1. Pfeifer, Gail M. MA, RN, news director


Birth outcomes were better for these refugees than for U.S. women.


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African refugees in the United States face several risk factors for poor health, including language barriers, racial or political prejudice because of immigrant status, and limited access to or inadequate utilization of health care services. Yet, a recent study found that African refugee women had better prepregnancy health and fewer preterm births, cesarean sections, and low-birth-weight infants than both white and black U.S. women, despite underutilization of prenatal care.

Figure. Kafuli Agbem... - Click to enlarge in new window Kafuli Agbemenu (center) explains recruitment for a study on reproductive health decision making to a group of women from the Somali Bantu Community Organization of Buffalo, NY. Photo courtesy of Kafuli Agbemenu.

Such paradoxical findings may be explained by the so-called healthy immigrant effect, meaning these populations tend to be the healthiest and most resilient of their peers in choosing to leave their home countries and, therefore, have better health outcomes than native-born individuals in the host country. A worrisome finding, however, is the refugees' underutilization of prenatal care services, which has implications for refugee women's health in general as well as for the maternal health care providers caring for them.


To address the needs of refugees, nurses should know the cultural history of the populations they serve and the life stories and experiences of individual patients, advised Kafuli Agbemenu, assistant professor in the University at Buffalo School of Nursing and lead author of the study. The study notes that refugees may be hesitant to seek health care in the United States for a variety of reasons, including feeling ostracized and marginalized. "What nurses may interpret as reluctance might just be cultural shyness or a different understanding of a concept thought to be commonplace to a U.S. citizen," Agbemenu told AJN.


One way nurses can learn about refugee populations and their communities is by participating in local and regional conferences and social initiatives, Agbemenu suggests. Agbemenu follows her own advice, serving on the board of the Somali Bantu Community Organization, which helped start a farm with local refugees from mostly agrarian cultures. The farm has provided the refugees with a way to use existing skills to earn income and has helped to make them feel more welcome in the larger community.


To ensure the next generation of nurses will be able to provide culturally appropriate care for their patients, Agbemenu champions a community service component in her public health nursing course for senior nursing students. "One of our most memorable engagements was a group of students who taught elementary school children in the Somali Bantu afterschool program how to dress for winter," she said. "Because most of the children were newly arrived refugees, the concept of dressing for winter was new to them, and one that needed reiteration."


For more information and guidelines on refugee health, visit M. Pfeifer, MA, RN, news director




Agbemenu K, et al. J Women's Health (Larchmt) 2019;28(6):785-93.