Due, ClemenceZiersch, Anna (Flinders University)Winter, Amelia Kate2025-07-232025-07-232024https://hdl.handle.net/2440/146279The First 1000 Days (from conception to a child’s second birthday) is a key period for child development and therefore an important period in which to promote wellbeing and healthcare engagement for parents. Research indicates that people from refugee backgrounds generally experience lower levels of wellbeing and face greater obstacles to accessing healthcare than the general population. However, there is limited research specifically examining these challenges for refugee parents. This thesis therefore aimed to: 1) systematically synthesise previous research on the physical and mental wellbeing outcomes of women and men from the Greater Middle East with migrant and refugee backgrounds in the First 1000 Days; 2) understand access to health services and health service engagement for women with a refugee background from Syria and Afghanistan in the First 1000 Days; and 3) explore the wellbeing of women from Syria and Afghanistan with a refugee background in the First 1000 Days and how this intersects with health service engagement. This thesis includes three manuscripts from two separate studies. The first study was a systematic review of the wellbeing outcomes and risk and protective factors for parents from the Middle East in the First 1000 Days. Very few studies included fathers from refugee backgrounds. Mothers experienced worse wellbeing outcomes than the general population, with risk factors including loneliness, isolation, and changing roles and family dynamics. Additionally, women faced significant barriers to health service engagement that impeded help-seeking, particularly for mental health. Overall, this review found the provision of supportive, client-centred healthcare is essential to support wellbeing for parents with refugee backgrounds across the First 1000 Days. The subsequent qualitative study sought to address the research gaps identified in the systematic review but focused on mothers. Interviews were conducted with 14 Syrian women, 14 Afghan women, and 15 health service providers in South Australia and analysed thematically. Drawing on the Levesque Framework for Access to Healthcare, the second paper explored perinatal and child and family health service engagement for women with refugee backgrounds from Syria and Afghanistan in the First 1000 Days. Key findings indicated that overall women were satisfied with many elements of the healthcare they received and wished to engage with healthcare services in general. However, women experienced a range of barriers to healthcare access, particularly later in the First 1000 Days period. Paper 3 explored the wellbeing of women with refugee backgrounds from Syria and Afghanistan in the First 1000 Days, identifying four key factors which influenced wellbeing. These included making autonomous decisions about their own (and their child’s) healthcare, accessing culturally appropriate health and wellbeing supports, navigating changing relationships (particularly with partners), and the benefits and challenges of parenting in a new country. Overall, the findings of this thesis demonstrate the importance of continuity models of care that are accessible to families with refugee backgrounds across the entire First 1000 Days; that families are appropriately referred between culturally safe and relevant services in the First 1000 Days; and that mental health screening and care is provided continuously across the First 1000 Days, again in a culturally safe manner. The findings of this thesis also demonstrate the need for more research pertaining to the delivery of appropriate care around family planning and the wellbeing of fathers.enFirst 1000 Daysrefugee healthwellbeinghealthcare engagementmaternal and infant healthThesis