were trying to make extra money, deliver babies more efficiently or make them have fewer babies. Some feared that C-sections could kill them or make them unable to have children. In other cases, the reasons for the C-section had simply been lost in translation.
- Key quote: “I had a patient who had given birth by C-section seven times. I told her we needed to talk about the risks to her and her unborn children of having additional surgeries. She had a very supportive partner, but nonetheless, she told me, ‘Somali men—as soon as we stop having babies, they go find another woman,’” one provider reported. The report noted that many women confirmed that fear and said it was one of the main reasons they gave birth annually.
Female genital cutting
Somalia’s 98 percent rate of female circumcision is one of the highest in the world. This often leads to difficult deliveries and requires specific types of episiotomies that practices might not regularly use. Some doctors also don’t believe in repairing the female circumcision after labor, which can cause conflict between mothers and doctors.
- Key quote: “We have no business intervening in a woman’s sexual identity. For many Somali women, her circumcision is a beautiful thing that she is proud of,” said one provider.”
In traditional Somali culture, the extended family cares for the “ummul” (new mother) for 40 days after the birth—keeping them company, caring for their children and bringing them meals. At the end of the 40-day period there is a coming out celebration with the baby. In the United States, though, the women spend two days in the hospital and then have to go back to taking care of their household while their husband returns to work. Consequently, many of the Somali mothers reported feeling lonely and isolated after childbirth.
- Key quote: “Somalia childbirth was a better experience for me—I had moral support, physical support and emotional support,” one woman said. Added another: “After you deliver and leave the hospital, don’t be surprised if you end up going shopping at Cub Foods on the way home.”
Differences Between Western Medicine and Somali Cultural TraditionCatergory Western Medicine Somali Cultural Tradition Medical Model Preventative Curative Prenatal Care Every 2-4 weeks Little to none Preferred Caregiver Physician Midwife Modesty Male or female physician Female physician/midwife Finding Physicians Complex referral system Community stories/word of mouth
ChildbirthHospital Home Gestation Period 38-40 weeks 42+ weeks Post-Date Induce labor No interventions Labor Lying down with fetal monitor Walking around Pain Management Epidural Prayer Delivery Mother pushes out Midwife pushes up and out Husband Participation Husband in delivery room Women in delivery room Language English or Somali interpreter Somali Cesarean Section Myriad reasons Lifesaving only Female Genital Cutting Illegal Infibulation Episiotomy Midline Medio-lateral Postpartum Two days in hospital 40 days at home Support System Nuclear family Extended family/neighbors Family Size Couple decides Allah decides/peer pressure Child Spacing Modern birth control Breastfeeding only (2 years)