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Abstract

Background: Civil war and clan conflict in Somalia caused a refugee crisis in Eastern Africa in the late 1990s and early 2000s. Many Somali women were forced to leave their families and previous lives of stability behind in search of safety; there was no certainty about the end of the violence. Their unstable condition without protection quickly made many Somali women become refugees. Those Somali women who were able to seek out this protective status and successfully apply for resettlement in the United States were among the few who were able to physically escape the cruelty of clan violence. Nevertheless, upon resettlement to the United States, Somali refugee women were faced with a new, unique set of circumstances and barriers to navigate with healthcare access. While accessibility to health care providers was in short supply back in Somalia, these women are still underprivileged in accessing health care in the United States by virtue of their identity as part of two minority identity groups—Muslim and Black. Somali refugee women show resilience in overcoming the many obstacles in their journeys through acclimating to life in a new country. Nevertheless, it remains imperative that Somali refugee women receive equitable access to healthcare opportunities—particularly reproductive and mental health care given their needs as an especially vulnerable population. Objectives: This thesis addresses questions about the importance of listening to the narratives of traumatized yet resilient populations like Somali refugee women. Their stories identify the importance of language access for resettled individuals who may not be comfortable speaking English fluently to their health care providers. Additionally, this thesis identifies the importance in contextualizing misconceptions and stigmas about reproductive and mental health care through furthering the understanding of Somali culture. Stakeholders—including community leaders, refugee resettlement officers, mental health clinicians, primary care providers, Imams—should be able to identify gaps in between current healthcare infrastructure and advocate on behalf of the Somali refugee women in their communities. Methods: The research for this senior thesis was conducted in two phases: the first included a series of in-depth semi-structured interviews with 32 Somali refugee women and 56 key informants who work directly with this population across four interview sites: Columbus, OH; Phoenix, AZ; San Diego, CA; and Seattle, WA. The second phase involved transcribing, coding, and identifying the most glaring issues in the Somali refugee community. This process allowed for further in-depth research about the issues regarding the refugee resettlement process, reproductive health care access, and mental health care access. Results: The narratives of the Somali refugee women and key informants across all interview sites identified that Islamophobia, structural racism, socioeconomic inequality, stigma, language barriers, cultural misconceptions, and lack of public health education contribute to their barriers of healthcare access. There are also already initiatives currently in place at certain interview sites that directly combat several of these barriers to access, and these programs are successful in their formation of communities that Somali refugee women can rely on. Conclusion: Though Somali refugee women are representative of one vulnerable population in the United States, many of the challenges experienced by them are parallel to those of other refugee and immigrant communities. Suitably, this thesis offers five key recommendations for community leaders, public health officials, and other relevant stakeholders to implement in order to better educate and provide solutions for improved access to reproductive and mental health care services for vulnerable populations—including Somali refugee women—in the United States