Provider Gender: A Barrier to Immigrant Women's Obstetrical Care, from the Patient and Provider Perspectives

Christa L Aubrey
2016
Objectives: To explore the barrier of obstetrical provider gender for immigrant women, to understand the importance, effect, and challenges of having a male provider intrapartum, from the patient and provider perspectives. Method: A focused ethnography was conducted using purposive and convenience sampling of 38 immigrant women, and 20 obstetrical care providers (10 resident and 10 staff obstetricians) from one hospital in Edmonton, Alberta, Canada. Data collection comprised of semi-structured
more » ... nterviews antenatally (38) and postpartum (21), and observation intrapartum (17) for patient respondents, and a single semi-structured interview for provider respondents. Interviews were audio-recorded and transcribed verbatim. Data was managed using Quirkos software, and analyzed by thematic analysis. Results: From the patient perspective, although all women preferred a female provider, influenced by a culture of modesty and often interwoven with Islam, they would accept care from a male provider. Nonetheless, all women experienced varying degrees of psychological stress from having a male provider intrapartum, which for a small minority led to significant and potentially serious consequences. From the provider perspective, physicians empathized with women, and respected their autonomy to prefer a female provider. However, they were resistant to accommodating these requests, citing concerns regarding the structure of the health system, difficulties ensuring coercion-free patient decision-making, implications for training and quality of care, and fear of perpetuating and exacerbating gender inequalities in medicine. Conclusion: A key finding of this study was that despite their preferences, women would accept care from a male provider. However, the implications of accepting this care differed, and for a small minority were significant, manifesting in delayed care seeking, psychological disturbance, iii and interpersonal relationship stress. There is a need to identify these women who are at risk of significant negative outcomes, in order to respond appropriately. Viewing this issue in the context of acculturation may help physicians to both conceptualize the preference for a female provider in a balanced perspective, and help to inform subsequent responses to this and other issues that arise in intercultural contact in the healthcare system. iv
doi:10.7939/r3js9hg6j fatcat:zk4ytdowtbctlptqpfnbjivhp4