. 2024 Feb 13;8(Suppl 2):e014075. doi: 10.1136/bmjgh-2023-014075

Table 2.

Review findings and CERQual grading for theme 2 ‘differences from home country’

Review finding	Contributing papers	Supporting quote	CERQual grade*
Cultural differences in postnatal care Some women identified differences in provision of care and culturally acceptable (or perceived unacceptable) care provided in their new country. They mentioned feeling unable to abide by their culture relating to maternal/newborn care. Some women mentioned that they felt that specific interventions or practices from their new country were being imposed on them, or similarly, that things that were commonly practiced in their home country were not acceptable in their new home. There were also differences in how-and what- women communicate with their healthcare provider. Some women highlighted the importance of religion in their postnatal care	22 studies: Almeida et al,⁶⁰ Chu,⁴³ Davis,¹⁰ ⁶⁷ DeSouza 2005, Doering et al,⁶⁸ Grewal et al,⁶¹ Gurman and Becker,⁴⁶ Higginbottom et al,⁶⁹ Higginbottom et al,⁴⁸ Kim et al,²⁸ Lam et al,⁵⁰ Lee et al,⁶⁵ Phanwichatkul et al,⁷⁰ Qureshi and Pacquiao,⁶³ Reitmanova and Gustafson,⁶⁶ Renzaho and Oldroyd,⁵⁶ Rice,⁷¹ Riggs et al,⁵⁵ Shafiei et al,⁶² Ta park et al,⁷² Waugh,⁷³ Wikberg et al⁵⁸	‘In this country there is no fireplace for you to sleep next to but you have already spend a lot of time in the hospital so you just come home. In this country, you would stay for three or four days there and so you already have strength and when you come home then you just go straight into bed’. (Rice⁷¹ immigrants from Laos in Australia) ‘But they make me [take a shower] in the hospital. I have to. The nurse came in and told me. And she would not bring the baby for me. If I don’t take a bath, they won’t give me the baby to feed … So I did, I went in to take a quick shower and then came out. It makes me feel like it’s sort of a parent’s order. They say protect the baby from germs [and] all that. I understand, but I have my own beliefs, so when I get home, I do different way. I just do what I [am] supposed to do’. (Davis¹⁰ immigrants from South East Asia in the USA)	Moderate
Postpartum seclusion (‘Doing the month’/cuarentena) Many women, from Asia and Latin America, mentioned the practice of ‘doing the month’ or ‘cuarentena’ which would have been central to their postnatal care back home, and difficulties with implementing it in their new environment, whether because they now felt it restricting or because they had a hard time getting others to respect it	6 studies: Chang 2018, Davis,¹⁰ Grewal et al,⁶¹ Lam et al,⁵⁰ Rice,⁷¹ Waugh⁷³	‘Because we are not in China we will not “zuo yue zi” [at] one hundred percentage according to the “zuo yue zi” methods in China. It’s fine as long as I feel okay about it in my heart’ (Chang 2017, immigrants from China and Taiwan in Canada) ‘Covering up—that’s for the entire 40 days. It’s partly for the baby and partly for yourself. You cover your ears, or put cotton in your ears so that the drafts can’t get in because of the headaches and so that you don’t get the aches and pains in your bones and all that. Also the feet—without socks, on the cold floor—it gives you aches and pains like reumos, achy bones/ joints, and you get varicose veins. It’s called like phlebitis. That’s el frio, or el aire’. (Waugh⁷³ immigrants from Mexico in the USA)	Moderate
Gender of healthcare provider For many, mainly from studies with a heterogeneous population of women with diverse legal statuses, including asylum seekers and refugees, the gender of health professionals and interpreters was critical to how women engaged with care, including their comfort in disclosing health or family concerns. This was presented by most women as a difference with how services would be offered in their home country and a barrier to accessing care	7 studies: Higginbottom et al,⁴⁷ Hill et al,⁶⁴ Reitmanova and Gustafson,⁶⁶ Shafiei et al,⁶² Shafiei et al,⁷⁴ Wikberg et al,⁵⁸ Yelland et al⁵⁹	‘After birth because I had a tear they told that a male doctor should come for stitches … my husband gave permission but I am still unhappy about the male doctor who came for stitches. For stitches should be a female doctor; most women would ask for a female doctor’ (Shafiei et al⁶² immigrants from Afghanistan in Australia) ‘The doctor was good, first I was a bit (shy) … because it was a man’. (p644) (Wikberg et al⁵⁸ immigrants from several countries in Finland)	Low
Newborn feeding practices Women mentioned differences in perception of newborn feeding as compared with their home countries. Some mentioned other feeding practices that were common to them, especially immediately after birth, whereas others focused on the importance of breast feeding. Some women mentioned different understandings of what facilitates or interferes with breast feeding Other women also mentioned the need for support from healthcare workers and the community relating to breast feeding	5 studies: Higginbottom et al,⁶⁹ McFadden 2013⁷⁵, Phanwichatkul et al,⁷⁰ Qureshi and Pacquiao,⁶³ Waugh⁷³	‘I had special instructions. I had decided that I wanted my nand (sister-in-law) to give my first child the ghutti. My mother especially bought some ghutti and went to her house to get her to dip her finger in the ghutti. Then when the baby was born my mother fed her the ghutti so in effect it was both my nand’s and my mother’s ghutti’. (Qureshi and Pacquiao⁶³ immigrants from Pakistan in the USA) ‘I want to ask this thing that at that time there is no milk, during the first few days, 2, 3 days after the birth there is no milk so why do they keep on telling me to get them to suck and feed’. (McFadden 2012, immigrants from Bangladesh in the UK)	Low
Perceived better care at home country/new country Women from a few studies mentioned that care offered in their ‘new’ country was better than in their home country, including access to more and better facilities and services, better care, and lower costs. In some instances, women were pleased with receiving the same quality care as locals. However, some women preferred services from back home. Some of these differences related to services available, as well as interventions and tests and different recommendations. Some women stated that having an appointed family doctor was recognised as a facilitator. Some women mentioned differences that they perceived as better care in their home countries	12 studies: Almeida et al,⁶⁰ Alshawish et al,⁴² Crowther and Lau,⁴⁴ Grewal et al,⁶¹ Gurman and Becker,⁴⁶ Higginbottom et al,⁴⁸ Kim et al,²⁸ Lee et al,⁶⁵ Sami et al,⁵⁷ Shafiei et al,⁶² Wikberg et al,⁵⁸ Wikberg et al⁷⁶	‘Here is better; in Afghanistan there isn’t any doctor, anything [facility]; in the area that we used to live, there is no doctor; here there are a lot [of doctors] … when there’s a problem, the nurse would come soon … a doctor is available if there is a problem’ (Shafiei et al⁶² immigrants from Afghanistan in Australia) ‘But when the baby is born care is much better [in the UK] than in Poland’ (Crowther and Lau⁴⁴ immigrants from Scotland in the UK)	Moderate

*High, moderate, low, or very low.