In Their Own Voices: Ethiopian Immigrant Women in the United States

Introduction: Ethiopians represent the second largest African immigrant group in the United States (U.S.) (Anderson, 2017). Female African immigrants have become a faster growing population than males (Oliphant, 2017). Ethiopian society is historically patriarchal, where women are subordinate to men based on cultural and religious practices. There are fewer career opportunities for women and they are disadvantaged economically, socially, educationally, politically, and in their health-status (Ayferam, 2015; Bayeh, 2016; Girum et al., 2018; Oliphant, 2017; Woldetensay et al., 2018). Adverse practices against women include gender-based violence and intimate partner violence, female genital mutilation (FGM), early marriage of girls with discontinuation of their education, disrespectful and abusive healthcare practices, and food allocation to men and boys (Abathun, Sundby & Gele, 2018; Adinew & Mekete, 2017; Boyden, Pankhurst, & Tafere, 2013; Chiatti, 2014; Gebremichael et al., 2018; Grum, Brhane, Hintsa, & Kahsay, 2018; Pankhurst, 2014). Compared to Ethiopian males, women and girls suffer a higher proportion of new HIV infections and their access to healthcare and treatment is lower (Girum et al., 2018). Further, immigration is a stressful experience and the process does not end with arrival in the U.S. Finding housing, employment, a place of worship, schools for children, healthcare, and becoming a member of a community take time and can be frightening and overwhelming (Oliphant, 2017). First-generation Ethiopian immigrants often “lack access to health care, face linguistic barriers, and generally have limited knowledge in the critical areas of health and wellness” (Ghobadzadeh, Demerath & Tura, 2015, p. 1072). There is a paucity of research examining Ethiopian immigrants’ experiences and no transcultural nursing studies. Since immigrants are subject to health disparities based on language differences, cultural preferences and traditions, pre-existing or chronic conditions, and lack of knowledge about how to navigate the complex healthcare system in the U.S. (Douglas et al., 2014; Ghobadzadeh, Demerath & Tura, 2015), nurses need to be aware of cultural practices of Ethiopian immigrants and health risks to women, in order to support their transition to life in the U.S. and provide culturally congruent care.

Purposes: This poster reports the findings from a qualitative ethnonursing study whose aim was to (1) identify and describe the culture care beliefs and practices of Ethiopian immigrants living in the mid-Atlantic region of the United States, and (2) to advance the science of transcultural nursing. This poster specifically presents reflections by women representing exemplars centering on their culture care beliefs and practices that have been abandoned, modified, and/or retained following immigration to the U.S.

Methodology: Leininger’s Theory of Culture Care Diversity and Universality guided the research and provided the theoretical framework for this qualitative ethnonursing study (McFarland & Wehbe-Alamah, 2018). Following IRB approval and written informed consent, the researcher conducted semi-structured interviews with each participant. Data were collected from 5 key and 10 general informants through Wehbe-Alamah’s Open Inquiry Guide (Wehbe-Alamah, 2005), face-to-face recorded interviews, field notes, participant observation, and journaling. Data collection focused on obtaining culture care beliefs and practices based on Leininger’s Sunrise Enabler (McFarland & Wehbe-Alamah, 2018) explicating demographics, kinship, social, cultural, religious, technological, economic, and political factors, and worldviews. The interviews were transcribed verbatim by a professional transcriptionist and transcripts were reviewed by the researcher and crosschecked with the recorded interviews for accuracy and completeness.

Results: Five major themes were synthesized from the research data. These included preservation of cultural identity, support of family and friends, practice of women helping women, presence of freedom and educational opportunities, and availability of quality healthcare.

Discussion: Analysis of the data indicated that life in the U.S. resulted in a change in traditional gender roles for men and women. Women saw a move toward gender equality and empowerment. There was more joint decision-making by spouses. Women expressed a change in attitude against FGM and early marriage of girls, which supported the study by Abathun, Sundby, and Gele (2018) in which information and public awareness campaigns about the harmful effects of FGM had a positive effect on abandonment of the practice. Parents encouraged both sons and daughters to complete primary, secondary, and tertiary education. Women continued the practice of women-helping-women in order to maintain strong networks of support and social connections in the U.S. Likewise, Woldetensay et al. (2018) found that social support from family and friends was essential to a healthy life. Women preferred healthcare professionals to ask them questions about their culture and to accommodate the cultural practices and beliefs that they valued. As also found in the study by Ghobadzadeh, Demerath and Tura (2015), there was a need by nurses encourage health maintenance and health screening activities for both men and women. Participants felt that considerable opportunities were available in the U.S. for women and girls economically, socially, and educationally, which had a positive influence on the health and well-being of individuals, families and communities.