Immigrant mothers in the United States are raising an increasing proportion of the population of children (Urban Institute, 2013). Immigrant women have high birth rates in comparison to women born in the United States. Since 1970, the increase in U.S. births has been driven in part by immigrant mothers (Livingston, 2016). The Pew Research Center (Livingston) reports births by foreign-born mothers were up from 274,000 in 1970, to approximately 901,000 births in 2014, whereas births by U.S.-born women have declined since 1970. Recent estimates suggest an expected increase in the immigrant population as a proportion of the total population over the coming decades (Livingston).
Nurses support immigrant mothers during childbirth, while they perform mothering roles, and to understand normal child development (O'Reilly, 2010; Passel & Cohn, 2017). Researchers have discussed immigrant mothering practices and the challenges of immigrant mothers in the United States; however, no summary of the scope of this research was identified. Understanding the experiences of immigrant mothers helps nurses create groundwork to incorporate immigrant women's experiences into culturally sensitive need-based programs. The purpose of this review is to explore current research on what is known about immigrant women's mothering experiences in the United States to guide future nursing theory, research, and practice.
Background
An immigrant mother is a foreign-born woman who becomes a mother before or after she relocates to the United States (O'Reilly, 2010). Immigrant mothers are not a monolithic group. Their experiences are not universal to their country of origin but are affected by their economic and social conditions, cultural beliefs, and gender ideology, which may be different based on their ethnic groups and families (O'Reilly; Urban Institute, 2013). For many immigrant mothers, their own acculturation process and their mothering experiences take place at the same time, after arriving in the United States. Immigrant mothers share their immigrant identity, which influences the way they care for, raise, and educate their children (O'Reilly; Schmied et al., 2012). Immigrant mothers face challenges beyond their U.S. peers, even those who are poor, minorities, or underserved.
Immigration often increases social vulnerability for women because gender role dynamics may change, finding housing may be difficult, proficiency in the English language is often challenging, and immigrant women often lack adequate support from their new social networks (Gelatt, Peters, Koball, & Monson, 2015; Okeke-Ihejirika, Salami, & Karimi, 2016). They may struggle with health literacy or fear deportation due to their immigration status (Pappano, Olwan, & Sinno, 2016). Immigrant women are also simultaneously experiencing mothering responsibilities and trying to adjust to living in the U.S. culture as an immigrant (Gelatt et al.; O'Reilly, 2010). Some may have to cope with being marginalized due to their immigrant status in addition to being women of color (O'Reilly).
Immigrant women's experiences of mothering often reflect culture, social class, and historical period (Gelatt et al., 2015). Historical laws have affected socioeconomic status of immigrants. In 1965, the Immigration and Nationality Act favored highly educated and skilled immigrants from Asian countries (Keely, 1971). In 2010, 48% of immigrants from Asia were college graduates; by 2016 that number had risen to 52% (Geiger, 2018; U.S. Census Bureau, 2010). In contrast, in 1942, the Bracero program permitted Mexican citizens to do agricultural work in the United States and resulted in a largely low-wage labor migration stream (Hansen, 1988). Few immigrants from Mexico hold college degrees (5% in 2010; 6% in 2016) (Geiger; U.S. Census Bureau).
The word "motherhood" is used to indicate the patriarchal convention of motherhood. The term "mothering" is used to reference lived experiences of caring for a child or children by a mother (O'Reilly, 2010). In this review, the term immigrant mother is defined as a woman of childbearing age, born in another country, who immigrated to the United States, and who is caring for children under the age of 18 years old regardless of birth origin of her children.
Methods
This scoping review of the scientific literature mapped and summarized the range of literature currently available to identify gaps about immigrant women's experiences of being mothers in the United States. The review is significant because there are no randomized controlled trials, which makes it challenging for researchers to conduct a systematic review. We used methods as per Arksey and Malley (2005) and Levac, Colquhoun, and O'Brien (2010) for the review. It is described in a step-wise linear fashion; however, an iterative process was used, with each step reassessed and improved over the course of the research.
Identifying the Research Questions
The following research questions were used: (1) What is known about immigrant women's experiences of being mothers in the United States? (2) What groups of immigrant mothers have been studied? (3) What health and social issues have been explored among various groups of immigrant mothers? and (4) What theoretical frameworks, instruments to measure mothering, research gaps, and implication for future research were identified?
Identifying Relevant Studies and Studies Selection
A medical librarian-assisted literature search was performed using Ovid MEDLINE, CINAHL, SCOPUS, Web of Science, JUSTOR, and PsycINFO databases. Search terms included "parent*" and "immigrant*" and "mother*" in the title, abstract, or key words. Additional searches included "child*," "child rearing," "daughter*," "son*," and "raising children" in the abstract, title, or key words. These words were combined with those that represented immigrants, including "alien*," "asylum seeker*," "emigration*," "foreigner*," "immigration*," "incomer*," "migrant*," "naturalized citizen*," "newcomer*," and "refugee*." The literature search was conducted in 2019 and included articles from January of 2000 to May of 2019. The search yielded 1,976 articles after duplicates were deleted. An ancestry search of reference lists of articles and authors was also completed; 136 additional articles were found. See Figure 1.
Inclusion criteria were studies using any research method that included immigrant mothers from any geographical regions or place of origin, regardless of length of stay in the United States or ages of children. Articles were included in the review if they were written in English and if they described immigrant mothering in the United States. Articles that included both immigrant mothers and mothers from United States were retained if authors distinguished differences in reporting results. Articles that included both immigrant mothers and fathers were retained if authors distinguished differences in reporting results. Articles were excluded if they solely reported immigrant mothering in countries other than the United States or solely reported undocumented immigrant mothers' experiences.
Charting, Collating, and Summarizing
Data from each manuscript included authors, publication date, immigrant mothers' country of origin, study aims, summary of demographic information, outcome measures, and main findings. The literature was organized thematically, according to geographic regions of origin. Different studies were compared to identify gaps in research on immigrant womens' experiences as mothers and reported results as a narrative summation that emerged from analysis of the literature, focusing on research questions.
Results
Twenty-two articles met inclusion criteria. Researchers focused on a variety of experiences related to being mothers in the United States. Immigrant women in the studies tended to be in their 30s, most were married, tended to have a low income, and most had two or three children. Approximately half of the immigrant women had less than a high-school education, and approximately half had a college education. Supplemental Digital Content, Table 1, http://links.lww.com/MCN/A57 provides an overview of the foci of each of the studies, the immigrant mother's country of origin, and the research objectives, sample, demographic data, method of data collection, and findings. Table 2 is an abbreviated summary of the studies. Differences in social influences surrounded food (attitudes or actions a mother uses in the process of feeding her child); discipline; education; and providing emotional support through mothering styles were explored among various groups of immigrant women. Physical activity, child development, reproductive health education, and vaccines were health issues explored among various groups of immigrant women. No articles were found on immigrant mothers from Middle Eastern or European countries, and none addressed how faith tradition and religious practice influenced mothering practices.
Theoretical Frameworks
Seven used a theoretical framework. Chao (2000); Cheah, Leung, Tahseen, and Schultz (2009); and Chen, Chen, and Zheng (2012) use Baumrind's typology of parenting. Chao and Chen et al. used this theory to investigate culturally regulated customs of mothering and compared Caucasian mothers living in the United States with immigrant Chinese mothers. Other theoretical frameworks used included the Family Resiliency Model, the Social Cognitive Theory, and the Theory of Planned Behavior (Ayon, Messing, Gurrola, & Valencia-Garcia, 2018; Colon-Ramos et al., 2017; Momin, Chung, & Olson, 2014; Villegas, Wiley, Hannon, Teran-Garcia, & Hammons, 2019).
Instruments to Measure Mothering
In seven studies, researchers used different instruments to measure mothering. Six instruments were used to measure parenting practices. The instruments included the Caregiver's Feeding Style Questionnaire, Chao's Training Items, the Psychological Well-Being Scale, the Parenting Daily Hassles Questionnaire, the Strengths and Difficulties Questionnaire and Scheme, and the Parenting Styles Dimensions Questionnaire.
Asian Countries
Twelve studies focused on mothers who immigrated from Asian countries: Cambodia, China, India, Korea, and Vietnam. In four studies, mothers maintained the social milieu from their culture of origin in which meaning, and knowledge of their mothering styles were constructed (Cheah, Leung, & Zhou, 2013; Chen et al., 2012; Momin et al., 2014; Straub, Melvin, & Labbok, 2008). For instance, Chen et al. (2012) studied Chinese immigrant mothers and found that mothering styles reflected the indigenous concept of "jiaoyang," which implies educating and child rearing. Mothers referenced this concept when they described prioritizing the teaching of good manners and traditional Chinese cultural values (Chen et al.).
Three studies specifically looked at diversity in styles of mothering among mothers born in Asia and middle-class Caucasian U.S. mothers (Chao, 2000; Cheah et al., 2009; Cheah et al., 2013; Cheah, Li, Zhou, Yamamoto, & Leung, 2015). The primary cultural differences between mothers born in China and middle-class Caucasian U.S. mothers were the cultural concept of independence versus interdependence, and the mothers' expressions of warmth (Chao; Cheah et al., 2013). Middle-class Caucasian U.S. mothers tended to encourage independence, emphasized self-sufficiency, and expressed more warmth toward their children, whereas mothers born in China tended to emphasize authoritative mothering, interdependence, and social hierarchy (Chao; Cheah et al., 2013; Cheah et al., 2015).
Six studies assessed unique social influences surrounding nutrition and were from Asian countries. Immigrant mothers expressed an intentional effort to retain features of their native culture's feeding preferences while embracing features of American culture. For instance, Vietnamese and Korean mothers cited fast-food restaurants as a source of unhealthy food; nevertheless, they purchased fast food for their children because they worked outside the home and were too exhausted to cook (Babington & Patel, 2008; Kim, Conway-Turner, Sherif-Trask, & Woolfolk, 2006; Park, Patil, & Norr, 2016). However, when mothers tried to encourage their children to eat healthy food, Asian Indian, Cambodian, Chinese, Korean, and Vietnamese mothers all preferred to cook food from their country of origin over U.S. American food when possible (Babington & Patel; Kim et al.; Momin et al., 2014; Park et al.; Straub et al., 2008; Zhou, Cheah, Van Hook, Thompson, & Jones, 2015). Vietnamese mothers did not use commercially prepared baby food but instead began to feed a traditional homemade vegetable soup mixed with rice to babies around 6 months of age (Babington & Patel). Similarly, Straub et al. (2008) found that mothers from Cambodia also used homemade rice soup using a recipe from their country of origin as their baby's first introduction to solid food.
In Asian Indian and Chinese immigrant mothers, authoritarian feeding styles were common (Momin et al., 2014; Zhou et al., 2015). Chinese immigrant mothers enforced rules surrounding eating, such as cleaning the plate and used social comparisons and spoon-feeding to persuade their children to eat (Zhou et al.).
Burke et al. (2015) investigated Cambodian mothers' knowledge of the human papillomavirus (HPV) vaccine and influences of choices surrounding vaccination for their daughters. Some mothers were unaware of the vaccines unless their healthcare provider had given them information about the vaccines. Others decided against the vaccine because of lack of knowledge about benefits.
Latin American Countries
Eight studies focused on mothers who immigrated from Latin American countries; specifically, Brazil, Dominican Republic, Mexico, and Puerto Rico. In five studies, immigrant mothers described the impact of neighborhood factors on physical activity, food choices, and children's sleep routines. Latina immigrant mothers cited lack of safety in neighborhoods as reasons their children lived a sedentary lifestyle (Ayon et al., 2018; Lindsay, Sussner, Greaney, & Peterson, 2009). Latina mothers also reported that suboptimal sleep routines in preschool-age children were related to multifamily housing and neighborhood noise (Lindsay, Moura Arruda, Tavares Machado, De Andrade, & Greaney, 2018). Two studies reported neighborhood food environment influenced their children's preferences for unhealthy food, and lack of availability of healthy foods was contributing to their children's increased body mass index (Colon-Ramos et al., 2017; Villegas et al., 2018).
Three studies examined social influences on breastfeeding practices of immigrant mothers (Lindsay et al., 2017; Schlickau & Wilson, 2005; Vaughn et al., 2010). All found three of the same factors that promoted the decision to breastfeed in Latina mothers: encouragement from cultural beliefs, hospital education, and supportive family members.
African Countries
Two studies focused on mothers who immigrated from various African countries: Ghana, Guinea, Kenya, Liberia, Nigeria, Somalia, South Sudan, and Zambia. Immigrant mothers faced challenges with social aspects of U.S. culture, especially disapproval of physical punishment, which is typical in their culture. Further, they were concerned about the autonomy given to adolescents, such as in dating and engaging in sexual intercourse. Immigrant mothers wanted their children to develop the cultural identity, heritage, and values of their country of origin (Agbemenu, Hannan, Kitutu, Terry, & Doswell, 2018; Nilsson, Barazanji, Heintzelman, Siddiqi, & Shilla, 2012).
Discussion
Researchers focused on various experiences related to being mothers in the United States. Mothering styles, social influences surrounding food, and child health and development were explored among various groups of immigrant women. None of the studies used observational or longitudinal designs. Although this represents an emerging body of literature on immigrant women's experiences of being mothers in the United States, moving forward it is necessary to conduct complementary studies including more diverse samples, as well as longitudinal and observational studies that can further explore the role of cultural and psychosocial factors that influence immigrant mothering practices over time. This evidence will be essential to distinguish factors between ethnic groups that are amenable to interventions.
Researchers explored diverse mothering styles in areas such as discipline, education, providing emotional support, and sexual education. Immigrants from Latin American countries comprise the largest minority group in the United States (U.S. Census Bureau, 2010), yet few researchers studied their mothering styles. Further research is needed to explore mothering styles and experiences across mothers from different cultures.
Even though motives for immigration differ, most women encountered similar challenges of leaving their native culture and adapting to U.S. culture. Researchers found that immigrant women faced a negotiation with their children to balance the teaching of traditional cultural values alongside new values. For instance, immigrant mothers from Africa met these obstacles by slowly changing their style of discipline as they became acculturated to mimic the preferences of their new country. Chinese immigrant mothers described a preference for cooking recipes from their country of origin while incorporating U.S. fast food into their diets because of convenience. Essentially, mothers described varying degrees and rationales for accepting and rejecting different aspects of their native culture and U.S. culture. For many immigrant mothers, the passing on of culture to the next generation was very important. However, mothers negotiated with their children to attempt a compromise between the new and traditional cultural values, rather than handing down strict morals and traditions from their country of origin.
Researchers tend to place immigrants into general groupings based on assessment of how much they associate with customs from their country of origin versus their country of immigration. As an alternative, these results support research that investigates fusion of immigrants' constructed knowledge from their country of origin with customs in the United States that may create a fusion of new cultural forms (Croucher & Kramer, 2016; Hermans & Kempen, 1998). Future researchers could consider acknowledging impact of mothers' historical and current social locations on their mothering practices.
Researchers found mothers concerned about neighborhood food choices, noise, and safety. Historical trends in immigration patterns as well as immigration laws may contribute significantly to the observation that mothers born in Latin American countries express more concerns with neighborhood safety, food choices, and noise compared with immigrants from Asian countries. Less-educated immigrants likely lack the socioeconomic resources to live in safe, quiet neighborhoods that have accessible grocery stores or places for play or physical activity. However, the studies did not examine immigrant farm workers who may live in more rural areas. Future research should explore the range of situations and social context of immigrant mothers and take this into account when they design interventions for children.
Researchers addressed several issues related to child health and development indicating that new knowledge can impact the decision-making patterns of immigrant mothers. Healthcare professionals often assume mothers have a universal science-based knowledge of health, without realizing some immigrant women may lack understanding of many health issues (Granado-Villar et al., 2013). For example, some immigrant mothers lack basic knowledge about vaccinations or sexual activity, or their knowledge may be incorrectly influenced by myths. Hill, Elam-Evans, Yankey, Singleton, and Kang (2018) reported that vaccine coverage may vary in children under 3 years of age depending on the birth country of a child's parents. Future research should focus on culturally regulated myths related to children's health and health literacy. Education provided by interdisciplinary professionals to immigrant women may be particularly important in influencing increased vaccine uptake, but more research is needed among immigrant women.
None of the studies included specifically examined the impact of faith traditions or religious practices on mothering practices. Religion is an element that may affect everyday habits of raising children (Naser et al., 2012; Singh, Rai, Alagarajan, & Singh, 2012). Islamic teachings or Christian rules and traditions may influence the way immigrant families care for and educate their children. For instance, Islamic Sharia, the religious law forming part of the Islamic tradition, includes recommendations about caring for women and their children (Hutchinson & O'Leary, 2016). Within Islam, adolescents should be taught the Fiqh, the human interpretation of Sharia law, which is used to teach adolescents about puberty, marriage, childbirth, basic hygiene, and breastfeeding, as well as their roles and responsibilities in these activities (Hutchinson & O'Leary). This could influence how a healthcare provider interacts, for example, with an immigrant mother and her adolescent daughter who is being treated at a hospital. Future nursing research should explore religious beliefs and related practices that affect the everyday habits of immigrant mothers.
No articles were found on Arabic immigrant mothers in the United States, although from 2010 to 2015, half of the growth of the American Muslim population has been due to immigration (Mohamed, 2016). Future research should focus on immigrant mothers from Arabic countries and others who are underrepresented in research.
Limitations of this Review
Some literature may have been missed due to studies being published in other formats or in languages other than English. Only a few countries were represented. Group heterogeneity limited ability to examine what is known about immigrant women's experiences of being mothers in the United States. An obstacle for nurses studying this topic is "immigrant mothers" is a very broad term given diversity of immigrants to the United States. Some immigrants (e.g., those from the United Kingdom, Canada, or Australia) may speak English as a first language and, theoretically, may have fewer immediate problems. Therefore, rigorous inclusion and exclusion criteria should be identified.
Future Research
We found that only a few issues on immigrant mothering in the United States have been explored, and only a few different ethnic groups of immigrant mothers have been studied. Immigrant mothers come to the United States for different reasons: to provide a better future for their children, to seek paid work, or to escape war, among others. This toxic level of stress, long term, can affect developing brains and other organ systems, leading to diseases during adulthood such as cardiovascular disease, mental illness, substance abuse, and even premature death (Shonkoff & Garner, 2012).
Nurses need theoretically-based studies to understand the experiences and customs that influence immigrant women's experiences as mothers in the United States to identify their strengths and challenges. Clarifying the role of confounding variables, such as demographics, social support, toxic stress, and acculturation on health, may have practical and theoretical importance. Because ethnic groups vary in their cultural beliefs, future research should focus on conducting nursing and interdisciplinary studies that provide in-depth data about specific immigrant mothers. Future nursing research should focus on ways to address implicit and explicit biases among clinicians. Cultural conflicts may occur with immigrant women during communication in healthcare settings due to ethnocultural differences in beliefs or values, thus researchers should consider structural and organizational polices. Researchers should explore how workplace habits, unwritten rules, and formal policies may be misunderstood, support cultural biases, or even be culturally offensive. Creating partnership with immigrant women on a structural level may reduce potential dividing influence of ethnocultural differences during care.
Clinical Implications
By recognizing and building on existing strengths of immigrant mothers, nurses can support all families in providing a safe, healthy environment for their children. A deeper understanding of beliefs and expectations of immigrant mothers can assist nurses in developing interventions that support immigrant women and their children, strengthen families, and assist in creating culturally sensitive need-based programs. The foundations for health and wellbeing, emotional, physical, and intellectual, are laid during childhood (Marmot, 2010). Through everyday interactions with mothers, children develop many skills and achieve developmental milestones (Wilson & Gross, 2018). Little is known about common mothering practices of immigrant women in the United States, and the role the mothers play in maintaining and sustaining the health and wellbeing of their children. Many immigrant mothers struggle with keeping traditions from their culture of origin, while also taking on aspects of their new culture. Nurses can support and provide education to immigrant mothers as they navigate these common challenges.
Clinical Implications
* Knowledge of the influence of culture on diversity in styles of mothering, health beliefs, and practices is helpful to encourage education for immigrant mothers to support healthy behavior modification.
* An awareness of immigrant women's culture and beliefs that may influence their mothering related to feeding, discipline, and health of their children can assist in meeting their needs.
* Clinicians working with immigrant women and their children should consider neighborhood factors and use local leaders and local assistance programs to facilitate provision of comprehensive health care.
* Resources to enhance health education and communication can be helpful to encourage mothers to promote sexual and reproductive health among sexually active children including human papillomavirus vaccination.
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Immigrant Women's Experiences as Mothers in the United States: A Scoping Review
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References