Caught between worlds: West African immigrant mothers` experiences with the Finnish healthcare system: a qualitative study using the socioecological model

Abstract

Background

The rising number of African immigrants in Finland correlates with increasing healthcare needs, yet little attention has been given to West African immigrant mothers. The study aimed to explore how West African immigrant mothers experience and navigate the Finnish healthcare system, with their accounts primarily situated within maternity and child health services. A qualitative cross-sectional design was used to collect data using an in-depth pilot-tested semi-structured interview guide with (N = 29) West African immigrant mothers living in the Helsinki Metropolitan Area in Finland. Snowball and purposive sampling methods were used to recruit participants who met the following inclusion criteria: (1) were single or married; (2) were biological or adoptive mothers with African partners; (3) had lived in Finland for between 1 and 30 years; and (4) spoke English, Finnish, or Pidgin English. The interviews were recorded and transcribed using an edited transcription approach. An inductive content analysis was first conducted using ATLAS.ti, after which the analysis continued deductively by applying the Socioecological Model.

Results

The findings revealed that participants´ experiences with the Finnish healthcare system are influenced at the intrapersonal, community, institutional and policy levels. Mothers reported: (1) Bias, racism, and discrimination during healthcare encounters, (2) Cultural expectations of physicians' competence, (3) Challenges in expressing healthcare needs, (4) Postpartum cultural expectations and experiences of maternity and child health services, (5) Trust in the Finnish healthcare system, (6) Community narratives and healthcare encounters, (7) Healthcare encounters that undermined trust, (8) Perceived cultural competence of healthcare professionals, (9) Language barriers during healthcare encounters, (10) Navigating health and social services, and (11) Impact of immigration policies on postpartum support.

Conclusion

Although the findings are grounded mainly in maternity and child health contexts, they point to broader implications for trust and healthcare engagement that may extend to non-communicable disease prevention and management. They also highlight opportunities to strengthen culturally responsive policies and practices, build trust through community-based approaches, enhance healthcare professionals’ cultural competence, and develop interventions responsive to the needs of West African immigrant mothers.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-15253-z.

Background

The population of African immigrants in Finland is consistently rising, including mothers from West Africa [1]. Like other minority immigrant groups in Finland, West African immigrant mothers often face complex challenges navigating between their cultural beliefs and the expectations of Finnish institutions, particularly in healthcare settings [2]. Experiences during healthcare encounters, language barriers, limited information about available services, institutional policies, and cultural beliefs can shape participants´ perceptions of the healthcare system [3, 4]. For instance, a study conducted by [5] indicates that migrants from the Middle East and Africa were least likely to be satisfied in all aspects of access to care.

The Finnish healthcare system and access to care

The Finnish healthcare system is based on universal coverage, providing healthcare services to everyone residing permanently in Finland [6]. The healthcare system is divided into public, private, and occupational healthcare. Publicly funded services include primary healthcare, maternity care and preventive services, which are relatively affordable for everyone [7]. Additionally, everyone has the right to receive emergency medical treatment during their stay in Finland, irrespective of their nationality or country of origin [8]. According to Finland´s new healthcare reforms enforced in 2023, healthcare is organized into 21 Well-being Service Counties (WSC), the city of Helsinki and the former hospital district of Helsinki and Uusimaa (HUS). The WSCs are financed from the state budget through taxation and are responsible for organizing primary and secondary healthcare, including social and rescue services. According to the Ministry of Social Affairs and Health, the Finnish healthcare system is based on preventive, corrective and rehabilitative health services, aimed at maintaining and improving the health, well-being and work ability of the population, including functional capacity, social security and reducing health inequalities [9].

Healthcare professionals in Finland are categorized into licensed professionals and professionals with a protected occupational title. The National Supervisory Authority for Welfare and Health (Valvira) is responsible for issuing licenses and maintaining a public register, JulkiTerhikki, of all healthcare professionals in Finland [5]. For the West African immigrant mother, especially those unfamiliar with the Finnish healthcare system, this structure can be difficult to understand and navigate, particularly in the context of professional rules, building trust, and lived experiences during healthcare encounters [2].

Healthcare quality, trust, and experiences of care

The Global Burden of Disease study conducted in 2018 put Finland in the top position with one of the best healthcare systems in the world [10]. Additionally, Finland was ranked the best country to become a mother by the international Save the Children organization for the second year in a row and has consistently ranked in the top 10 positions for each of the 16 years of compiling the index report [11]. However, in the World Index of Healthcare Innovation, Finland performed poorly in the category of choice, climbing to 31st place with one main reason being strict limitations of patient access to healthcare providers, despite being ranked 3rd place in Quality of care [12]. Research conducted in Finland also indicated that, while Somali women generally expressed satisfaction with maternity care, challenges such as nurses’ attitudes and communication barriers were identified [5]. Despite these positive results on the Finnish healthcare, public confidence has seen a significant drop over the past years, according to the Terve Suomi (Healthy Finland) report, published by the Finnish Institute for Health and Welfare (THL). The results indicate that confidence in the functioning of the healthcare system dropped in 2024 from 76% to 54%, with reasons being continued difficulties in accessing doctors’ services and high user fees, which particularly hinder access to services among older adults [13]. Healthcare mistrust is particularly prevalent among racial and ethnic minority groups who have experienced or perceived systemic discrimination and unequal treatment within the healthcare setting [14, 15].

Cultural negotiation in healthcare encounters

Experiences during healthcare encounters are influenced by individuals’ cultural beliefs and expectations of healthcare professionals [16]. Migrating with children or becoming a parent in a new country comes with challenges, and West African immigrant mothers, like other immigrant mothers, must adapt to a new reality in the host country by bridging cultural gaps through reconciling their own beliefs, values, health practices, norms, and expectations with those of the Finnish healthcare system. These negotiations may involve different understandings and perceptions of health and health practices, differences in expectations between healthcare professionals and patients, and communication styles. Cultural negotiations can be influenced by participants’ previous healthcare experiences in their countries of origin, language barrier, social networks in Finland, socioeconomic status, and interactions with healthcare professionals [16, 17]. Previous studies regarding barriers experienced by immigrant women included, but were not limited to, unfamiliarity with the healthcare system, limited access to information on available services, lack of cultural interpreters, barriers with communication, including language, reluctance to seek care, and cultural differences between patients and healthcare professionals [18, 19]. Cultural negotiation is a two-way encounter that is reciprocal and collaborative and can influence how participants perceive the care provided, their willingness to engage with health services, and compliance with health advice [16, 17], especially in relation to the prevention of non-communicable diseases (NCD).

West African immigrant mothers in Finland

In this study, West African immigrant mothers refer to women who migrated to Finland from the 16 countries of West Africa, a region with a population about 466 million and official languages primarily English and French [20]. While these countries share certain historical, geographical, and cultural connections, West Africa is highly diverse, encompassing multiple nationalities, ethnic groups, religions, cultural traditions, and hundreds of indigenous languages, which continue to play an important role in everyday life, cultural identity, and their healthcare experiences. Participants from the two English-speaking regions of Cameroon were included in this study because of the region´s historical and cultural ties, most especially similarities in cultural beliefs, customs and cuisine [21]. The largest West African communities in Finland are those from Nigeria and Ghana, followed by immigrants from the English-speaking regions of Cameroon, The Gambia, Sierra Leone, and Liberia. Together, these communities comprise approximately 15,444 individuals. Most migrate for family reunification, education, or asylum. Despite the small proportion of the African population (1,4%) in Finland, it is worth noting that there has been a significant increase over the past year [1]. In West African families, mothers play a central, and unifying role which is crucial in influencing household and heath behaviors [22–24], making them key actors in promoting the health of the entire family. Importantly, for many West African immigrant mothers in Finland, maternal healthcare services constitute their primary and most frequent point of contact with the Finnish health system. These encounters, therefore, form a crucial context for understanding their health practices, perceptions, and lifestyle-related decisions.

Knowledge gap and study rationale

West African immigrant mothers in Finland represent part of the growing immigrant population, but their experiences with the healthcare system remain understudied. The paucity of knowledge regarding their experiences is due to the limited number of studies on African immigrants, which have largely focused on immigrant mothers from Somalia [25]. However, the healthcare needs and experiences of immigrant mothers cannot be generalized across African populations.

Given the central role that mothers play within families, their experiences with the healthcare system can have far-reaching consequences for both their own health and the wellbeing of their families. Cultural and structural differences may shape healthcare encounters, access to services, communication with healthcare professionals, and overall satisfaction with care, making it essential to understand how immigrant mothers navigate these interactions. For many West African immigrant mothers, maternity and child health services constitute the first and most sustained point of contact with the Finnish healthcare system. As a result, these settings often shape mothers’ broader experiences of healthcare navigation, communication with professionals, trust in the system, and access to support.

This study explores how West African immigrant mothers experience and navigate the Finnish healthcare system across different healthcare settings, while recognizing that their accounts are primarily situated within maternity and child health services. The study addresses the following research questions: (1) How do West African immigrant mothers experience and navigate the Finnish healthcare system? (2) How do West African immigrant mothers negotiate cultural expectations and practices across socioecological levels while interacting with the Finnish healthcare system?

Theoretical framework

The Socioecological Model (SEM) was initially conceptualized by developmental psychologist Urie Bronfenbrenner in the 1970s and developed as a framework to understand the dynamic interaction between individual development and environmental influences [26]. By the 1980s, it had evolved into a comprehensive theory, emphasizing that human behavior and health outcomes are shaped by interactions across multiple levels of influence, from the individual to institutional policies and societal structures [26, 27]. Over time, SEM has been widely adopted across diverse fields, including public health, social work, and environmental science, as a multidimensional framework for analyzing how layered social and environmental influences shape individual behaviors and outcomes [28, 29].

The model consists of five interconnected levels. The individual level is made up of personal characteristics such as knowledge, beliefs, attitudes, behaviors, and psychological well-being. The interpersonal level considers the influence of close social networks, including family, friends, and peers. The community level refers to the wider social and cultural environment. The institutional and policy levels combine the policies, procedures, and organizational structures within healthcare institutions that influence healthcare provision and access, as well as the laws and regulations that govern equity and equality in healthcare [28, 29].

The SEM is suitable for this study, as it acknowledges that West African mothers’ experiences with the healthcare system are multidimensional. It enables the findings to be mapped across different layers of influence, extending beyond the intrapersonal level to include interpersonal, institutional, and policy contexts that shape these experiences.

Methodology

Qualitative research seeks to understand concepts, experiences, and opinions by exploring people’s behaviors, emotions, and lived realities. Rather than quantifying events, it offers depth and interpretation of human behavior and social interactions, such as experiences with the Finnish healthcare system [30, 31]. A qualitative approach is suitable for this study as it allows for an in-depth exploration of the lived experiences of West African immigrant mothers in Finland regarding the Finnish healthcare system, providing evidence-based information that can be used to develop culturally sensitive policies and interventions that address the healthcare needs of this immigrant group.

Participants and data collection

This study involved 29 in-depth, semi-structured interviews with first-generation West African immigrant mothers living in the Helsinki Metropolitan Area of Finland. Participants were recruited through purposeful and snowball sampling, starting with community leaders who hold formal and informal influence within the West African diaspora groups in Finland, including leaders of cultural associations, churches and community-based social networks, contacted through phone, email and WhatsApp. Eligibility criteria included being a biological or adoptive mother (single or married), residing in Finland, and having a partner of African origin. Prior research shows that immigrant mothers’ experiences are shaped by cross-cultural ties, including the partner’s country of origin, which significantly influences family norms, support systems, and interactions with services [2, 32, 33]. Additionally, interviews were conducted in English, Finnish, or Pidgin English, languages spoken by the first author, and must have lived in Finland for between 1 and 30 years. This would enable the researchers to determine if the duration of stay influenced participants´ experiences with the Finnish healthcare system. Occupational status was not used as a selection criterion, as it was not the focus of this study.

Interviews were conducted between July 2021 and October 2022 and were guided by the PEN-3 [34] model, a three-dimensional framework designed to analyze how culture influences health and the Ecological Models [26]. A pilot phase with three participants led to minor adjustments in the interview guide. (Appendix 1) The interview questions were grouped into themes, including perceptions of health; lifestyle patterns and health behaviors; role expectations; sociocultural and socioeconomic factors influencing health behaviors; social networks; and knowledge of health promotion and chronic disease prevention. Experiences during healthcare encounters emerged as an important topic during the interviews. Consequently, a follow-up question was asked of all participants, including those in the pilot study, to explore how these experiences had influenced their perceptions of the Finnish healthcare system, both positively and negatively. Qualitative individual interviews were chosen over group discussions to foster openness and minimize social desirability bias, particularly within the context of a small and closed community like that of West African immigrant mothers in Finland. Interviews averaged 67 min in length, were primarily conducted in English (97%), and took place at the participant´s chosen date, time, and location. All interviews were audio-recorded, assigned pseudonymous participant identifiers (e.g., M1, M2) to protect confidentiality, and securely stored on a computer. The first author, who conducted the interview and led the analysis is a health researcher with extensive experience working with immigrant communities and from a similar background as the participants. To maintain reflexive awareness, the author kept a reflective diary documenting analytic decisions and emotional responses, and potential biases during data collection and analysis. The second and third authors do not share the same cultural background as the participants, which provided analytical distance and supported critical questioning of interpretations. Informed consent was obtained from all participants by signing an informed consent form, and data collection ceased upon reaching data saturation (see Table 1 for the demographic characteristics of the study participants).

Table 1.

Demographic characteristics of the study participants (n = 29)

Characteristics	n (%)	Additional details
COUNTRY OF ORIGIN
Nigeria	11 (38%)
Ghana	7 (24%)
The Gambia	4 (14%)
Cameroon	3 (10%)
Sierra Leone	3 (10%)
Liberia	1 (3%)
Age of participants	-	Mean: 37; Range: 28–47
Age of children (years)	-	Mean: 6.6; Range: 0.75–21
Duration of stay in Finland (years)	-	Mean: 11; Range: 3–28
Number of children	-	Mean: 2.7; Range: 1–4
MARITAL STATUS
Married/Cohabiting	21 (72%)
Single/Divorced	8 (28%)
EMPLOYMENT STATUS
Employed	20 (69%)
Student	6 (21%)
Unemployed/Maternity leave	3 (10%)

Note: Values are presented as numbers (percentages) unless otherwise indicated. Means are calculated and presented with ranges for continuous variables

Data analysis

The phase of the analysis process involved familiarization with the data. The first author ET transcribed all interviews and reviewed each transcript multiple times to gain a comprehensive understanding of the content. An edited transcription approach was used to correct minor grammatical error and punctuation while preserving participants’ intended meanings, which was important given the use of English, Pidgin English, and local slang. The first author’s familiarity with these language forms supported accurate interpretation.

In the second phase, initial inductive coding was conducted in ATLAS.ti. Each transcript was read line by line, and meaningful units of text were identified and assigned open codes reflecting participants’ own words and experiences navigating maternal healthcare and negotiating cultural contexts. Sections of the coded data were independently reviewed by TV and RL to enhance credibility, and discrepancies were resolved through discussion. The agreed-upon codes were integrated into an inductively developed coding framework that was systematically applied across all transcripts, producing themes that captured recurring patterns in mothers’ experiences.

In the third phase; the deductive phase, these themes were organized into higher level categories using the Socioecological Model (SEM), enabling the researchers to map influences across individual, interpersonal, institutional, and policy levels. SEM provided a structured lens for interpreting the findings while the inductive coding ensured that the analysis remained grounded in participants’ accounts. Anonymized quotations are presented to illustrate key findings and authentically represent the voices of West African immigrant mothers who participated in the study.

Trustworthiness

In this study, several measures were employed to ensure the trustworthiness of the findings [35]. Credibility was supported through independent review of coded segments by multiple authors until consensus was reached. Dependability and confirmability were strengthened by maintaining detailed records of the analytical process, including transcripts, coding, and reflexive diary entries. Transferability was addressed by providing detailed descriptions of the study context, participant characteristics, and recruitment procedures.

Ethical considerations

Participation in the study was entirely voluntary, and informed consent was obtained from all participants after they had received, read, and understood a detailed information letter outlining the purpose, procedures, and ethical considerations of the research. Participants were explicitly informed of their right to withdraw from the study at any point without any negative consequences. To uphold ethical standards, all data were securely stored in accordance with data protection guidelines, and pseudonyms were assigned to protect participants’ identities. No personal identifiable information was included in the analysis, as direct quotations were used in the findings to represent participants’ voices while preserving their anonymity [36, 37].

Given the first author´s shared cultural background with the participants, particular care was taken to maintain professional researcher-participant boundaries throughout the research process, in line with the ethical principles set out by the Finnish National Board on Research Integrity. In Finland, ethical approval was not needed for this kind of research setting [36]. Ethical approval was waived by the University of Helsinki Research Ethics Committee in the Humanities and Social and Behavioural Sciences because the research did not include any of the factors that would require an ethical review. Additionally, as this research falls within the human sciences and does not constitute medical research, it is not subject to the guidelines of the WMA Declaration of Helsinki.

Demographic characteristics of the study participants

As shown in Table 1, Most participants were originally from Nigeria (n = 11, 38%), followed by Ghana (n = 7, 24%). Participants had a mean age of 37 years (range: 28–47 years), had lived in Finland for an average of 11 years (range: 3–28 years), and had an average of 2.7 children (range: 1–4 children). The mean age of the children was 6.6 years (range: 0.75–21 years). Most participants were married or cohabiting (n = 21, 72%), while 20 participants (69%) were employed full-time.

Findings

The findings of this study have been categorized using the Socioecological Model (SEM), according to the appropriate layers that are relevant to the study, as shown in Fig. 1.

Fig. 1.

Study findings based on Bronfenbrenner’s socioecological model [29]

Intrapersonal /individual

Bias, racism, and discrimination during healthcare encounters

Participants reported experiences of bias, racism, and discrimination, most of which occurred during pregnancy, childbirth, and post-partum care. Some participants expressed the belief that their skin color affected the quality of care they received, suggesting they could never be treated the same as native Finns. One participant reflected, “I believe that as a woman of color, no matter how important you are in Finnish society, I will only trust someone non-judgmental, who doesn’t look at your color, who treats you as their patient.” “…when I was there, I felt like an object.” (M11) Several participants also felt that their health concerns were dismissed until their conditions worsened. As one recounted, “The experience I had was just purely racism. I got to the hospital, and I was in pain, but they did not want to give me all the support that I needed until it became too bad. And it left me having a raptured womb. So, that experience has kind of made me not to even want to give birth anymore.” (M2).

Participants described instances in which doctors were perceived to demonstrate unconscious bias. Such biases may influence physicians’ clinical judgments, communication, and decisions regarding patient care. One participant recounted: “I know many people think Africans cannot be depressed, we cannot have mental health issues. This is not true.” (M10) These accounts illustrate how perceived racism and discrimination shaped participants’ experiences of healthcare encounters and influenced their trust in the care they received.

Cultural expectations of physician´s competence

Cultural perceptions of how a competent doctor should behave during medical assessments shaped participants’ views of medical expertise. Some participants reported having a different scale to determine a competent practitioner, where he or she is expected to possess immediate knowledge of diagnoses without relying on external tools. As one participant noted, “If you go to the hospital and you give a complaint to the doctor, they like this issue of looking it up in the computer… I think the doctor should know everything. The doctor should already know what is going on with me when I explain, instead of going to the computer to check.” (M22) These accounts demonstrate how culturally shaped expectations of physicians influenced participants’ perceptions of competence during healthcare encounters.

Challenges in expressing healthcare needs

Expressing healthcare needs was seen as a challenge by some participants due to fear of punitive actions from social institutions. For this reason, some participants preferred to withhold vital information from the Social and healthcare professionals. As one participant shared, “They always ask how I was, but I never wanted to talk about it. Because I think nothing will be done about it. I feel there is no practical thing they are going to help me with. I didn’t want to tell them I was stressed, even though I was stressed.” (M18) Participants’ fears of negative consequences influenced their willingness to openly communicate their health concerns during healthcare consultations.

Postpartum cultural expectations and experiences of maternity and child health services

Postpartum cultural expectations shaped participants’ experiences of maternity and child health services by influencing the type of support they expected from healthcare professionals during the postpartum period.

Participants reported feeling overwhelmed by childcare in Finland, which they described as being far more challenging than in their home countries. One participant, who had experienced motherhood in both contexts, explained: “Having to take care of kids here is 100 times more difficult than back home. I had my first child in…, and I had my second and third in Finland. The difference is just too much.” (M6).

Many described the postpartum period in Finland as lonely and stressful, reflecting a significant cultural mismatch with the extensive support traditionally provided by family and the wider community in their countries of origin. These experiences influenced participants’ expectations of maternity and child health services and shaped how they perceived the adequacy of postpartum support provided by healthcare professionals. As one participant said: “In Africa, we have help from others, from our neighbors, aunties, or uncles. But here, it’s only me and my husband.” (M11) Another added: “Being a mother in … is less stressful because it takes the whole community to raise a child.” (M23).

These postpartum experiences had both physical and psychological consequences, especially for first-time mothers. One participant shared: “I had children in 2013, and I had postpartum depression. This is something back home we will not even think about.” (M23) Another recalled: “The first child I cried for a month because I was operated on and there was nobody. I kept on crying every day.” (M18). Participants described physical symptoms like headaches, tiredness and hair loss and stated by one participant: “Being a mother affected my health really badly. If you look at my hair, I have lost so much hair, which is caused by stress.” (M28) Collectively, these accounts demonstrate how differences in postpartum cultural expectations shaped participants’ expectations and experiences of maternity and child health services during the postpartum period.

Trust in the Finnish healthcare system

A few participants expressed trust in the Finnish healthcare system, which stemmed from positive experiences during healthcare encounters. These participants often compared the availability and accessibility of care in Finland with that in their countries of origin, as illustrated by one participant who stated: “If you are sick here, you get quick help. But in Africa, if you don´t have money, there is no help for you. Some of them, even with the money, still don´t get the right place to go. Here, they treat you before they start talking about paying. So, at least they value life.” (M26) Positive healthcare experiences contributed to participants’ trust in the Finnish healthcare system and reinforced perceptions of equitable access to care.

Interpersonal/community

Community narratives and healthcare encounters

Sharing personal health-related experiences within family and community networks shaped participants’ expectations of future healthcare encounters and influenced their willingness to disclose health concerns during consultations. These concerns were often reinforced by stories of perceived punitive actions by social institutions, leading some participants to withhold important health information during healthcare encounters. One participant explained how she deliberately avoided using the word “stress” during consultations for fear of the consequences: “So, I really don´t have to be using those words often. I have to keep it in my head. If not, the more you repeat it, they will say this lady has a problem, and then they will call the social worker and child protection and a whole lot of things. So even if I am stressed, I will keep it.” (M8).

Healthcare experiences shared with members of the community often spread rapidly within the community. Strong communal bonds, particularly in spaces such as church gatherings and community events, offered participants a space to express their feelings and discuss issues affecting their lives, as one participant described, “We go there, chat, and discuss some of the challenges. When you go to church, you can chat and confide with someone you trust.” (M20) Experiences shared within family and community networks influenced participants’ expectations of future healthcare encounters and their communication with healthcare professionals.

Institutional

Healthcare encounters that undermine trust

Almost all participants described one or more negative healthcare encounters that contributed to feelings of mistrust toward the Finnish healthcare system. Several participants became emotional while recounting these experiences, indicating their lasting impact. Even when the incidents had occurred more than five years earlier, participants described them as traumatic and influential in shaping their trust in subsequent healthcare encounters. As one participant explained: “With the healthcare system, when it comes to the care that foreigners get, I don´t trust it. I had an incident where they were going to give me blood without my consent, and with my second child… my husband was left there for more than 4 hours without a word. He didn’t know what was happening. He didn’t know if I was alive.” (M21) Several participants attributed their mistrust to experiences with physicians, particularly following perceived misdiagnoses or medication errors. One participant recalled: “I have been misdiagnosed in Finland., I was given the wrong medication, and I was feeling the side effects. I went back to the hospital, and they said the doctor was supposed to have called you. Sorry, you were given the wrong medication. If I had not gone back to the hospital, what would have happened to me?” (M23) Some mothers also described medication errors involving their children’s care. One participant explained: “The doctor checked and said she had an ear infection, and he made a prescription for 7 days. On the third day, she started having rashes all over her body. When the doctor checked her file, he said they had given her the wrong prescription.” (M7) These experiences illustrate how negative healthcare experiences contributed to long-term mistrust of the Finnish healthcare system in the context of maternity and child health services.

Perceived cultural competence of healthcare professionals

Participants highlighted a perceived lack of culturally competent care during healthcare encounters. Several participants described experiences with public health nurses in maternity and child health clinics (neuvola), midwives, and hospital nurses, who they felt did not fully understand their cultural backgrounds and healthcare needs. One participant explained that public health nurses at the maternity and child health clinic (neuvola) primarily focused on the child’s health rather than the mother’s well-being:

“When I go to the neuvola (Maternity and child health clinic), mainly they ask about the child’s health. They could pay attention to African mothers. We are too shy to express how we feel.” (M10) Participants felt that more proactive and culturally sensitive communication from public health nurses could help identify underlying concerns such as stress or depression.

Several participants also experienced a lack of cultural competence among midwives during childbirth, which they believed affected clinical assessment and care. One participant described how midwife misinterpreted her appearance during labour:

In the cause of giving birth… I was not examined when I told them I was having a contraction. I think there was a bit of a cultural issue here. Before I went to the hospital, I was like I have to look nice for my baby to see the mother looking that nice. So, I put on good makeup before going to the hospital. When they saw my appearance, they thought I was not in pain. So, they told me to go for a walk. I said no, I cannot walk. They insisted that it was good for me. When they checked, I had dilated almost 10 cm. The nurse couldn´t believe it. The cultural aspect here is that they did not know that in Africa, when you are going to the hospital, you have to look presentable. She had to call another nurse to come and confirm if I was really dilated. I was in pain, but they didn´t believe me. (M21).

The participant believed that the midwife’s interpretation of her appearance reflected a lack of awareness of cultural norms regarding personal presentation during childbirth. These accounts illustrate how culturally insensitive communication and care influenced participant´s experiences of maternity and child health services.

Another participant described what she perceived as unprofessional behaviour from a midwife despite the absence of language barriers: “When I was in labor, I was told I was 3 cm dilated and that I should go pee, and I started feeling the need to push. I screamed out of the pressure. The nurse told me I was hurting her ears, and I had my baby on the floor, like lying down on the floor, because when I came out of the bathroom, I knew I couldn´t make it to the bed, so I had to lie down.” (M23).

Some participants also reported that healthcare professionals did not provide timely or culturally appropriate preventive health information. One participant explained that she was not informed about the importance of vitamin D supplementation for people with darker skin until she had lived in Finland for some time: When I first moved here, I was not told that I had to take vitamin D. So, I was living here for some time before I got that information. Because in …., we don´t take vitamin D, which was not in my routine.” (M21) These accounts demonstrate how culturally insensitive communication and care shaped participants’ experiences of maternity and child health services.

Language barriers during healthcare encounters

Several participants identified language barriers during healthcare encounters as a significant factor contributing to negative experiences and mistrust. Due to the lack of a shared language, healthcare professionals, including doctors, nurses, and midwives, were sometimes perceived as being unable to provide clear or sufficient information. One participant shared: “…sometimes they want to tell me something, and they like to use the Finnish word, let’s try to see if we can find it in English. They keep searching, and they are like aah they can’t express this particular word in English.” (M7).

At the same time, some participants reported difficulties expressing their own healthcare needs, which further complicated communication. “The language has also had an impact. There are some things that you cannot explain well to the health practitioners to understand what you really mean.” (M21) Others described how the absence of a common language led to a lack of information or even misinformation. For example, one participant whose husband was not provided information about her current health situation recalled, “…It’s the language. Because they didn’t know who would go and speak to him in English, he being a foreigner.” (M24) To some participants, language barrier was frequently used as an excuse to justify culturally insensitive care or the failure to provide necessary information. As one participant put it, “I feel like the language is always what they use. It’s always that you don’t speak the language.” (M1) These accounts illustrate how language barriers affected participants’ communication during healthcare encounters.

Navigating health and social services

Some participants described challenges in navigating the healthcare and social support systems, especially those who had not lived long in Finland. A lack of accessible information about available resources and support emerged as a major challenge for many, particularly during stressful periods such as postpartum. As a result, some relied heavily on informal networks, such as friends and family, for information and limited support. One participant emphasized, “Many Africans don’t know about the support or services that are out there for us. That is a huge thing.” (M9).

Others reported that when support was offered, it was often insufficient or delayed, particularly for those with limited Finnish language skills. One participant recounted, “…The social came and said they can also render help, but once a day in a week for 3 hours… It’s been almost 6 months, and nothing has been done. They called me and said we haven’t gotten someone who can speak English or Swedish, only Finnish.” (M13) These accounts illustrate how limited knowledge of available health and social services affected participants’ ability to navigate the Finnish healthcare system, particularly during the postpartum period.

Policy

Impact of immigration policies on postpartum support

Almost all participants felt that Finnish immigration policies failed to recognize the unique needs of African immigrant mothers, particularly regarding extended family involvement during the postpartum period. A common concern was the repeated refusal of visa applications for mothers or other close relatives, who traditionally provide crucial postpartum support. Despite meeting financial requirements, participants reported that visa applications were often denied without clear justification. As one participant explained: “I applied for a visa for my mum, but they refused. So, I had to do all of this by myself. I wish I had been a parent in [another country], not Finland, because the stress one is undergoing both emotionally and physically is so hard and draining.” (M8).

The lack of familial support placed a substantial emotional and physical burden on new mothers, particularly during the postpartum as many relied on healthcare professionals for support traditionally provided by extended family. In cases where a parent or in-law was granted a visa, participants highlighted the essential and beneficial support they received, though it was often short-lived because visas were typically granted for only three months. One participant shared: “Thank God my mother-in-law was around for the first 3 months. After 3 months, I faced reality when she left. I felt that I needed help, and it was very stressful.” (M12).

Attempts to extend the visa were often unsuccessful, further compounding stress: “Three months is not enough… I tried to extend the visa, but it was rejected.” (M22) Some participants described the visa process as costly both financially and emotionally, with the duration of granted visas not reflecting the effort involved: “For me to go through all these financially, and emotionally, and you end up getting only three months?” (M19) “The struggle is not worth the length of time given for the visa.” (M20). Several participants felt that social services and public health nurses working in maternity and child health clinics (Neuvola) could have done more to support their visa applications for postpartum assistance. One participant stated: “I have been talking to social and Neuvola (Maternity and child health clinic), as many times as I can think of, asking them to help me write a note so that I can use it to bring my junior sister or anybody, just someone who can help me.” (M13). Depression was a prominent outcome of the absence of support and was described by nearly all participants, as one mother stated: “I withdrew from everything. I didn´t want to do any kind of social stuff. I think I was depressed even though I was never diagnosed.” (M9) Together, these accounts demonstrate how immigration policies indirectly shaped participants’ healthcare experiences by limiting access to culturally expected postpartum support.

Discussion

Although this study explored West African immigrant mothers’ experiences of the Finnish healthcare system more broadly, participants’ narratives were predominantly situated within maternity and child health services. For many immigrant mothers, these services represent the first and most sustained point of contact with the healthcare system and may shape healthcare navigation, communication with professionals, trust, and access to care. The findings are therefore interpreted primarily within the maternity and child health context, while also providing insights into participants’ broader experiences of engaging with and navigating healthcare services in Finland.

The findings demonstrate that mothers’ experiences were shaped by factors operating across socioecological levels, including interpersonal communication challenges, institutional gaps in cultural competence, and structural forms of discrimination rooted in policies and organizational practices. Issues such as language barriers, perceived professional incompetence, lack of informed consent, misdiagnosis, treatment errors, and disregard for patient autonomy illustrate how institutional and structural dynamics intersect with individual encounters. These multilevel influences are consistent with previous evidence showing that language barriers, cultural differences, and negative healthcare encounters can undermine communication, trust, and engagement with healthcare services among immigrant populations [15, 19].

Participants’ experiences and challenges, including communication barriers, limited cultural responsiveness, and difficulties navigating the healthcare system, also appeared relatively stable over time. This suggests that mothers perceived persistent institutional and structural barriers within maternity and child health services, consistent with previous research indicating that many barriers faced by migrants persist and are largely independent of the duration of residence in the host country [38].

A sense of community played a vital role in supporting participants’ emotional well-being, yet the circulation of negative healthcare experiences within these networks also shaped shared perceptions of the Finnish healthcare system. Community discussions often functioned as informal and trusted sources of information, meaning that a single negative encounter could be amplified and incorporated into broader narratives of caution or mistrust. This pattern aligns with a scoping review on African immigrants in the United States, which highlights how community-level storytelling can reinforce both protective behaviors and avoidance of healthcare services [39]. Such circulating narratives may further weaken trust [15, 40, 41], particularly in the Finnish context, where confidence in the healthcare system has recently declined among ethnic Finns following healthcare reforms [13]. For immigrant communities already facing structural and communication barriers, these shared negative accounts may intensify hesitancy and reduce willingness to seek care when needed.

Participants’ trust in the healthcare system was also shaped by their direct encounters with healthcare professionals, past traumatic experiences, and perceptions of unequal treatment. These experiences contributed to varying degrees of mistrust, echoing previous studies showing that racial and minority groups who have experienced discrimination or inadequate communication during healthcare encounters report higher levels of mistrust [14, 15]. Such mistrust can have significant consequences, including reduced treatment adherence, delayed diagnoses, and negative impacts on both physical and psychological wellbeing [15, 42–44]. The findings therefore align with a growing body of research demonstrating that mistrust influences how individuals interpret their healthcare experiences and make decisions about when and how to seek care [39, 45].

Cultural expectations surrounding medical expertise also shaped perceptions of professional competence. Although contemporary medical practice emphasizes evidence-based decision-making and interdisciplinary consultation, some participants viewed the need to consult external sources as a lack of competence. These perceptions may weaken healthcare engagement, contributing to non-adherence and delayed help-seeking. In contrast, research on doctors’ expressions of uncertainty found that the use of books or computers during consultations was generally accepted as a constructive means of accessing accurate information, whereas explicit verbal expressions of uncertainty were perceived as undermining patient confidence in the doctor’s expertise [46].

Participants further described a lack of culturally sensitive care, particularly among people of color, which they attributed to limited cultural competence and unconscious biases among healthcare professionals. From a socioecological perspective, these experiences operate across multiple levels. At the interpersonal level, they reflect the quality of patient, nurses and doctors´ interactions, where communication styles, assumptions about patients’ backgrounds, and implicit biases shape how care is delivered and interpreted. At the institutional level, participants’ accounts point to systemic gaps in training, organizational norms that do not prioritize cultural responsiveness, and clinical environments that are not designed to accommodate diverse cultural expectations. At the structural level, participants’ accounts reflect broader inequities described in previous research, including Eurocentric models of care and policies that insufficiently address the needs of immigrant communities. Consistent with previous research, culturally competent healthcare delivery is central to achieving quality and equity for minority populations [47]. When such competence is lacking, mistrust deepens, communication becomes strained, and patients may step back from services, contributing to poorer health outcomes. Taken together, these findings highlight the importance of viewing cultural competence not only as an individual skill but also as an institutional responsibility [48]. The findings also align with a United Kingdom (UK) survey on patient experience and trust in the National Health Service (NHS), which found that patients from Black and ethnic minority groups felt that primary care providers were less likely to listen to their concerns [49]. Given that the relationship between a healthcare professional and a patient is grounded in trust, lack of cultural sensitivity can further exacerbate healthcare mistrust across all levels of the SEM.

Participants also reported challenges in communicating with healthcare professionals, often due to the absence of a shared language and a perceived lack of empathy. In some cases, mothers felt that the language barrier was used as a justification for dismissive or negative attitudes, reinforcing feelings of marginalization. These findings align with previous research showing that the lack of a common language is a major barrier during healthcare encounters [39, 50, 51]. Language barriers can hinder patients’ ability to articulate symptoms and concerns, increasing the risk of misdiagnosis, inappropriate treatment, poor treatment adherence, delays in care, and reduced trust and satisfaction [50, 51]. Beyond the clinical encounter, limited language proficiency can also restrict patients’ understanding of available services and pathways to care, further constraining access and utilization [52].

Finally, many participants reported experiencing emotional distress, loneliness, and symptoms of depression when loved ones were denied visas to provide postpartum support, a form of care deeply rooted in their cultural traditions. These accounts were shaped by expectations of postpartum care in their home countries, where extended family members play a central role in supporting the mother and caring for the newborn. In contrast, Finland’s predominantly nuclear family structure and more individualistic social norms left many mothers feeling isolated during a period when communal care is typically expected. Social support is well established as a protective factor for maternal physical and psychological wellbeing, consistent with studies demonstrating its positive influence on maternal health and child development [53]. Conversely, the absence of such support can heighten vulnerability to loneliness, stress, depression, and anxiety [54]. These experiences highlight how a lack of institutional understanding of immigrant mothers’ cultural expectations, combined with restrictive or culturally insensitive policies, can contribute to social marginalization. Participants perceived that recent immigration policies limiting family reunification further restricted access to culturally meaningful postpartum support [55], deepening the gap between mothers’ needs and the support structures available to them.

Implications for policy and practice

Taking into consideration the growing African immigrant population in Finland and the increasing diversity of clientele, the findings of this study highlight the urgent need for culturally sensitive healthcare policies. Such policies should prioritize training healthcare professionals in cultural competence and implementing reforms that acknowledge the unique characteristics and family dynamics of immigrant groups. Building trust between African immigrants and healthcare professionals also requires institutional commitment and the engagement of cultural mediators who bridge both language and cultural gaps. By preventing and de-escalating misunderstandings, these mediators play a crucial role in fostering effective communication, resolving conflicts resulting from cultural misunderstandings, and increasing immigrants’ awareness of available services [56, 57].

To ensure that healthcare policies truly reflect a diverse Finland, policymakers should actively include minority group representation in healthcare discussions and decision-making processes. In addition, public health strategies on health promotion should move beyond a one-size-fits-all approach by addressing cultural, social, and psychological barriers that hinder timely and sustained engagement with the healthcare system.

Recommendations for future research

Given the influential role that West African immigrant mothers play in shaping family health behaviors and the strong influence of community narrative on healthcare perceptions, interventional studies are needed to identify effective strategies for establishing trust, improving access to care, and promoting positive healthcare engagement and outcomes among the immigrant groups in Finland. Comparative studies involving other immigrant groups would also be valuable, as they would help identify broader patterns and variations in healthcare access, trust, and help-seeking across diverse populations.

Conclusion

Although the study considered broader interactions with the Finnish healthcare system, participants’ accounts were primarily situated within maternity and child health services, and the findings should therefore be interpreted within these contexts. Guided by the socioecological model, the findings show that individual, interpersonal, institutional, and policy-level factors shaped mothers’ experiences and influenced communication, trust, and healthcare engagement, with potential implications for non-communicable disease prevention and management. The findings also indicate opportunities to strengthen culturally responsive policies and practices, build trust through collaboration with grassroots organizations and cultural mediators, enhance healthcare professionals’ cultural competence, and develop public health interventions that reflect the needs and cultural contexts of West African immigrant mothers.

Strengths and limitations of the study

The study provides valuable insight into West African immigrant mothers’ experiences of the Finnish healthcare system, an area that remains underexplored, with participants’ accounts primarily situated within maternity and child health services. The qualitative methodology and application of the Socioecological Model enabled examination of the individual, interpersonal, institutional, and structural factors shaping participants’ experiences. The inclusion of direct quotations enhanced transparency and ensured that participants’ perspectives were clearly represented.

The first author’s shared cultural background with participants may have supported trust and open dialogue, which was particularly valuable given the sensitivity of the topics discussed. Reflexive journaling was used throughout the research process to examine potential assumptions and reduce the influence of researcher subjectivity. In addition, the analysis was conducted collaboratively with two researchers from different cultural backgrounds, supporting reflexivity, interpretive depth, and the credibility and trustworthiness of the findings.

Despite its strengths, this study has several limitations. Although part of the interview explored experiences with the Finnish healthcare system more broadly, participants’ accounts were predominantly drawn from maternity and child health services, which represented participants’ main point of contact with the healthcare system. Consequently, the findings may not fully reflect West African immigrant mothers’ experiences in other areas of the Finnish healthcare system. Additionally, participants’ experiences primarily involved physicians, nurses, midwives, and public health nurses working within these health care and therefore may not reflect experiences with all healthcare professionals or other sectors of the Finnish healthcare system. Furthermore, although participants were grouped under the broader category of West African immigrant mothers for analytical purposes, considerable heterogeneity exists within this population, and the findings should not be generalized to other African immigrant populations or cultural groups. As with other qualitative interview studies, the findings are based on participants’ self-reported experiences and may therefore be influenced by recall bias and subjective interpretation. Finally, recruitment through community leaders may have influenced who was reached and who felt comfortable participating. To minimize this potential bias, participation was voluntary, multiple recruitment pathways were used, and community leaders were not informed about who ultimately agreed to participate.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

HUS

City of Helsinki and the former hospital district of Helsinki and Uusimaa

NCDs

Non-communicable diseases

NHS

National Health Service

SEM

Socioecological Model

THL

Finnish Institute for Health and Welfare

UK

United Kingdom

Valvira

The National Supervisory Authority for Welfare and Health

WSC

Well-being Service Counties

Author contributions

All authors contributed to the study. The interviews were conducted and transcribed by the first author ET, who also led the initial coding. Two other authors, TV and RL independently coded portions of the data to enhance credibility. The first author ET then applied the agreed-upon coding scheme to the full dataset, and drafted the full manuscript, with TV and RL providing feedback on all versions.

Funding

Open Access funding provided by University of Helsinki (including Helsinki University Central Hospital).

Data availability

The datasets analyzed during this study are not publicly available due to information that could compromise the privacy of research participants but are available from the corresponding authors upon request.

Declarations

Ethical approval and consent to participate

Participation was voluntary, and informed consent was obtained from all participants before data collection. The University of Helsinki Research Ethics Committee in the Humanities and Social and Behavioural Sciences confirmed that prior ethical review was not required because the study did not involve any of the conditions requiring ethical review under the applicable Finnish guidelines. The study was conducted in accordance with the ethical principles of the Finnish National Board on Research Integrity. As the study was non-medical human-sciences research, it was not governed by the WMA Declaration of Helsinki.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.