When I can be my whole authentic self, I feel safe and know that I belong : A photovoice study exploring what culturally safe pregnancy care is to Karen women of refugee background in Victoria, Australia

Journal article

Coe, Rowena, Toke, Shadow, Wallace, Heather, Riggs, Elisha, Brown, Stephanie J., Szwarc, Josef and Biggs, Laura J.. (2024). When I can be my whole authentic self, I feel safe and know that I belong : A photovoice study exploring what culturally safe pregnancy care is to Karen women of refugee background in Victoria, Australia. Ethnicity and Health. 29(6), pp. 720-744. https://doi.org/10.1080/13557858.2024.2359388
AuthorsCoe, Rowena, Toke, Shadow, Wallace, Heather, Riggs, Elisha, Brown, Stephanie J., Szwarc, Josef and Biggs, Laura J.
Abstract

Objectives
Inequitable pregnancy care experiences and outcomes disproportionately affect refugee background women in Australia. Culturally safe care is essential for achieving health equity, however, cultural safety can only be determined by the person receiving care. To our knowledge, women of refugee background in Australia are yet to be asked what culturally safe pregnancy care is to them. Specifically, this study aimed to explore what culturally safe pregnancy care is to Karen women (from Burma) of refugee background.

Design
A photovoice study founded on community-based participatory research principles was undertaken with a Karen community of refugee background living in Victoria, Australia. A community advisory group was established, guiding study design and conduct. Five S’gaw Karen-speaking women with experience of pregnancy care in Australia were invited to take photos within their community. Participants shared their photos and stories with each other in four online discussion groups.

Results
Reflexive thematic analysis guided by a critical constructionist lens developed three themes: Building foundations for belonging; cultivating reciprocal curiosity; and storytelling as an expression of self and shared power. These themes sit within the overarching theme When I can be my whole authentic self, I feel safe and know that I belong.

Conclusion
When Karen women can embrace their cultural and spiritual identity without fear of discrimination, including racism, culturally safe pregnancy care is possible. This study contributes to the design and delivery of maternity services by providing insights that can enhance equitable and culturally safe pregnancy care for Karen women of refugee background.

Keywordscultural safety; pregnancy care; health equity; refugee health; photovoice; reflexive thematic analysis; Karen women; community–based participatory research
Year2024
JournalEthnicity and Health
Journal citation29 (6), pp. 720-744
PublisherRoutledge
ISSN1355-7858
Digital Object Identifier (DOI)https://doi.org/10.1080/13557858.2024.2359388
PubMed ID38867355
Scopus EID2-s2.0-85195668143
Page range720-744
FunderAustralian Catholic University (ACU)
Australian College of Midwives
National Health and Medical Research Council (NHMRC)
Operational Infrastructure Support (OIS) Program, Victorian Government
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online12 Jun 2024
Publication process dates
Accepted20 May 2024
Deposited29 May 2025
Grant ID2018144
1198270
Additional information

© 2024 Informa UK Limited, trading as Taylor & Francis Group.

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