Dr Rosemary G Schwarz
The Royal Women’s Hospital
Victorian Foundation for Survivors of Torture
The University of Melbourne
beyondblue Victorian Centre of Excellence
Project completion year
This project aimed to evaluate the cultural appropriateness of two mental health interventions within an obstetric hospital setting. The study involved Iraqi-born women who were undergoing obstetric care at the Royal Women’s Hospital and their husbands. The interventions included:
- provision of a bilingual health worker for the duration of care at the hospital
- a therapeutic intervention developed using collaborative therapy.
Collaborative therapy aims to increase consumer participation and encourage self-efficacy and self-reliance through psycho-education, with an emphasis on the development of coping skills and strategies. The intervention provided comprehensive psychosocial treatments, but did not involve a psychiatric diagnosis.
Fourteen men and 14 women participated in the patient focus groups. The focus groups consisted of either Iraqi refugee women or their husbands, and participants were asked about their attitudes to pregnancy, childbirth and impending parenthood and their experiences with The Royal Women’s Hospital, its treatment and staff.
Interviews with staff members were used to evaluate the acceptability of the treatments.
Both male and female participants agreed that obstetric care at The Royal Women’s Hospital was superior to that in Iraq. This included their perceptions of staff attitudes. However, participants indicated that the emotional state of the women was less well catered for in Australia than in Iraq.
The female participants, who arrived in Australia with refugee status, indicated high levels of stress which were exacerbated during pregnancy and childbirth. The absence of female networks and isolation from family were seen as major stressors, and women acknowledged this emotional distress impacted on their ability to function as wives and mothers.
The male participants expressed concern regarding their wives’ distress. They sought assistance in their efforts to help their wives and requested information and education. The loss of female networks was seen as a major factor in exacerbating the stress of an already traumatised group.
Both men and women were supportive of the interventions, considering them to be highly desirable and acceptable.
Staff who were interviewed were aware of the psychosocial needs of these patients and were supportive of the proposed interventions.
Implications for policy, practice and further research
The study demonstrated a need for and acceptance of culturally appropriate interventions among Iraqi women and their husbands. Introduction of such treatments at hospitals like The Royal Women’s Hospital would provide assistance and support for refugee women, linking them to health services – especially mental health services – they may not normally access. This could also initiate contact with and improve health outcomes for other family members.