Résumé :
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[BDSP. Notice produite par INIST-CNRS 9R0xIFDp. Diffusion soumise à autorisation]. Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a'maternal migration effect'as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the'three delays'framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005 - 2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of broken trust, which can be mutually held between women and providers. An additional factor is women's'negative responses to future care'which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2'language discordance'can lead to a'reliance on interpreter service'which can cause delays in Phase 3, when'reciprocal incongruent language ability'is worsened by suboptimal interpreter systems.'Non-reciprocating care conceptualisations'limited system-level care guidelines'and'low staff levels'can additionally delay timely care in Phase 3.
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