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Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis

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posted on 2022-10-11, 00:17 authored by Sarah Min-Lee Khaw, Rana Islamiah Zahroh, Kerryn O'Rourke, Ruth Elizabeth Dearnley, Caroline Homer, Meghan A Bohren

Background: Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders' perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes. Methods: We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders' perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings. Results: Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas' role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women's experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme. Conclusion: Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.


This project is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200100264; MAB). Both SMK and RIZ are supported by the University of Melbourne's Human Rights Scholarship, as well as Australian Government Research Training Program (SMK) and Melbourne Research Scholarship (RIZ). KO's and RED's time are supported by Birth for Humankind. CH's time is supported by National Health and Medical Research Council Principal Research Fellowship. MAB's time is also supported by a Dame Kate Campbell Fellowship.


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BMJ Global Health





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© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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