Online Group antenatal care: reaching out to Eritrean refugees. A mixed method study

Pregnancy is a universal human experience, yet the path to a healthy birth looks very different depending on where a woman lives and what language she speaks. In countries with advanced healthcare systems, expectant mothers often receive regular check-ups, clear information about their rights, and support from a network of professionals. However, for refugees fleeing conflict and displacement, these standard services can feel like a maze built in a language they do not speak, filled with rules they do not understand. This is particularly true for women from Eritrea arriving in the Netherlands, a country that hosts a large number of refugees from that nation. Many of these women carry the weight of traumatic pasts and face barriers such as limited literacy, cultural differences, and a deep mistrust of unfamiliar systems. When a woman cannot easily ask her doctor questions or understand why a certain test is needed, her health and the health of her baby are at risk. To address this, healthcare providers have turned to a model called group antenatal care. Instead of seeing a doctor alone for a few minutes, women meet in a circle with eight to twelve others who are due around the same time. They share a midwife, discuss their concerns openly, and learn from one another, turning a medical appointment into a shared learning experience.

When the pandemic forced hospitals and clinics to close their doors, this group model had to move online. Researchers wondered if this digital shift could still work for Eritrean women, who might face additional hurdles like poor internet connections or a lack of experience with video calls. They wanted to know if a screen could ever replace the warmth of a shared room, or if it could perhaps offer a new kind of safety that allowed women to speak more freely. A team of researchers in the Netherlands set out to find the answer. They organized eighteen online groups for pregnant Eritrean women between 2022 and 2023. Each group met nine times over the course of the pregnancy, facilitated by an experienced midwife and a cultural mediator who spoke the women's native language, Tigrinya. The goal was not just to check blood pressure or listen to a baby's heartbeat, but to create a space where these women could learn about the Dutch healthcare system, discuss sensitive cultural topics, and build confidence in their own voices.

The study revealed that moving this care online was not only possible but highly effective in breaking down barriers. The women, who came from all over the country, used the sessions to learn practical things they had never been told before. They discovered how to arrange for a maternity nurse to visit their home after the baby arrives, a standard practice in the Netherlands that many did not know existed. They learned about their legal rights, such as the right to an interpreter during medical visits, and realized they did not have to accept confusion or silence. One woman noted that she finally understood she could ask for help if a doctor did not speak her language, a realization that shifted her from feeling helpless to feeling empowered. The groups also tackled deep-seated myths about health. For instance, many women believed that a traditional homemade beer called Suwa was safe to drink during pregnancy because it was made from grains, not realizing it contained alcohol. Through open discussion, they learned that this drink could harm their babies, and the shared conversation made it easier for them to accept this new information than if a doctor had simply told them to stop.

Perhaps the most powerful aspect of these online meetings was the ability to discuss topics that are often considered too private or shameful to mention. In a safe, confidential environment, women talked about female genital mutilation, domestic violence, and the roles of men and women in their families. A cultural mediator was present to help navigate these conversations, ensuring that the women felt understood and respected. The researchers found that the women began to question old beliefs, such as the idea that male circumcision was necessary for fertility, after learning that many Dutch men were not circumcised and still had children. They also discussed the fear of domestic violence, realizing that they had the right to be treated with respect and that violence was not a normal part of marriage. The online format, paradoxically, seemed to lower the guard that some women might have kept up in a physical room, allowing them to share stories and ask questions they had never dared to voice before.

The women reported feeling more confident and less afraid of the healthcare system. They felt better prepared for childbirth, understanding the difference between normal pregnancy discomforts and signs that required immediate medical attention. They learned about pain relief options like epidurals and how to communicate their wishes to their doctors. The sense of connection they felt with the other women was strong during the pregnancy, with many participants exchanging messages and support through a group chat. However, the study also noted a limitation: once the babies were born and the formal sessions ended, this online connection tended to fade. Unlike physical groups where women might meet for coffee or playdates, the digital ties were harder to maintain over the long term. The researchers observed that while the online model successfully delivered information and built trust, it struggled to create a lasting community without additional effort.

In the end, the study suggests that online group care is a vital tool for reaching vulnerable populations who might otherwise fall through the cracks. It proved that with the right support, such as a language-speaking mediator and a skilled facilitator, a video screen can be a bridge rather than a barrier. The women gained knowledge, rights, and a sense of agency that they had previously lacked. While the online format may not perfectly replicate the long-term social bonds of in-person groups, it offers a flexible and accessible way to ensure that refugee women receive the care and respect they deserve. The researchers concluded that this approach should be part of the standard care strategy for migrant communities, provided that steps are taken to keep the connections alive after the pregnancy ends. The work showed that when healthcare meets people where they are, even in a digital space, it can transform fear into understanding and silence into a voice.