Between 2010 and 2022, the number of Afghan immigrants in the United States grew from about 54,000 to 195,000. After the fall of Afghanistan to the Taliban in August 2021, more than 76,000 Afghans came to the U.S. through Operation Allies Welcome. This wave of resettlement made it clear: healthcare providers needed better ways to support Afghan newcomers, especially pregnant women adjusting to a completely new healthcare system.
A growing need in Washington State
Even before Operation Allies Welcome, Washington State was already welcoming significant numbers of Afghan refugees. In 2018, approximately 2,400 Afghan refugees resettled in the state, particularly in King County. HealthPoint, a community health center that serves most of the county’s refugees, noticed that nearly twice as many Afghan refugees were pregnant compared to other refugee groups. These expecting mothers needed prenatal care and support, using a safe and culturally sensitive approach.
Building on what works
HealthPoint turned to CenteringPregnancy, a proven group prenatal care model. Instead of one-on-one prenatal appointments, this approach brings pregnant women together in groups to learn, support each other, and build community while getting prenatal care. Research shows this approach reduces pregnancy complications, improves birth outcomes, and helps reduce health disparities. HealthPoint adapted the model specifically for Afghan women:
- All sessions included a Dari-speaking interpreter.
- Afghan staff reviewed materials and discussions to ensure cultural relevance.
- Activities were adapted for varying literacy levels and for newcomers unfamiliar with the U.S. healthcare system.
For example, with Centering Pregnancy, women vote on topics they’d like to discuss. HealthPoint adapted this activity to use images rather than words and women placed marbles in jars labeled with both pictures and Dari text to vote on topics.
In 2018-2019, HealthPoint launched a pilot with two groups of pregnant Afghan women, tracking outcomes through medical records and surveys to see if group prenatal care delivered in Dari could be both feasible and effective for Afghan refugee women.
From promising practice to published study
At the Migration Health Initiative (MHI), we look for innovative programs like this one that have shown to have a positive impact in local settings that could serve as a model for others. The MHI qualitative team collaborated with colleagues from HealthPoint, Harbor-UCLA Medical Center and the University of Washington Department of Pediatrics to document findings from the pilot.
We’re excited to share that this work has been published in the Maternal and Child Health Journal.
What the results show
The study included 21 Afghan refugee women who participated in the two pilot groups between 2018 and 2019. The results were impressive:
- Women stayed engaged: Almost all participants (95%) made it to nine or more prenatal visits during their pregnancy, meeting the standard for adequate care.
- Positive delivery outcomes: Most women (86%) had vaginal deliveries, and there were no extremely low birthweight babies. The C-section rate was just 14%, much lower than Washington State’s 29% average.
- Strong follow-through: Every single woman came to her postpartum checkup. Within three months after giving birth, 90% were using birth control. All the moms started breastfeeding, and nearly half were still breastfeeding at six months.
- Mental health support: The study found that 46% of participants showed signs of mental health concerns when they first arrived, higher than other refugee groups. The group sessions provided not just medical care, but also crucial emotional support during a stressful time.
Expanding the model
The pilot’s success led HealthPoint to make group prenatal care the standard for all pregnant patients in every language. Since then, they’ve run 24 additional cohorts, with 18 in Dari. and created “CenteringParenting” groups in Dari for families with babies and toddlers.
The impact has spread beyond HealthPoint, too. CenteringPregnancy now offers materials in Dari, so other clinics nationwide can use this approach.
Resources to support your work
If you’re working with Afghan families, check out these MHI resources which are designed to support the capacity of organizations serving refugees, immigrants, and migrants with practical tools.