Models of Maternal Healthcare for African refugee women in High-Income Countries: A Systematic Review

Objective: To explore models of maternal healthcare for African refugee women and their acceptability, cost and associated outcomes. Design: A systematic review and content analysis Setting: High-income countries Participants: African refugee women Review methods: Seven databases were searched to identify peer-reviewed literature using defined keywords and inclusion criteria. Two authors independently screened the search findings and the full texts of eligible studies. The quality of the included studies was appraised, and the findings were analysed using a template. Results: Nine studies met the criteria. Four studies were qualitative, two quantitative and three studies used mixed methods. Four models of care were identified: midwifery-led care, hospital-based integrated care, primary care physician-led integrated care and a holistic refugee-specific primary healthcare model (one-stop shop). Issues affecting care delivery were identified as communication barriers, low health literacy, high transport costs and low engagement of refugee women in their care. Key conclusions: The lack of evidence regarding the impact of care models on the maternal healthcare outcomes of African refugees highlights the need to improve care evaluations. These results reinforce the importance of education and interventions to build refugee women's health literacy and strength-based communication approaches supported by multidisciplinary, multilingual and highly trained teams of health professionals. There is also a need to involve African refugee women in shared decision making. Implications for practice: The findings suggest the need for universal access to a woman-centred whole-of-system care approach for African refugees that emphasises culturally competent, safe, respectful and compassionate multi-professional care and greater economic security to cover costs.