Public Defense: Sanjana Arora

This thesis draws attention to access to healthcare for older Pakistani immigrant women in Norway, a moral issue of distributive justice and equitable access. It explores older Pakistani immigrant women’s perspectives and experiences in accessing healthcare services. It also explores both older Pakistani women’s and family caregivers’ perspectives and expectations on formal and informal care in the future.

This study is based on qualitative data collected through a review of the literature (article 1) and empirical data collected through semi-structured interviews and a focus group discussion (article 2, 3 and 4). In total 23 older Pakistani immigrant women and 10 informal caregivers participated in the study. The data was analysed using thematic synthesis (article 1) and a thematic analysis approach (article 2, 3 and 4).

Findings

The findings show the need for exploring both contextual and individual characteristics to understand older migrants’ unique experiences of healthcare access. The study sheds light on how Pakistani immigrant women engaged in ethnic boundary-making to access healthcare services, and how this activity fed on an ethnicised cultural discourse in the public sphere,. The study furthermore suggests that traditional conceptions of care do influence older Pakistani women’s preferences of access to formal care services. Traditional views of filial piety also seem to exacerbate the families’ care burden.

The findings are conceptualised through theoretical approaches of postcolonial feminism, ethnic boundary-making and intersectionality. Concepts of discourse, power, double consciousness, culture, ethnicity and equity are also used to enable an in-depth interpretation of findings.

Discourses on immigrants, though seemingly naïve and non-discriminatory, influence how immigrants are met in healthcare institutions. They not only influence their access to healthcare services, but also influence how immigrants perceive themselves. Conceptualizing issues of access exclusively through cultural or language barriers or in line with preferences of care resulting from social and cultural norms would only reflect the existing power imbalance in healthcare encounters.

This study problematizes the essentializing gaze of discourse. The challenge of access is therefore no longer a problem of simply managing a culturally and linguistically diverse patient population, but a struggle due to power differences and institutional disadvantages. Institutional disadvantages in access furthermore seem to put a burden on informal care and create an erroneous illusion of lack of need for formal healthcare services.

This study identifies individual efforts to bypass barriers to healthcare access, reflecting acts of agency by participants. Such strategies were either attempts to de-stigmatize themselves, reinterpret their own identity positively or attempts to detach themselves from their community. However, as such strategies are only employed at the individual level, they do not affect the existing hegemonic power structures.

Conclusion

The thesis concludes by arguing that experiences of accessing healthcare services are shaped by historical and contemporary conceptions of the immigrant, prevailing social inequalities in Norwegian society, and individuals’ social positioning at the intersections of ethnicity, age, gender and class.

This thesis calls for revisiting healthcare arrangements in the light of the new and developing demographic changes. Recommendations are given to increase awareness and use of culturally safe practices in healthcare, to address the issue of power imbalance and structural barriers and achieve the goal of equity of access to healthcare services.