General Health Care Recommendations
OB-GYN Care for Afghans: A Toolkit for Clinicians

On this page:
Mental health
Lead toxicity
Connecting to other resources
References

• Afghans may experience mental health challenges for many reasons, including trauma and violence experienced in Afghanistan and the stress of resettlement such as social isolation, family separation, language barriers, culture shock, financial stress, and concern for separated loved ones. Therefore, it may be difficult to distinguish if symptoms are postpartum-induced. Screening and, as appropriate, referral to mental health services is recommended.¹
• The CDC recommends lead toxicity screening for all pregnant and lactating Afghan women, as they are a high risk population, and elevated maternal blood lead levels can have negative health effects for the mother and baby. ²
• Ask what resources patients may need to help care for themselves, their family, and their new baby. Examples include nutrition programs, transportation services, car seats, household supplies, educational classes, and cultural centers. Connect patients with a public health nurse or social worker, if possible, as they may be especially equipped to make community connections. 

Mental health

Due to chronic exposure to war, displacement, gender-based discrimination, and limited access to mental healthcare, many Afghans have significant mental health needs.³ In Afghanistan, access to mental health services is limited and mental health is considered a taboo topic. There are many stressors Afghans may experience, including trauma experienced in Afghanistan, the stress of resettlement such as social isolation, family separation, language barriers, culture shock, financial strain, and concern for separated loved ones. Therefore, it may be difficult to distinguish if mental health symptoms are postpartum-induced. Mental health screening should be completed during pre- and post-natal visits. It may also be helpful to refer the patient and their family to community resources and mental and behavioral health services.

For guidance on mental health screening, including screening tools, refer to the Centers for Disease Control and Prevention’s (CDC) Mental Health Refugee Health Domestic Guidance. If a patient is showing signs of acute distress, consider the principles of psychological first aid and make appropriate referrals to mental health providers with experience caring for Afghan families. The U.S. Committee for Refugees and Immigrants has behavioral health services (BHSI) that may be beneficial.

Lead toxicity

Lead exposure and elevated blood lead levels are of concern for Afghan newcomers, particularly infants, children, and females of reproductive age (specifically those who are pregnant, breastfeeding, or trying to become pregnant). The CDC recommends that all pregnant and lactating Afghan women be screened for lead toxicity, as described in their Guidelines and Recommendations | 
Childhood Lead Poisoning Prevention.²  

Lead can cross the placenta and elevated blood lead levels may cause gestational hypertension, spontaneous abortion, low birth weight, and impaired neurodevelopment. When screening for potential sources of lead exposure, ask patients about home remedies, including herbal remedies, given that some may contain lead or other substances that could cause drug interactions or adverse effects.⁴

If a patient has an elevated blood lead level, attempt to identify and mitigate lead sources and discuss non-lead-containing alternatives. State health programs and community health workers also may be able to assist. Cookware, pressure cookers, and surma (eye makeup used on children) are common sources of lead. Iron, vitamin D, and calcium supplements are important to take during pregnancy and may reduce lead poisoning and iron deficiency anemia.  Even if a woman has elevated blood lead levels, she should be encouraged to continue breastfeeding as long as her levels are below 40 mcg/dL.⁴

Connecting to other resources

Newly arrived Afghans may not be aware of all the resources and services available to them in the U.S. Ask about what resources and support patients may need to help care for themselves, their family, and their new baby. Some examples include the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or Supplemental Nutrition Assistance Program (SNAP), other food-assistance programs, transportation services, car seats, household supplies, Early Childhood Family Education programs, English and other educational classes, and other community resources such as cultural centers. Connect patients with a public health nurse or social worker, if possible, as they may be especially equipped to have these conversations and make community connections.

References