New study: Ethnic boundary-making in health care: Experiences of older Pakistani immigrant women in Norway

Older immigrant women experience several barriers in accessing health care. In this study, PhD student Sanjana Arora from the research group and coworkers have explored how older Pakistani women are met with, and respond to, barriers to health care in Norway. The data included interviews with 23 older Pakistani women and 10 caregivers.

They found that some feel criticized by healthcare workers for not having learnt Norwegian language. Few report feelings of being treated differently than Norwegians and contemplated whether this had to do with language barriers or because they are ‘immigrants’. The interplay of language barriers and being an immigrant fuelled what goes under the name of ethnic boundary making.

Moreover, they often experience being treated as if they ‘exaggerate their symptoms’ and feel they are not taken seriously. Several participants adopted the practice of exaggerating pain to compensate for existing boundaries in health care and adapt to existing ethnic boundaries. Paradoxically, this might also fuel the discourse about immigrants being ‘exaggerators’. The study highlights this interplay between societal discourse and healthcare interactions, and how participants adapt to ethnic boundaries without challenging them.

Negative stereotypical discourses on immigrants spill over into healthcare and generate insecurity among older Pakistani women. Therefore, such ethnicised cultural discourse in the public sphere fuelled the making of ethnic boundaries in health care.

Having encountered ethnic boundaries in health care, older Pakistani women actively coped through various strategies in order to gain back their agency. They  constructed ‘them’ vs. ‘us’ categories and ascribed hierarchical attributes of more knowledge/capability to Pakistani doctors. They engaged in boundary works in order to reverse the stigma and reinterpreted their own identity more positively. Some women employed the strategy of appearing satisfied with their health care, despite poor experiences and detached themselves from other community members, to escape the collective stigma.

The study shows some of the ways in which the delivery of healthcare services, despite being largely state-funded, contributes to inequities in older Pakistani women’s access to and utilisation of these services in Norway.

Read the paper here.

Reference: Arora S, Straiton M, Rechel B, Bergland A & Debasay J (2019). Ethnic boundary-making in health care: Experiences of older Pakistani immigrant women in Norway. Social Science & Medicine Vol 239.

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