Minnesota is home to about 87,000 Somali-Americans, making up 1.6% of our entire population. This is more than any other state in the nation. Most reside in the Twin Cities metropolitan area. As a significant part of the communities we serve, it is crucial they’re met with inclusive and culturally sensitive care that respects and reflects their rich backgrounds and beliefs.
While this may seem intuitive, as health care professionals navigate busy clinics and hospitals, it’s easy to make quick assumptions or fail to recognize a patient’s cultural differences.
To ensure our Somali-American patients and families feel valued, respected and supported, experts from The Midwest Fetal Care Center (MWFCC), a collaboration between Allina Health and Children’s Minnesota, conducted research on the perceptions, personal and community experiences, and barriers to specialized maternal-fetal care of Somali-American families.
The study
The team conducted a focus group study of 50 Somali‐American women in seven groups. Interviews took place at a local Somali community center and were conducted in Somali by experienced facilitators who were licensed nurses. Researchers used qualitative analysis techniques to identify and report five key themes.
The findings: five key themes
1. Adherence to religious belief (namely Islamic) is crucial and informs their opinions on the permissibility of fetal intervention. Most notably, the tenet of predetermination was discussed as faith in God’s plan and control. It is a concept rooted in the belief that God has already determined everything that will happen (Sunni) or that God knows everything that will happen (Shi’a).
2. Participants valued consensus to inform the pregnant person’s decision regarding potential fetal intervention, including the importance of (1) hearing multiple medical opinions, (2) considering prior experiences and pregnancy outcomes, and (3) hearing input from family and the wider community.
3. Confidence in the Western medical system was a major concern for the Somali‐American women in this study, including:
- Trust in medical professionals.
- Deference to expertise.
- The need to communicate effectively and overcome language and literacy barriers.
- Concerns regarding diagnosis accuracy and distrust of diagnostic tools.
4. The Somali‐American participants considered multiple factors when contemplating a fetal intervention, as discussed above, but ultimately their decision prioritized saving the life of the baby and the mother. In these instances, they also found it important to seek multiple opinions from specialists.
5. The primary treatment consideration was a reluctance to intervene before birth and the preference to avoid directly treating the baby in utero. Fetal surgery presents a push–pull relationship for women as their religion dictates that a diagnosis for the fetus is the predetermined will of God; however, the mother has the responsibility to ensure the stability of the fetus and do whatever is needed to ensure its wellbeing.
Action in response to findings
The focus group facilitators organized a conference between the study team and five local Imams, or religious leaders in the Muslim community, for their guidance on the permissibility of fetal surgery. After a short educational presentation about the goals and methods of fetal surgery and several rounds of clarifying questions, the Imams unanimously agreed that fetal intervention is allowed in Islam. This determination needs to be shared with our local community, and it is recommended that any Somali‐American family feeling faith‐conflicted about choosing fetal surgery as a care option should seek religious consultation for reassurance.
Conclusions
Overall, religious beliefs are a key factor in the health care decision-making process for Somali-American women. Building trust, providing culturally sensitive patient‐centered care and using Somali speaking providers, when possible, would allow families to better process the complex diagnoses and encourage others in their community to follow suit.
