Refugee mothers’ voices : exploring postpartum emotional and mental health experiences after resettlement and childbirth in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Public Health in School of Health Sciences at Massey University, New Zealand

Abstract

Postpartum psychological distress is a common health concern among women in Aotearoa New Zealand during the first year after childbirth (MOH, 2021). Although refugee mothers are at heightened risk of developing postpartum emotional and mental distress (WHO, 2018), little is known about their experiences in Aotearoa New Zealand. In recent decades, Aotearoa New Zealand has resettled refugee women from diverse conflict-affected regions, including the Middle East, who currently represent approximately one-fifth of the national refugee quota intake (INZ, 2025). This study explored Middle Eastern refugee women’s postpartum emotional challenges and the barriers they face in seeking support following resettlement in Aotearoa New Zealand. A scoping review was first conducted to map international evidence on postpartum mental health among Middle Eastern refugee women in high-income countries. McLeroy’s socio ecological framework (1988) was used to interpret multi-level barriers to help-seeking, including mental health literacy, language constraints, cultural norms and stigma, social isolation, and complex or inequitable healthcare systems. The findings informed the subsequent qualitative study to investigate the individual, interpersonal, cultural, and systemic influences on postpartum wellbeing and help-seeking among Middle Eastern refugee women in Aotearoa New Zealand who had given birth within the past five years. In the qualitative study, in-depth semi-structured interviews were conducted and were grounded in a constructivist paradigm, which assumes that knowledge and reality are constructed through human experiences and interactions (Guba & Lincoln, 1994; Mann & MacLeod, 2015). The findings were also interpreted using McLeroy’s socio-ecological framework (1988) to examine how individual factors, interpersonal relationships, community norms, and broader structural conditions interact to shape women’s help-seeking behaviours. Eight Middle Eastern refugee women (n = 8), originally from Syria and Palestine, participated in the interviews. They had been living in Auckland, Wellington, and Christchurch for between two and nine years. Participants ranged in age from their early twenties to early forties, with the majority having two or more children born in Aotearoa New Zealand. Their youngest children ranged in age from four months to three years. Data were analysed using reflexive thematic analysis, undertaken through a hybrid inductive deductive approach. Coding and theme development remained grounded in participants’ accounts, and the data were subsequently interpreted through the socio-ecological model. Four overarching themes were identified, highlighting barriers to seeking informal and formal support: (i) limited awareness and lack of information, (ii) interpersonal challenges, (iii) cultural and gender norms, and (iv) systemic barriers. These themes interacted across multiple socio-ecological levels and constrained women’s agency to attend to their needs and access timely support. Participants recommended increasing the availability of linguistically matched maternity healthcare providers, in-person interpreters, tailored education for husbands, culturally informed communication, transport and childcare support, and more flexible family visa options to enable postpartum support. Building on these findings, collaboration across government, maternity services, and refugee led organisations is essential to translate these findings into sustainable, equitable, and culturally safe postpartum care pathways in Aotearoa New Zealand. Future research incorporating appropriate clinical assessment and exploration of digital or community-based supports could further strengthen the evidence base. Evaluating postpartum interventions with refugee women, their families, and service providers, and co-designing culturally responsive care models that include practical supports and early mental health promotion for partners, are needed.