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January 21, 2020

A foundation for ‘safe motherhood’ created with and for the Somali community

On a recent Saturday evening, a dozen women gathered around a table at a community room in the White Center neighborhood of Seattle, settling in with snacks and conversation.

The evening’s program would be more education than entertainment, an opportunity to discuss topics so sensitive that, without the group of women assembled that night, might not be discussed at all.

Against one wall of the room, a model of the female reproductive system. Standing before them, a doula, one of three medical professionals from the Somali community there for that night’s installment of Mama Amaan, a series of lessons on prenatal and postpartum care, designed with and for Somali women.

Part grassroots service, part research project exploring the effectiveness of a culturally sensitive health care intervention, Mama Amaan (Somali for “safe motherhood”) is a partnership between the Somali Health Board of Tukwila and the University of Washington. The goal: to test the feasibility of a community-developed and run program of pre- and postnatal care services.

With the support of a grant from the UW Population Health Initiative, Mama Amaan brings together women in five different locations around South Seattle and South King County for monthly lessons in the physical, mental and emotional issues of pregnancy, childbirth and postpartum life.

Delivered by local Somali doulas and nurses, the lessons aim to assist East African immigrant and refugee communities in accessing and navigating  mmaternal health services.

“The health care system in the U.S. hasn’t been incorporating what works for these women, taking into consideration where they come from. This creates health inequalities for this immigrant population,” said Rachel Chapman, an associate professor of anthropology and global health at the UW. “Besides needing health care that is accessible, appropriate and affordable, we need health care to be much more responsive to the communities we serve. That’s where anthropology can be a useful tool.”

South Seattle’s Rainier Valley is among the most diverse neighborhoods in the city, home to many refugee and immigrant communities. But it also has some of the most negative health outcomes for women and infants, Chapman said.

It was while learning about these disparities that Chapman and local nurse practitioner, Muna Osman of the Somali Health Board, began meeting with women in the community. They brought local doulas, midwives and nurse practitioners to understand the needs and cultural norms. Somali women said they often felt discriminated against, ignored or insulted in traditional health care settings, and language was often a barrier. The very topics of pregnancy and childbirth aren’t openly discussed.

Since those early meetings, the Mama Amaan research and pilot study team quickly grew to include a UW alum as field coordinator, five UW undergraduate medical anthropology and public health as research assistants, and two UW graduate students in global health. All of the people involved are Somali women, and the team’s familiarity with the community made them especially skilled to conduct the focus groups, interviews and other data collection.

“We heard from Somali women that they are completely aware of the current barriers to providing the best of care to the Somali community. They also communicated their need for pre- and postnatal support, specifically citing education to empower them to be the drivers of their own care,” said Sumaya Mohamed, a graduate student in the UW Department of Global Health and the project’s administrative coordinator.

Mama Amaan launched last spring with a program of monthly lessons — nine, in fact, to match the cycle of pregnancy — ranging from anatomy and nutrition, to C-sections and the stages of labor. In some cases, participants are also referred to health care providers and to assistance from the federal Special Supplemental Nutritional Program for Women, Infants and Children.

But underlying all of it is the spirit of community: Conversation, as much as instruction, enlivens each session. So far, as many as 60 women have attended sessions across the five sites; more than a dozen have given birth, and eight have been attended to through the postpartum period.

“In this first year of the program, our goal is to find out what works for the community and what doesn’t, and how we can respond in the most community-responsive ways possible,” Chapman said. From there, depending on funding, the team seeks to expand geographically and to measure specific health impacts of the services.

“First, we looked at what we could do with this community that makes health education a safe and happy experience,” Osman said. “Now, the question is, can you take something developed by and for a community and scale it up?”

Other collaborators on the project are Health Alliance International and the Parent Trust for Washington Children. Additional funders are the UW Royalty Research Fund, the UW Center for Studies in Demography and Ecology, the UW School of Public Health and the UW Department of Global Health.

For more information, contact Chapman at rrc4@uw.edu and Osman at feedmair1@gmail.com.