A new report on Somali women in Minnesota sheds light on the resistance of Somali women to cesarean sections, prenatal care and family planning.
The report by Nancy Deyo, a senior advisor for the Women's Refuge Commission, based in New York, aims to help bridge the cultural gap between Somalis and their western physicians so doctors can understand their patients better and Somali mothers can receive the care they need.
Many of the 32,000 Somalis in Minnesota have lived here for 20 years or more, yet their cultural traditions about pregnancy and birth continue to clash with western medicine.
Giving birth in Somalia is fraught with risk. One out of every 12 women dies due to pregnancy-related causes, giving the country one of the highest maternal mortality rates in the world.
For Somali women living in Minnesota, childbirth is not as lethal, but it can still be a traumatic experience.
"Somali women have a perception that doctors rush to c-sections," Deyo said. "And they frankly don't understand why they're not given more time to have natural births."
While the clash of Somali and western birth cultures is well known among Minnesota Somalis and their health providers, it has not been well documented in medical literature.
To illuminate and overcome some of the cultural divisions, in August, Deyo convened focus groups in Minneapolis that were attended by 25 Somali women, a dozen Somali men, Somali religious leaders and a handful of health providers with experience in treating Somali women.
Minnesota-based Somali advocacy group Isuroon sponsored the report. During the focus groups, Somali women repeatedly said cesarean sections are not done in Somalia, Deyo said. In contrast, roughly a third of births in the United States are c-sections. That's a figure that many, even in the U.S. medical profession, believe is too high.
Deyo said most of the Somali mothers told her they want to avoid a c-section at all costs.
"As a result they are reluctant to do post-dates testing at 42 weeks to try to determine if the baby needs to come out or not," she said of the tests that determine the health of the baby late in the mothers' pregnancies. "That's one of the situations where they want to let Allah decide what's going to happen, and they're going to make peace with it."
Fartun Weli, executive director of Isuroon, said one of the other reasons there's so much fear about c-sections in the Somali community is that the procedure is perceived as a western medical tactic to limit population growth.
“Somali women have a perception that doctors rush to c-sections.”Researcher Nancy Deyo
"When we talked to the men, some of them believe that the reason that [for] their wives, that the c-section is high, is part of controlling," Weli said. "It's like controlling them [from] having a lot of babies."
Weli said large families are considered a blessing in Somalia and too many c-sections may limit the number of children a woman can have. She has heard from Somali women who have driven to Wisconsin to deliver their babies, believing rumors that the c-section rate there is lower than in the Twin Cities.
While the topic of c-sections dominated many of the Somali focus group discussions, the report also identified other pregnancy and birth practices that some Minnesota Somalis don't understand or agree with.
"Somali women very simply prefer female providers, period," Deyo said. "And this is an issue of modesty. Very simply they do not want to show their private parts to a male provider who is not their husband."
They also don't understand why they need to go to the doctor so often during their pregnancy to get measured and tested, or why there's not more support to help a new mother in her home in the weeks after she gives birth to help her recover and avoid depression, she said.
Dr. Stephanie Walters, medical director of the Health and Wellness Center at Macalester College and an Isuroon board member, said if health providers don't make an effort to address some of these concerns, their patients won't bother getting the care they need.
"They're not going to follow through with a plan that they either don't agree with or don't understand, or wasn't sufficiently explained or isn't accessible for them," Walters said.
Despite the many cultural differences between birth in the United States and Somalia, Fartun Weli said her community has adapted somewhat to the western medical model and should be recognized for that.
"There are a lot of rumors out there that the community is very closed and that they don't want to change and all that stuff," Weli said. "But this answers all the questions and says that's not true. Really this community wants to change, and actually change before even the system had adjusted to the demographic changes of our community."
Now that the study has been done, Weli hopes more Minnesota providers will do what they can to adapt to some of the preferences of their Somali patients.