The proportion of women with an immigrant background who have given birth was 74 % in 2020. This differs from the native population, where the corresponding rate was 55 %. (Kuusio et al. 2020, 124.) 15 % of babies were born into foreign language-speaking families in 2020 and the number is growing all the time (According to Sinkko &; Mäki 2021; Kankaanpää, Kaukonen, Klemetti & Vesterinen 2022,1). In our nursing practice, we are encountering an increasing number of clients with immigrant backgrounds, and our work environment is multicultural. Developing competencies through education is essential to fulfill this need. The Intercultural Learning Online project, in its way, enables the development of skills that specifically aim to promote intercultural understanding through teaching and learning.

Maternity and child health clinic visits are insufficient for immigrants

The maternity and child health clinic system and support services are comprehensive, and the services reach almost all expecting families and their children. According to studies, children of immigrant parents are diagnosed with more developmental disorders in Finland compared to the native population. They are at higher risk of being taken into foster care, and the risk of facing more challenges in social, emotional, and behavioral situations is increased. (Kankaanpää et al. 2022, 1, 7.) According to studies, the psychological burden among the population with a foreign background was 17 %, slightly more common, compared to the general population, which was 13 % (Kuusio et al. 2020, 121).

According to a study by Kankaanpää et al. (2022), maternity and child health clinic workers feel that maternity and child health clinic visits are insufficient for immigrants. More information was requested especially on experiences of violence, post-traumatic symptoms, immigration, cultural background, and the challenges of parenthood. The use of an interpreter, the unfamiliarity of the service system, and individual and diverse support needs require sufficient resources for the work and the possibility of work management. (Kankaanpää et al. 2022, 1, 7.)

Sexual education is a part of the core studies in public health nurse education

One of the objectives of the sexual and reproductive health program is to consider cultural diversity. Sexual and reproductive health research and active organizational activities promote sexual and reproductive health. (Kuusio et al. 2020, 126-128.) At Laurea University of Applied Sciences, sexuality education is considered in teaching, and it is included in core studies. Multiculturalism and a culturally sensitive approach are integrated into the studies in public health nurse education. For example, one of the objectives of the course “Public Health Nursing and Service Integration for Special Groups” for the student, is to be able to analyze special issues related to multicultural client work and immigration in social and health care and to utilize research data and recommendations in the guidance and nursing of clients in a vulnerable position and with an immigrant background (OPS 2021). However, according to a study by Kuusio et al. (2020), maternity and child health clinic workers feel that they need more information and practice on how to work with families with an immigrant background in Finland (Kuusio et al. 2020, 126-128).

Online lecture by a lecturer with an immigrant background as an expert

The projects can be seen in higher education institutions as an opportunity for different pedagogical solutions. The ILO- Intercultural Learning Online project is one of the projects of Laurea University of Applied Sciences in co-operation with partner universities like Maastricht University, Roma Tre University, Aristotle University of Thessaloniki, and the European Migrant Platform. The ILO project aims to promote intercultural understanding through teaching and learning, to create models for integrating highly qualified immigrants into teaching activities, and to promote self-awareness among students with a migrant background by providing them with role models while integrating lecturers with a migrant background into working life networks. One of the activities of the ILO project is to organize online and onsite lectures with immigrant backgrounds as experts. (ILO 2023.)

Handan Sayer, “Senior Gender Equality Expert and General Secretary and Co-founder of EMP”, lectured online to public health nursing students on the topic ”Migrant Women’s Pregnancy, Childbirth and Maternity Care in Europe – how to Support a Woman with an immigrant background in Maternity clinic”. The lecture was organized open-access and there was a possibility to attend by students from partner universities.

Maternity and child health clinic workers need support for working with clients from immigrant backgrounds

According to Sayer (2023), pregnancy might increase the risk of vulnerability for migrant women, and they are at risk of poorer pregnancy outcomes. The prevalence of gestational diabetes was reportedly higher among the population with a foreign background compared to the general population, but there were significant country-specific variations noted (Bastola et al. 2020). According to studies, migrants have slightly worse health than the general population in Finland (Kieseppä et al. 2022, 2). Long-term illnesses occur in 35% of individuals with a foreign background. This does not significantly differ from the general population. 65% of individuals with a foreign background perceive their health as good, which in contrast, is 73% in the general population. Obesity, diabetes, and mental health issues are becoming significantly prevalent, especially among individuals from the Middle East and North Africa. (Kuusio et al. 2020, 109, 114.) However, it’s noteworthy that there were significant country-specific differences in the results of this research.

According to Sayer (2023), they face different obstacles and challenges in their destination country. We need culturally competent healthcare, equitable, high-quality care, trauma-informed maternity care, and continuity of care. New models of maternity care are needed to support migrant women’s socioeconomic and psychosocial needs. The risk factors for immigrants highlighted in Sayer’s (2023) lecture are also highlighted in a report by Koukkula et al. (2019), according to which maternity and child health clinic workers experience an increased need for psychosocial support among clients with an immigrant background, lack of a social network and ignorance of the Finnish service system (Koukkula et al. 2019, 38). Maternity and child health clinic workers find interpreter-mediated work challenging and wish for more time and resources and, above all, support for working with clients from immigrant backgrounds. We need more training and information on encounters, speaking up, and how to consider linguistic and cultural factors and various challenges in family life. (Kuusio et al. 2020, 126-128.) Previous study has shown that the attitudes of healthcare professionals were poor, and they have communicational problems with migrants (Kieseppä et al. 2022, 2). By increasing the authenticity of cultures, better communication between families with an immigrant background and maternity and child health clinic workers can be promoted.

Immigrants are dissatisfied with health services

In their study, Kieseppä et al. (2022) compared the satisfaction of people with an immigrant background with health services and their availability in Finland relative to the Finnish native population. According to this study, immigrants’ satisfaction was lower than that of the native population. People with a migrant background are vulnerable customer groups and therefore need special support for health services. However, the study showed that health service dissatisfaction varies between immigrant groups. Women who have moved from the Middle East or Africa need more maternity care services than other immigrants. In some cases, public health care is the only possibility to access health care because of user fees in private health care and occupational health care in Finland, which increases inequality in access to health services. Immigrants should be met in health care individually not to consider migrants as a uniform group. Dissatisfaction with health services is increased by lack of knowledge, language barrier, long waiting times, and negative experiences with the services. (Kieseppä et al. 2022, 7.)

The lecture by ILO raised the knowledge among public health nursing students on how to support working with clients with an immigrant background

According to studies, women with an immigrant background have more childbirths and abortions relative to the Finnish population. Sexual and reproductive health services focus on guidance, sexuality education, and contraceptive counseling. The guidance must consider sexual and reproductive health rights and the possibility of safe and reliable contraception. For people from different backgrounds, culturally sensitive work is important because of the sensitive topic of sexual and reproductive health. (Kuusio et al. 2020, 126-128.) The Lecture made possible by the ILO – Intercultural Learning Online project, responded to the need for maternity and child health clinic workers to support working with clients with an immigrant background by raising awareness among public health nursing students. Organizing an expert lecture also enabled highly educated experts with immigrant backgrounds to network and integrate into working life. The experience of integrating teaching and the project was successful.

Resources:

• Bastola, K., Koponen, P., Härkänen, T., Luoto, R., Gissler, M. & Kinnunen T.I. 2020. Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland. Women’s Health. 2020;16. doi:10.1177/1745506520910911
• ILO – Intercultural Learning Online 2023. Website. Referred 14.6.2023.
• Kankaanpää, S-L. Kaukonen, S., Klemetti, R. &; Vesterinen, E. 2022. Maternity and child health clinic workers’ experiences of working with immigrant clients. Research in brief 56/2022. National Institute for Health and Welfare. Helsinki. Referred 7.6.2023.
• Kieseppä, V., Veláquez, R.G., Vehko, T. & Kuusio, H. 2022. Satisfaction with access to health services among the foreign-born population in Finland: a survey-based study. BMC Health Services Research 22:781. Referred 7.6.2023.
• Koukkula M., Bildjuschkin, K. &; Klemetti R., 2021. Report on the implementation of the Action Plan on Sexual and Reproductive Health 2014–2019 – Online survey of actors in 2019. Working paper 17/2021. National Institute for Health and Welfare. Helsinki. Referred 7.6.2023.
• Kuusio, H., Seppänen, A., Jokela, S., Somersalo, L. &; Lilja E. (eds.). 2020. Health and well-being of people with foreign background in Finland FinMonik study 2018–2019. THL – Report 1/2020. Helsinki. Referred 7.6.2023.
• Laurea University of Applied Sciences. Study guide. Curricula. Public health nursing training. 2021. Referred 7.6.2023.
• Sayer H. 2023. Migrant Women’s Pregnancy, Childbirth and Maternity Care in Europe – how to Support a woman with an immigrant background in a maternity clinic. Online Lecture 28.3.2023. Laurea-ammattikorkeakoulu. Vantaa.