'And that was her choice': Dutch general practitioners' perceptions of the autonomy of patients with non-western migration backgrounds who experience domestic violence.

Women in the Netherlands with non-western migration backgrounds experience domestic violence at the intersection of culture and gender, and visit their general practitioners (GPs) with health concerns related to the violence. Drawing on semi-structured interviews with GPs, this paper illuminates how GPs navigate the process of decision-making around intervention in domestic violence, with particular attention to the role of autonomy. Patient autonomy is a core principle in Dutch general practice. The term refers to the principle that GPs must respect that competent adults can make autonomous decisions about the care they do and do not want, and that GPs must respect patients' views, choices, and ways of life. The interview data shows great variation in how GPs respond in situations of domestic violence against women with non-western migration backgrounds. Deploying 'somatechnics of perception', this paper explores how GPs' perceptions of their patients' autonomy are both the agent and effect of a complex and embodied negotiation of gender, race, culture, ethnicity, medical ethics, and morality. In highlighting how these patients' autonomy is rendered (un)intelligible and (il)legible in contextually specific ways, this paper sheds light on how GPs in the Netherlands can better assist women with non-western migration backgrounds who experience domestic violence.

Experiences of peripartum depressive symptoms among Chinese middle-class migrant women in the Netherlands: a qualitative study of migrant motherhood.

BACKGROUND: A low educational level and poor economic status have repeatedly been identified as the main risk factors of peripartum depression among migrant women in existing studies. However, there is limited knowledge about a group of highly educated and middle-class migrant women, and how this group of migrant women deals with those risks and which protective factors facilitate a successful transition into motherhood in the host country. This study aims to shed light on the multifaceted psychosocial challenges during the peripartum period for Chinese migrant women in their relationships with intimate partners, mothers, and mothers-in-law. METHODS: In this qualitative study, semi-structured in-depth interviews were conducted digitally with 46 pregnant and postpartum middle-class Chinese migrant women with peripartum depressive symptoms in the Netherlands. The interview data were analyzed using content analysis. RESULTS: The multifaceted psychosocial challenges for women with peripartum depressive symptoms were classified into three key categories: the ambivalence towards different mothering values, perceived inadequate and mismatching social support and adverse childhood experiences. CONCLUSION: Well-educated middle-class Chinese migrant women with peripartum depressive symptoms faced challenges in the transition into motherhood due to the unmet self-expectations regarding the pursuit of a good quality of life and a happy motherhood. The nurturing intimate relationships and adequate social support in the host country have mitigated recollections of their adverse childhood experiences. Future prevention programs and postpartum care should consider the contextual specificity based on the childhood history. International mental health research should pay more attention to the growing and potentially vulnerable group of well-educated middle-class migrant women.

Understanding the relationship between maternity care providers and middle-class Chinese migrant women in the Netherlands: A qualitative study.

OBJECTIVE: This study aims to provide insights into the formation and the quality of the maternity care provider-woman relationship between midwives, maternity care assistants and middle-class Chinese migrant women in the Netherlands. DESIGN: online in-depth interviews addressing interpersonal trust, women's autonomy in shared decision making and culturally sensitive care PARTICIPANTS: 46 middle-class Chinese migrant women, 13 midwives and 12 maternity care assistants in the Netherlands FINDINGS: Midwives and maternity care assistants reported challenges interpreting the needs of middle-class Chinese migrant women in care practices while Chinese migrant women experienced receiving insufficient emotional support. Midwives and maternity care assistant tended to attribute women's different preferences for care to culture which reinforced difficulties of addressing women's needs. Middle-class Chinese migrant women experienced a lack of responsive care, feelings of being overlooked, being uncomfortable to express different opinions and challenges in developing autonomy in the shared decision-making process. CONCLUSIONS: A trusting relationship, effective communication with maternity care providers, and a culturally sensitive and safe environment could be beneficial for middle-class migrant mothers. Chinese migrant women held ambivalent attitudes towards both traditional Chinese health beliefs and Dutch maternity care values. Each individual woman adopted the practice of the "doing the month" tradition to a different extent. This indicated the need for maternity care providers to recognize women's various needs for more responsive and individualized care, especially for first-time migrant mothers to negotiate their ways through the new healthcare system. IMPLICATIONS FOR PRACTICE: We suggest a more proactive role for maternity care providers addressing the individual's subjectivity and preferences. Our findings are relevant and applicable for maternity care professionals conducting shared decision making with middle-class and highly educated migrant women living in Western contexts.

Dementia care-sharing and migration: An intersectional exploration of family carers' experiences.

BACKGROUND AND OBJECTIVES: Previous studies show that persons with a migration background (PwM) caring for a family member with dementia often experience access barriers to formal care services, and that family carers often perform the lion's share of care. Yet research offering a detailed account on their experiences of dementia care-sharing is sparse. In this paper, we respond to this knowledge gap by exploring how different social categories impact on practices of care-sharing in our participants and their families. RESEARCH DESIGN AND METHODS: A qualitative study of six PwM who provide care for a family member with dementia was conducted through two methods: semi-structured, life-story interviews followed by "shadowing" our participants in their daily lives. We were guided by intersectionality as an analytical lens in exploring the multifaceted experiences of care-sharing. FINDINGS: Throughout our analysis, intersections of migration history and social class stood out the most. We elucidate how they influence the attainment of necessary skills to organize and share care-tasks as well as perceptions of "good care." Additionally, our findings illustrate how one's position within the family, the presence or absence of supportive social networks, religion, gendered care norms, and relationship to the care-recipient are relevant to experiences of care-sharing. IMPLICATIONS: Rather than overemphasizing ethnicity and culture, practice and policy should take into account that intersections of various social categories affect care-sharing and the type of support that is (or is not) organized.

Harmful cultural practices in the consultation room: Dutch general practitioners' views and experiences.

We discuss Dutch general practitioners' responses to patients, mostly women of migrant background, with needs related to Harmful Cultural Practices. Our aim was to discover whether they encounter these kind of health issues and how they respond. We suspected that the patients concerned would not get the care they needed. We found that there is reason for concern, as based on general practitioners' own accounts we conclude that notwithstanding their great commitment to these patients they were disinclined to intervene, because they were cautious to judge other cultures and because they may have over- or underestimated the women's autonomy.

Persons With a Migration Background Caring for a Family Member With Dementia: Challenges to Shared Care.

BACKGROUND AND OBJECTIVES: By shedding light on the reasons why persons with a migration background (PwM) may take up the role of family caregiver of a person with dementia, and how this relates to gender norms, we aim to elucidate cultural and social dynamics that impede care sharing. RESEARCH DESIGN AND METHODS: A qualitative study of 12 PwM who provide care, or have recently provided care, for a family member with dementia was conducted through semi-structured interviews. Identified themes and patterns were analyzed with the help of Hochschild's interpretive framework of framing and feeling rules. FINDINGS: Our findings illuminate how motivations to provide care are framed through two moral framing rules, reciprocal love and filial responsibility, and how these framing rules are accompanied by the feeling rule of moral superiority over non-caregiving family members. We show how shared dementia care is impeded though these moral framing and feeling rules, and how gender norms impact on an unequal distribution of care-tasks. IMPLICATIONS: Healthcare practitioners should identify the moral dialectics of caregiving. This means that, on the one hand, they should be aware that moral framing rules may pressure women into exclusive caregiving, and that this can lead to health problems in the long term. On the other, healthcare practitioners should recognize that providing care can create a deep sense of pride and moral superiority. Therefore, showing acknowledgement of the caregiver contribution is a crucial step in creating trust between the caregiver and healthcare practitioner. Furthermore, asking for support should be normalized. Governmental advertisements on care-support can achieve this.

Narratives of meaningful endurance - how migrant women escape the vicious cycle between health problems and unemployment.

Migrant women in Europe have a higher incidence of health problems and have disproportionately high unemployment rates. We examine how Dutch and Turkish, Moroccan and Surinamese first and second generation migrant women escape the vicious cycle between health problems and unemployment by using the theory of the Sense of Coherence (SOC). We study how SOC works and whether SOC is also applicable outside the domain of health. Our findings from life story interviews (N = 54) show that women can escape this vicious cycle through the meaningful reconstruction of adversity. Women can put a halt on the on-going negative chain reaction through focusing on the meaning and purpose of adversity. We name such life stories narratives of meaningful endurance, which are characterized by structure, authorship and meaningful reconstruction, in opposition to its counterpart, narratives of non-directional distress. The three respective components of SOC - comprehensibility, manageability and meaningfulness - enable the attainment of a narrative of meaningful endurance and individuals with a stronger SOC are more likely to tell narratives of meaningful endurance. Theoretical and policy implications of our findings are discussed.

The mechanisms behind the formation of a strong Sense of Coherence (SOC): The role of migration and integration.

Considering how much we know about the impact of the Sense of Coherence (SOC) on different health-related outcomes, we know surprisingly little about how a strong SOC actually develops. In this study we examine the mechanisms behind the formation of a strong SOC and study the role of migration, integration and general resistance resources (GRRs) in this process. We held 46 life-story interviews with women of Turkish, Moroccan and Surinamese descent. We divided the respondents in a relatively strong and weak SOC group in order to discern patterns of life experiences associated with SOC development. We find that, as Antonovsky predicted, experiencing consistency and load balance are associated with a strong SOC. In opposition to Antonovsky's claims, decision making power is not a necessary condition to develop meaningfulness. Moreover, the women's life narratives show that migration and integration are related to the mechanisms shaping SOC, yet, the impact is subjective and depends on the availability and use of GRRs. Our findings provide improvements to Antonovsky's salutogenic theory and provide suggestions for interventions aimed at strengthening SOC.

"I felt so hurt and lonely": suicidal behavior in South Asian-Surinamese, Turkish, and Moroccan women in the Netherlands.

Young immigrant women in the Netherlands demonstrate disproportionate rates of suicidal behavior. This study investigated the origins of suicidal behavior in South Asian-Surinamese, Turkish, and Moroccan immigrant young women in order to identify ethnic- and gender-specific patterns of suicidal behavior. Based on life story interviews of women who had been enrolled in mental health care, we constructed five typical patterns in which social, cultural, and personal factors were interconnected. Suicidal behavior was influenced by the ability and right to act autonomously with regard to strategic life choices, as well as by the questioning of cultural values of self-sacrifice and protection of honor.

Suicidal behavior and ethnicity of young females in Rotterdam, The Netherlands: rates and risk factors.

OBJECTIVE: Although Western Europe is becoming increasingly multicultural, ethnic minorities are scarcely included in studies of suicidology. We investigated the prevalence of non-fatal suicidal behavior and examined risk factors in non-western female immigrant adolescents compared to majority female adolescents in the city of Rotterdam, The Netherlands. DESIGN: We conducted logistic regression on a dataset that consisted of self-reported health and well-being questionnaires filled out by 4527 adolescents of Dutch, South Asian-Surinamese, Moroccan, and Turkish origin. We examined whether young females of specific ethnic groups had elevated risk for attempted suicide. Well-known risk factors in suicidology of social economic class, level of education, life events, abuse, and family context were investigated to verify whether these factors are beneficial to explaining ethnic differences in suicidal behavior. RESULTS; We found that rates of attempted suicide among Turkish and South Asian-Surinamese young women were higher than of Dutch females, while Moroccan females had lower rates than Dutch female adolescents. Physical and sexual abuse, and an impaired family environment, as well as parental psychopathology or parental substance abuse contributed to non-fatal suicidal behavior of females across ethnicities. However, these risk factors, as well as low social economic class and of level of education, did not fully explain the vulnerability of Turkish and South Asian-Surinamese females. CONCLUSION: Our findings underscored the need for developing suicide prevention for specific minority females in multicultural cities in Western Europe. Screening programs, which aim at preventing suicide attempts by young immigrant women should include risk factors in the family environment and relationship with the parents as well as physical and sexual abuse. However, the study also showed that the disproportionate risk of Turkish and South Asian-Surinamese females could not be understood by risk factors alone and transpired that the origins of ethnic disparities in suicidal behavior deserve further examination.

Gender and cultural patterns of suicidal behavior: young Hindustani immigrant women in the Netherlands.

Patterns of suicidal behavior vary among cultures and along gender. Young Hindustani immigrant women attempt suicide four times more often than young Dutch women. This article explores multi-disciplinary explanations for suicidal behavior in this group. The interconnection of Durkheimian concepts of social integration and regulation with ecological insights into family relations and psychological and psychiatric theories on individual distress are relevant. It is suggested that young Hindustani women who display suicidal behavior possess certain personality and cognitive constellations that are interlocked with specific parenting styles in stressful family environments. These families are embedded in a context of moral transformations resulting from migration to a Western culture and may be facing difficulties accompanying the transitional processes encountered in the West, particularly those regarding gender roles. Durkheimian fatalistic and anomic suicides elucidate this. The Hindustani women who appear most at risk are those facing contradictory norms and overregulation, which prevent them from developing autonomy.