Last year, 28 percent of the women who gave birth in Sweden had been born in another country. Research shows that immigrants from low-income countries are six times more likely to die of pregnancy-related illnesses or complications than their Sweden-born counterparts and more than twice as likely to have a serious childbirth-related problem — such as shock from hemorrhage or septicemia, heart failure or severe eclampsia.

Sweden ranks high among countries for the quality antenatal care, but it still struggles to ensure equal pregnancy and childbirth care for all. Factors contributing to the higher mortality rate among some immigrants include pre-existing illnesses, such as tuberculosis. But differences in access to treatment in Sweden, inadequate use of interpreters and inadequate care can also contribute to higher death rates, said Annika Esscher, an obstetrician.

“Good communication is listed as one of the best ways to improve outcomes,” Dr. Esscher said.

Midwives at a nonprofit clinic in Gothenburg were the first in the country to start training doula culture interpreters 10 years ago. Since then, almost 200 women have been certified. Their services are offered in a few counties and cities to pregnant women who do not speak Swedish.

Studies show that the support of a trained doula can reduce the risk of complications and interventions during childbirth. Doulas also help women and their partners navigate an unfamiliar medical system and birth routines, and communicate with medical personnel, said Jennie Dalsmark, who started training doula culture interpreters in Halmstad in 2017.