Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a 'maternal migration effect' as pre-migration influences on pregnant women's post-migration care-seeking and consistent utilisation of available care. We apply the 'three delays' framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005-2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of 'broken trust, which can be mutually held between women and providers. An additional factor is women's 'negative responses to future care', which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 'language discordance' can lead to a 'reliance on interpreter service', which can cause delays in Phase 3, when 'reciprocal incongruent language ability' is worsened by suboptimal interpreter systems. 'Non-reciprocating care conceptualisations', 'limited system-level care guidelines', and 'low staff levels' can additionally delay timely care in Phase 3. © 2012 Elsevier Ltd.

Health Communication immigrant women Obstetric intervention Socio-cultural factors Ethnicity Maternity guidelines Maternal care encounter Migrant-friendly hospitals

doctor patient relation maternal care immigrant health risk health care personnel London [England] Pregnancy Complications London human language ability middle aged Practice Guidelines as Topic social aspect African American qualitative research interview African immigrant Young Adult income Humans conceptual framework Adolescent Emigrants and Immigrants England female Socioeconomic Factors purposive sample health care personnel management Risk Factors Africa qualitative analysis pregnancy cultural factor Article health care health care utilization guideline help seeking behavior pregnancy outcome patient compliance interpreter service adult naturalistic inquiry health care access United Kingdom maternal mortality therapy delay Health Services Accessibility expectation treatment refusal ethnicity low income population Maternal Health Services Cultural Characteristics Patient Acceptance of Health Care practice guideline health care availability Time-to-Treatment womens health health care delivery