Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Ellen Daley, Ph.D.

Co-Major Professor

Dinorah Martinez Tyson, Ph.D.

Committee Member

Cheryl Vamos, Ph.D.

Committee Member

Roberta Baer, Ph.D.


Phenomenology, Paraprofessional, Third Country Resettlement


Existent demographic changes in the United States are largely a result of the current international refugee crisis. Within the past three years, there has been an influx of refugees who were affected by the wars in the Democratic Republic of Congo (DRC). Congolese refugees were the highest number of all refugee groups to arrive in the United States in Fiscal Years 2016-2018, yet little is known about their lived experiences, particularly as they apply to reproductive health and family planning in general. Congolese refugee women who resettle in the United States are unique because many lived in refugee camps for protracted periods, they often have large families, and about 20% are single mothers; all factors that impact successful health outcomes, particularly with regards to reproductive health.

The gendered experiences of refugee women that include vulnerabilities to Sexual and Gender-based Violence (SGBV) which result in unplanned or unwanted pregnancies and limited access to preventative reproductive health services, sexual exchange for money, further compound their already vulnerable experiences. In The DRC, women have limited access to reproductive healthcare including emergency contraceptives and other modern contraceptive method options, and pregnancy termination services for victims of sexual violence, yet rape is commonly used as weapon of war. The availability of these services varies in second countries. Existing literature on family planning uptake by refugee women living in second countries of asylum highlights multifactorial contributors to their use of family planning that include service quality particularly in camps, cost, availability of modern method options, and cultural or religious opposition. Few studies have looked at Congolese refugee women’s family planning needs and experiences after resettling in the third country. Additionally, few studies have looked at how the previously identified factors such as access and cultural or religious beliefs interplay with the demands and women’s experiences in a new social structural environment to influence their beliefs about childbearing and consequent family planning practices.

The purpose of this study was to understand the contextual beliefs and experiences about childbearing among Congolese refugee women who resettled in two counties in West Central Florida. The Hermeneutic Phenomenological approach was the guiding framework for this study and Symbolic Interactionism was used to explain how women construct reproductive health beliefs based on their interactions with others in their various environments. Paraprofessionals are volunteers with the resettled refugee community who often serve as a bridge between refugees and various individuals or institutions in the host country. They are an emerging key group in refugee resettlement whose impact in women’s health decisions needs to be assessed.

Semi-structured in-depth interviews were conducted with 25 women and 7 paraprofessionals. Data analysis involved the use of the modified Van Kaam method of phenomenological analysis to create themes and uncover three key essences. These essences described (1) women’s experiences during the trajectory of their lives in flight, (2) beliefs about having children, and (3) the nature of their relationships with paraprofessionals.

This study revealed that recently resettled Congolese refugee women are a resilient group who value culture and religion as important contributors to their survival. Moreover, these two factors greatly influence their health and family planning practices. Responses from both women and paraprofessionals that cultural and individual beliefs about children included the view that a child is as a “blessing” “investment” and “helper with regards to financial support of the household and with assisting with childcare of younger siblings; However, family roles and expectations about children are changing, which may impact women’s views about having children in the resettlement context. Women were more likely to use modern methods of contraceptives in the second country compared to the post-resettlement setting, hinting at the role of structural vulnerabilities such as navigating the healthcare system; these include knowledge contraceptive method options, where to access family planning services, patient-provider communication including knowledge about women’s previous experiences, and cultural nuances that impact perceptions about having children. Paraprofessionals play a critical role in women’s resettlement experiences. Specifically, culturally and linguistically similar paraprofessionals could serve as a bridge between Congolese refugees and healthcare providers with regards to reproductive health, particularly regarding single mothers. In addition, male partner involvement in women’s family planning practices cannot be overlooked as it plays a crucial role in their decisions. Future research is needed which explores men’s perceptions about family planning in the resettlement context, and the longitudinal influence of host country beliefs about childbearing on Congolese refugee women’s perspectives.

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