Caught between worlds: West African immigrant mothers` experiences with the Finnish healthcare system: a qualitative study using the socioecological model

Abstract

The rising number of African immigrants in Finland correlates with increasing healthcare needs, yet little attention has been given to West African immigrant mothers. The study aimed to explore how West African immigrant mothers experience and navigate the Finnish healthcare system, with their accounts primarily situated within maternity and child health services. A qualitative cross-sectional design was used to collect data using an in-depth pilot-tested semi-structured interview guide with (N = 29) West African immigrant mothers living in the Helsinki Metropolitan Area in Finland. Snowball and purposive sampling methods were used to recruit participants who met the following inclusion criteria: (1) were single or married; (2) were biological or adoptive mothers with African partners; (3) had lived in Finland for between 1 and 30 years; and (4) spoke English, Finnish, or Pidgin English. The interviews were recorded and transcribed using an edited transcription approach. An inductive content analysis was first conducted using ATLAS.ti, after which the analysis continued deductively by applying the Socioecological Model. The findings revealed that participants´ experiences with the Finnish healthcare system are influenced at the intrapersonal, community, institutional and policy levels. Mothers reported: (1) Bias, racism, and discrimination during healthcare encounters, (2) Cultural expectations of physicians' competence, (3) Challenges in expressing healthcare needs, (4) Postpartum cultural expectations and experiences of maternity and child health services, (5) Trust in the Finnish healthcare system, (6) Community narratives and healthcare encounters, (7) Healthcare encounters that undermined trust, (8) Perceived cultural competence of healthcare professionals, (9) Language barriers during healthcare encounters, (10) Navigating health and social services, and (11) Impact of immigration policies on postpartum support. Although the findings are grounded mainly in maternity and child health contexts, they point to broader implications for trust and healthcare engagement that may extend to non-communicable disease prevention and management. They also highlight opportunities to strengthen culturally responsive policies and practices, build trust through community-based approaches, enhance healthcare professionals’ cultural competence, and develop interventions responsive to the needs of West African immigrant mothers.