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Sacks E, Brizuela V, Javadi D, Kim Y, Elmi N, Finlayson K, Crossland N, Langlois EV, Ziegler D, Parmar SM, Bonet M. Immigrant women's and families' views and experiences of routine postnatal care: findings from a qualitative evidence synthesis. BMJ Glob Health 2024; 8:e014075. [PMID: 38351019 PMCID: PMC10897958 DOI: 10.1136/bmjgh-2023-014075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Uptake of postnatal care (PNC) is low and inequitable in many countries, and immigrant women may experience additional challenges to access and effective use. As part of a larger study examining the views of women, partners, and families on routine PNC, we analysed a subset of data on the specific experiences of immigrant women and families. METHODS This is a subanalysis of a larger qualitative evidence synthesis. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews and grey literature for studies published until December 2019 with extractable qualitative data with no language restrictions. For this analysis, we focused on papers related to immigrant women and families. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and quality assessment were carried out using a study-specific extraction form and established quality assessment tools. Study findings were identified using thematic analysis. Findings are presented by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS We included 44 papers, out of 602 full-texts, representing 11 countries where women and families sought PNC after immigrating. All but one included immigrants to high-income countries. Four themes were identified: resources and access, differences from home country, support needs, and experiences of care. High confidence study findings included: language and communication challenges; uncertainty about navigating system supports including transportation; high mental health, emotional, and informational needs; the impact of personal resources and social support; and the quality of interaction with healthcare providers. These findings highlight the importance of care experiences beyond clinical care. More research is also needed on the experiences of families migrating between low-income countries. CONCLUSIONS Immigrant families experience many challenges in getting routine PNC, especially related to language, culture, and communication. Some challenges may be mitigated by improving comprehensive and accessible information on available services, as well as holistic social support. TRIAL REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoona Kim
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Nika Elmi
- School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Finlayson
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ramadan M, Rukh-E-Qamar H, Yang S, Vang ZM. Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review. PLoS One 2023; 18:e0287617. [PMID: 37883411 PMCID: PMC10602334 DOI: 10.1371/journal.pone.0287617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. METHODS Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. RESULTS In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. CONCLUSION Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.
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Affiliation(s)
- Marwa Ramadan
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Hani Rukh-E-Qamar
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Zoua M. Vang
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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Dion A, Carini-Gutierrez A, Jimenez V, Ben Ameur A, Robert E, Joseph L, Andersson N. Weight of Evidence: Participatory Methods and Bayesian Updating to Contextualize Evidence Synthesis in Stakeholders' Knowledge. JOURNAL OF MIXED METHODS RESEARCH 2022; 16:281-306. [PMID: 35872747 PMCID: PMC9297342 DOI: 10.1177/15586898211037412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Mixed methods research is well-suited to grapple with questions of what counts as valid knowledge across different contexts and perspectives. This article introduces Weight of Evidence as a transformative procedure for stakeholders to interpret, expand on and prioritize evidence from evidence syntheses, with a focus on engaging populations historically excluded from planning and decision making. This article presents the procedure's five steps using pilot data on perinatal care of immigrant women in Canada, engaging family physicians and birth companions. Fuzzy cognitive mapping offers an accessible and systematic way to generate priors to update published literature with stakeholder priorities. Weight of Evidence is a transparent procedure to broaden what counts as expertise, contributing to a more comprehensive, context-specific, and actionable understanding.
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Affiliation(s)
- Anna Dion
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Anna Dion, Department of Family Medicine, McGill University, 5858 chemin de la Cotes-des-Neiges, Montréal, Québec H3S 1Z1, Canada.
| | | | - Vania Jimenez
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | | | - Emilie Robert
- SHERPA University Institute, Montreal, Quebec, Canada
- ICARES Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Autonomous University of Guerrero, Acapulco, Mexico
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Lim M, Van Hulst A, Pisanu S, Merry L. Social Isolation, Loneliness and Health: A Descriptive Study of the Experiences of Migrant Mothers With Young Children (0–5 Years Old) at La Maison Bleue. Front Glob Womens Health 2022; 3:823632. [PMID: 35814837 PMCID: PMC9265247 DOI: 10.3389/fgwh.2022.823632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Migrant women with young children, including asylum seekers and refugees, have multiple vulnerability factors that put them at increased risk of social isolation and loneliness, which are associated with negative health outcomes. This study explored the experiences of social isolation and loneliness among migrant mothers with children aged 0–5 years as well as their perceptions on possible health impacts. Methods A qualitative descriptive study was conducted at La Maison Bleue, a non-profit organization providing perinatal health and social services to vulnerable women in Montreal, Canada. Recruitment and data collection occurred concurrently during the COVID-19 pandemic, between November and December 2020. Eleven women participated in individual semi-structured interviews and provided socio-demographic information. Interview data were thematically analyzed. Results Migrant women in this study described social isolation as the loss of family support and of their familiar social/cultural networks, and loneliness as the feelings of aloneness that stemmed from being a mother in a new country with limited support. Multiple factors contributed to women's and children's social isolation and loneliness, including migration status, socioeconomic circumstances, language barriers, and being a single mother. Women expressed that the COVID-19 pandemic exacerbated pre-existing experiences of social isolation and loneliness. Mothers' experiences affected their emotional and mental health, while for children, it reduced their social opportunities outside the home, especially if not attending childcare. However, the extent to which mothers' experiences of social isolation and loneliness influenced the health and development of their children, was less clear. Conclusion Migrant mothers' experiences of social isolation and loneliness are intricately linked to their status as migrants and mothers. Going forward, it is critical to better document pandemic and post-pandemic consequences of social isolation and loneliness on young children of migrant families. Supportive interventions for migrant mothers and their young children should not only target social isolation but should also consider mothers' feelings of loneliness and foster social connectedness and belongingness. To address social isolation and loneliness, interventions at the individual, community and policy levels are needed.
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Affiliation(s)
- Mona Lim
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | | | - Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- West Central Montreal CIUSSS, SHERPA University Institute, Montreal, QC, Canada
- InterActions Centre de recherche et de partage des savoirs, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
- *Correspondence: Lisa Merry
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5
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Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018). J Immigr Minor Health 2022; 24:256-299. [PMID: 33811583 PMCID: PMC8487436 DOI: 10.1007/s10903-021-01184-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
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Affiliation(s)
- Stefanie Machado
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Argentina E Servin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
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Parity and Psychosocial Risk Factors Increase the Risk of Depression During Pregnancy Among Recent Immigrant Women in Canada. J Immigr Minor Health 2021; 24:570-579. [PMID: 34595614 DOI: 10.1007/s10903-021-01284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
Prior investigations have examined risk factors associated to postpartum depression in immigrant women, but depression during pregnancy has received less attention. This study describes the prevalence and early determinants of antenatal depression among recent (≤ 5 years) and long-term immigrants (> 5 years), compared to Canadian-born women. 503 women completed standardized self-report questionnaires measuring sociodemographics and psychosocial factors. Multivariate logistic regressions identified first trimester risk factors for depression in each immigrant group. The prevalence of depressive symptoms was highest for recent immigrant (25.3-30.8%) compared to long-term immigrant (16.9-19.2%) and Canadian-born women (11.7-13.8%). Among recent immigrants, multiparity, higher stress and pregnancy-specific anxiety in early pregnancy increased the risk of antenatal depression. Among long-term immigrants, stress in the first trimester was significantly associated with antenatal depressive symptoms. Knowledge of modifiable risk factors (pregnancy-specific anxiety and stress) may help improve antenatal screening and inform the development of tailored interventions to meet the mental health needs of immigrant women during the perinatal period.
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Merry L, Pelaez S. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:411-413. [PMID: 34127462 PMCID: PMC8202737 DOI: 10.46747/cfp.6706411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa Merry
- Professeure adjointe à la Faculté des sciences infirmières de l'Université de Montréal (Québec).
| | - Sandra Pelaez
- Chercheuse au Centre de recherche du CHU Sainte-Justine à Montréal
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Desharnais-Préfontaine N, Pisanu S, Bellemare AM, Merry L. Les politiques publiques affectant négativement les familles demandeuses d'asile avec des jeunes de 0 à 5 ans au Québec. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:128-131. [PMID: 32783145 PMCID: PMC7851264 DOI: 10.17269/s41997-020-00392-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022]
Abstract
In 2019, 30,615 asylum claims were made in Quebec, representing almost half of the claims made in Canada. Asylum-seeking families with young children (0 to 5 years) represent a significant proportion of this population. Canada, as well as Quebec, have a responsibility to protect asylum seekers and to ensure that public policies promote health and well-being, especially among children. However, certain existing public policies exclude asylum seekers and are negatively affecting families. This commentary seeks to raise awareness among all those involved in policymaking, especially decision-makers, regarding asylum-seekers and three policy domains that are contributing to poverty, social isolation, and reduced access to care among asylum-seeking families with young children. These include the lack of eligibility for child benefits, the limited access to affordable daycare, and barriers to accessing family doctors. Consequently, both parents and children suffer impacts to their health and well-being. We are calling on our governments to assume their responsibilities and eliminate these inequities, and to ensure that the health of asylum seekers is considered in all policies.
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Affiliation(s)
| | | | | | - Lisa Merry
- Faculté des sciences infirmières, Université de Montréal, Institut universitaire SHERPA, CIUSSS du Centre-Ouest-de-l'île-de-Montréal et InterActions- Centre de recherche et de partage des savoirs, CIUSSS du Nord-de-l'île-de-Montréal, Montréal, QC, Canada.
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9
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Exploring the State of Gender-Centered Health Research in the Context of Refugee Resettlement in Canada: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207511. [PMID: 33076467 PMCID: PMC7602644 DOI: 10.3390/ijerph17207511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
Interdisciplinary health research that investigates gender as a relational process is necessary to facilitate a safe and healthy resettlement process for refugees in Canada. This scoping review explores the range, nature, and extent of published research examining gender in relation to refugee health during resettlement in Canada. An initial search of six databases yielded 7325 articles published before June 2019. A total of 34 articles published between 1988 and 2019 were included for in-depth review. Articles meeting inclusion criteria primarily focused on refugee women. Categories of focus included maternal health, social and emotional health, health impacts of sexual and gender-based violence and torture, access to health and social services, decision-making and health-seeking behavior, mental health, and sexual and reproductive health. Our thematic analysis identified connections between gender roles, expectations, ideals, and health through interactions and lived experiences within the family, community, and healthcare system. Review findings suggest that many refugee women are influenced by pervasive gender roles and expectations as well as exposed to gendered health systems and practices that may pose risks to health, particularly mental health and access to services. Further efforts should be made to understand processes and experiences of resilience and community building in countering negative impacts of gendered beliefs and practices on health during resettlement.
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Merry L, Villadsen SF, Sicard V, Lewis-Hibbert N. Transnationalism and care of migrant families during pregnancy, postpartum and early-childhood: an integrative review. BMC Health Serv Res 2020; 20:778. [PMID: 32838781 PMCID: PMC7446052 DOI: 10.1186/s12913-020-05632-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/06/2020] [Indexed: 12/05/2022] Open
Abstract
Background Migrant families’ transnational ties (i.e., connections to their countries of origin) may contribute to their hardships and/or may be a source of resiliency. A care approach that addresses these transnational ties may foster a positive identity and give coherence to experiences. We conducted an integrative review to determine what is known about transnational ties and the care of migrant families during pregnancy, postpartum and early childhood. Methods We searched 15 databases to identify literature reporting on a health or social program, service, or care experience of migrant families during pregnancy up to age five in a Western country (i.e., Canada, US, Australia, New Zealand or a European country). Information regarding if and how the service/program/care considered transnational ties, and care-providers’ perceptions of transnational ties, was extracted, analyzed and synthesized according to transnational ‘ways of belonging’ and ‘ways of being’. Results Over 34,000 records were screened; 69 articles were included. Care, programs and services examined included prenatal interventions (a mhealth app, courses, videos, and specialized antenatal care), doula support, maternity care, support groups, primary healthcare and psycho-social early intervention and early childhood programs. The results show that transnational ties in terms of ‘ways of belonging’ (cultural, religious and linguistic identity) are acknowledged and addressed in care, although important gaps remain. Regarding ‘ways of being’, including emotional, social, and economic ties with children and other family members, receipt of advice and support from family, and use of health services abroad, there is very little evidence that these are acknowledged and addressed by care-providers. Perceptions of ‘ways of belonging’ appear to be mixed, with some care-providers being open to and willing to adapt care to accommodate religious, cultural and linguistic differences, while others are not. How care-providers perceive the social, emotional and economic ties and/or the use of services back home, remains relatively unknown. Conclusion Significant knowledge gaps remain regarding care-providers’ perceptions of transnational ‘ways of being’ and whether and how they take them into account, which may affect their relationships with migrant families and/or the effectiveness of their interventions. Continued efforts are needed to ensure care is culturally safe for migrants.
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Affiliation(s)
- Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Canada.
| | | | - Veronik Sicard
- School of Kinesiology and Exercise Science, University of Montreal, Montreal, Canada
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11
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Snow G, Melvin GA, Boyle JA, Gibson-Helm M, East CE, McBride J, Gray KM. Perinatal psychosocial assessment of women of refugee background. Women Birth 2020; 34:e302-e308. [PMID: 32571715 DOI: 10.1016/j.wombi.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women of refugee background may be particularly vulnerable to perinatal mental illness, possibly due to increased exposure to psychosocial stressors associated with their forced migration and post-resettlement adjustment. AIM This study aimed to compare psychosocial risk factors reported by women of refugee background receiving maternity services at a public hospital, to those reported by Australian-born women in the same hospital. It further aimed to examine the referrals offered, and accepted, by the women of refugee background reporting psychosocial risk factors for perinatal mental illness. METHODS A retrospective hospital record review was conducted to compare the antenatal and postnatal psychosocial risk factors of 100 women of refugee background and 100 Australian-born women who gave birth at a public hospital in Victoria between 1 July 2015 and 30 April 2016, and who had completed the Maternity Psychosocial Needs Assessment. FINDINGS Women of refugee background were more likely than Australian-born women to report financial concerns and low social support at antenatal assessment, but were less likely to report prior mental health problems than Australian-born women at either assessment point. Both groups reported low rates of family violence compared to published prevalence rates. Of the women of refugee background assessed antenatally, 23% were offered referrals, with 52% take-up. Postnatally, 11.2% were offered referrals, with 93% take-up. DISCUSSION/CONCLUSION This study showed elevated rates of psychosocial risk factors among women of refugee background, however, possible under-reporting of mental health problems and family violence raises questions regarding how to assess psychosocial risk factors with different cultural groups. Lower antenatal referral take-up suggests barriers to acceptance of referrals may exist during pregnancy.
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Affiliation(s)
- Gillian Snow
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.
| | - Glenn A Melvin
- School of Psychology, Faculty of Health, Deakin University, Victoria, Australia; Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Monash Women's Maternity Services, Monash Health, Victoria, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Christine E East
- Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Monash Women's Maternity Services, Monash Health, Victoria, Australia; School of Nursing and Midwifery, Monash University, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia
| | | | - Kylie M Gray
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, United Kingdom; Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
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12
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Freedman J, Crankshaw TL, Mutambara VM. Sexual and reproductive health of asylum seeking and refugee women in South Africa: understanding the determinants of vulnerability. Sex Reprod Health Matters 2020; 28:1758440. [PMID: 32425112 PMCID: PMC7888032 DOI: 10.1080/26410397.2020.1758440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Women asylum seekers and refugees face huge challenges related to their sexual and reproductive health (SRH) and rights. In this article we explore the structural determinants of vulnerability to poor SRH for these women in South Africa, and focus particularly on the political, legal and economic structures which render them vulnerable. Based on a qualitative study carried out in Durban, South Africa, we argue that it is vital to go beyond analyses which prioritise the socio-cultural barriers to sexual and reproductive health and rights for asylum seekers and refugees, and to consider the wider national and international policies and legislation which create barriers to these women's rights to SRH.
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Affiliation(s)
- Jane Freedman
- Professor, Centre for Sociological and Political Research (CRESPPA), Université Paris 8 Paris, France
| | - Tamaryn L Crankshaw
- Senior Research Fellow, Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Victoria M Mutambara
- Post-Doctoral Researcher, HEARD, Univerity of KwaZulu-Natal, Durban, South Africa
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13
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Okegbile EO, Goldsmith MM, Crist JD. South Sudanese refugee Women’s healthcare access and use: An integrative review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Aubé T, Pisanu S, Merry L. La Maison Bleue: Strengthening resilience among migrant mothers living in Montreal, Canada. PLoS One 2019; 14:e0220107. [PMID: 31344081 PMCID: PMC6657858 DOI: 10.1371/journal.pone.0220107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 07/09/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. Methods We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. Results Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women’s intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. Conclusion Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country.
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Affiliation(s)
- Thalia Aubé
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | | | - Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Quebec, Canada
- InterActions Centre de recherche et de partage des savoirs, Montreal, Quebec, Canada
- SHERPA centre de recherche, Montreal, Quebec, Canada
- * E-mail:
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Quintanilha M, Mayan MJ, Jarman M, Bell RC. Prevalence and experiences of food insecurity among immigrant women connected to perinatal programs at a community-based organization in Edmonton, Canada. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2019. [DOI: 10.1108/ijmhsc-09-2018-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to investigate the prevalence of household food insecurity among immigrant women connected to perinatal programs offered through a community-based organization in Edmonton, and to explore their experiences in coping with food insecurity.Design/methodology/approachThis study utilized a mixed methods research design. A community-based participatory research approach was used to engage health workers who were connected to immigrant women and families through the Multicultural Health Brokers Cooperative in Edmonton. Through the health workers a sample of 213 immigrant women connected to their perinatal programs completed the Household Food Security Survey. Following the survey, 17 women completed semi-structured interviews which were analyzed using content analysis.FindingsThe vast majority of women (94 percent (n=199)) lived in food insecure households, and 53 percent (n=112) in severely food insecure. In semi-structured interviews, women specifically described not having enough money to buy vegetables, fruit and meat, and perceiving a lack of control over foods they ate and offered to their families.Practical implicationsThis study highlights the need for support to be provided to immigrant families for acquiring healthy food in Canada.Originality/valueThe mixed methods design with a decent sample of often underrepresented research participants highlights an area in need of further research and greater support.
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Exploring Health Service Underutilization: A Process Evaluation of the Newcomer Women's Health Clinic. J Immigr Minor Health 2019; 20:920-925. [PMID: 28660392 DOI: 10.1007/s10903-017-0616-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The BC Women's Hospital and Health Centre's Newcomer Women's Health Clinic (NWHC) opened in 2014 to fill a gap in services for newcomer women to Canada residing in Metro Vancouver. After 1 year the NWHC was operating at only 50% capacity. An evaluation was conducted to better understand the underutilization of clinic services. Evaluation data was collected via patient intake forms, patient feedback surveys, and one-to-one interviews with both newcomer women and service providers who work with newcomer women. Results highlight the heterogeneity in newcomer women's experiences including different perceptions of health, health needs, and health-seeking behaviours. Despite the population's diversity, some common experiences exist, including difficulties navigating and accessing a new health system and lack of awareness of the NWHC. Findings provide insight for improving the delivery of NWHC services, and contribute to a rich and ongoing dialogue concerning the diversity of experiences of newcomer women in Canada.
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Keboa MT, Hovey R, Nicolau B, Esfandiari S, Carnevale F, Macdonald ME. Oral healthcare experiences of humanitarian migrants in Montreal, Canada. Canadian Journal of Public Health 2019; 110:453-461. [PMID: 30850954 DOI: 10.17269/s41997-019-00193-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/06/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the oral healthcare experiences of humanitarian migrants in Montreal and their perceptions of ways to improve access to oral healthcare. METHODS We used focused ethnography informed by a public health model of the dental care process. The adapted McGill Illness Narrative Interview (MINI) guided interviews of a purposeful sample of humanitarian migrants who received or needed dental care in Montreal. Each interview (50-60 min) was audio-recorded for verbatim transcription. Observation of dental care episodes occurred during mobile dental clinics in underserved communities over the same period (2015-2016). Data analysis combined deductive codes from the theoretical frameworks and inductive codes from interview transcripts and field notes to inform themes. RESULTS We interviewed 25 participants (13 refugees and 12 asylum seekers) from 10 countries, who had been in Canada for a range of 1 month to 5 years. The dental care experiences of participants included delayed consultation, proximity to dental clinics, quality care, limited treatment choices, high cost, and long waiting times. A more inclusive healthcare policy, lower fees, integration of dental care into public insurance, and creation of community dental clinics were proposed strategies to improve access to dental care. CONCLUSION Humanitarian migrants in this study experienced inadequate oral healthcare. Their lived experiences help us to identify gaps in the provision of oral healthcare services, and suggestions of participants have great potential to improve access to oral healthcare.
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Affiliation(s)
- Mark Tambe Keboa
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada.
| | - Richard Hovey
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada
| | - Belinda Nicolau
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada
| | - Shahrokh Esfandiari
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Franco Carnevale
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Mary Ellen Macdonald
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada
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Kohlenberger J, Buber-Ennser I, Rengs B, Leitner S, Landesmann M. Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey. Health Policy 2019; 123:833-839. [PMID: 30878171 DOI: 10.1016/j.healthpol.2019.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
This paper provides evidence on (1) refugees' subjective well-being, (2) their access and barriers to health care utilization and (3) their perception of health care provision in Austria, one of the countries most heavily affected by the European 'refugee crisis.' It is based on primary data from the Refugee Health and Integration Survey (ReHIS), a cross-sectional survey of roughly five hundred Syrian, Iraqi and Afghan refugees. Results indicate that refugees' self-rated health falls below the resident population's, in particular for female and Afghan refugees. Whereas respondents state overall high satisfaction with the Austrian health system, two in ten male and four in ten female refugees report unmet health needs. Most frequently cited barriers include scheduling conflicts, long waiting lists, lack of knowledge about doctors, and language. Although treatment costs were not frequently considered as barriers, consultation of specialist medical services frequently associated with co-payment by patients, in particular dental care, are significantly less often consulted by refugees than by Austrians. Refugees reported comparably high utilization of hospital services, with daycare treatment more common than inpatient stays. We recommend to improve refugees' access to health care in Austria by a) improving the information flow about available treatment, in particular specialists, b) fostering dental health care for refugees, and c) addressing language barriers by providing (web-based) interpretation services.
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Affiliation(s)
- Judith Kohlenberger
- Institute for Social Policy, Department for Socioeconomics, Vienna University of Economics and Business, Welthandelsplatz 2, 1020 Vienna, Austria.
| | - Isabella Buber-Ennser
- Vienna Institute of Demography, Austrian Academy of Sciences, Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Welthandelsplatz 2, 1020 Vienna, Austria.
| | - Bernhard Rengs
- Vienna Institute of Demography, Austrian Academy of Sciences, Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Welthandelsplatz 2, 1020 Vienna, Austria.
| | - Sebastian Leitner
- Vienna Institute for International Economic Studies (wiiw), Rahlgasse 5, 1060 Vienna, Austria.
| | - Michael Landesmann
- Johannes Kepler University Linz, and Vienna Institute for International Economic Studies (wiiw), Rahlgasse 5, 1060 Vienna, Austria.
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Rouhi M, Stirling C, Ayton J, Crisp EP. Women's help-seeking behaviours within the first twelve months after childbirth: A systematic qualitative meta-aggregation review✰. Midwifery 2019; 72:39-49. [PMID: 30772692 DOI: 10.1016/j.midw.2019.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/11/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Women within the first 12 months after birth often do not seek professional help for post-childbirth morbidities. This systematic review uses the Behavioural Model of Health Services Use (BMSHU) to assess the barriers and facilitators to women's help-seeking from health professionals during the first twelve months after childbirth. METHOD A qualitative meta-aggregation was used for the review. Systematic searching of Medline via Ovid, CINAHL, EMBASE and Web of Science revealed an initial 691 papers, of which 48 were reviewed. Nine qualitative papers, peer-reviewed, English papers and published from 2000 to 2017, were identified. Studies selected according to the pre-defined protocol were assessed using The Joanna Briggs Institute Critical Appraisal Tools (JBIQARI). RESULTS Seventy-five findings were identified from the approved articles and aggregated into seven categories. Key themes that emerged were that women did not seek help because they accepted problems as a part of the motherhood role or because they feared being judged negatively. Women shared their issues with family and friends as trusted people. Low health literacy was a barrier to seeking help, as was lack of access to proper care and poor advice from families. The women's cultural context was an essential influence in whether or not they sought help. According to BMSHU, a model of key influences on women's help-seeking for maternal morbidities introduced.
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Affiliation(s)
- Maryam Rouhi
- School of Nursing, College of Health and Medicine, University of Tasmania, Advocate House, 9 Liverpool St, Hobart TAS 7001, Australia.
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Private Bag 135, Hobart TAS 7001, Australia.
| | - Jenifer Ayton
- Lecturer in Public Health School of Medicine, College of Health and Medicine, University of Tasmania, Private Bag 34, Hobart, TAS 7001, Australia.
| | - Elaine Peta Crisp
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Launceston 7250, Australia.
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20
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O'Mahony J, Clark N. Immigrant Women and Mental Health Care: Findings from an Environmental Scan. Issues Ment Health Nurs 2018; 39:924-934. [PMID: 30273096 DOI: 10.1080/01612840.2018.1479903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Immigrant women's mental health is a growing public health policy issue. New immigrant mothers may be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. The purpose of this environmental scan was to increase understanding of immigrant women's perinatal mental health care services within the interior of a western Canadian province. Four interrelated themes emerged to impact postpartum health of immigrant women: (i) community capacity building, (ii) facilitators of mental health support and care, (iii) barriers of mental health promotion and support, and (iv) public policy and postpartum depression. Knowledge gained from this study contributes to healthy public policy and practices that promote mental health and support among immigrant women.
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Affiliation(s)
- Joyce O'Mahony
- a School of Nursing , Thompson Rivers University , Kamloops , BC , Canada
| | - Nancy Clark
- b Faculty of Human and Social Development, School of Nursing , University of Victoria , Victoria , BC , Canada
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21
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Khan A, DeYoung SE. Maternal health services for refugee populations: Exploration of best practices. Glob Public Health 2018; 14:362-374. [DOI: 10.1080/17441692.2018.1516796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aishah Khan
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, GA, USA
| | - Sarah E. DeYoung
- Department of Health Policy and Management, University of Georgia College of Public Health, Athens, GA, USA
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22
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Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med 2018; 16:89. [PMID: 29890984 PMCID: PMC5996508 DOI: 10.1186/s12916-018-1064-0] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status. METHODS Twelve electronic database, reference list and citation searches (1 January 2007-July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively. RESULTS Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women's experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare. CONCLUSIONS This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women's experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities. SYSTEMATIC REGISTRATION Systematic review registration number: PROSPERO CRD42017073315 .
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Affiliation(s)
- Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Heather Brown
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Augustina Pemu
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Hayley Coleman
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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23
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Firth AD, Haith-Cooper M. Vulnerable migrant women and postnatal depression: A case of invisibility in maternity services? ACTA ACUST UNITED AC 2018. [DOI: 10.12968/bjom.2018.26.2.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Melanie Haith-Cooper
- Senior lecturer in midwifery and director of postgraduate research, University of Bradford
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24
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Mahon A, Merry L, Lu O, Gagnon AJ. Postpartum Pain in the Community Among Migrant and Non-migrant Women in Canada. J Immigr Minor Health 2018; 19:407-414. [PMID: 26883029 DOI: 10.1007/s10903-016-0364-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
International migrant women of childbearing age represent a large proportion of immigrants to high-income countries, yet research focusing on their postpartum health is limited. We investigated predictive factors for breast and non-breast pain 1 week post-birth in migrant and non-migrant women in Canada. Among migrant women, difficulty accessing health services; being from a middle-or high-income country; poor functionality in English and French; living with the father of their infant; and having no regular care provider were predictive of breast pain. Among non-migrant women, difficulties accessing health services, multiparity and prenatal education were predictive of breast pain, while receiving an epidural and having no regular care provider were predictive of non-breast pain. Among both groups, difficulties accessing health services and having no regular care provider were predictive of breast pain, while second degree or higher perineal tearing was predictive of non-breast pain. Migration-specific indicators should be considered in postpartum care planning.
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Affiliation(s)
- Abbey Mahon
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Lisa Merry
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Olivia Lu
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada.
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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25
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Mangrio E, Sjögren Forss K. Refugees' experiences of healthcare in the host country: a scoping review. BMC Health Serv Res 2017; 17:814. [PMID: 29216876 PMCID: PMC5721651 DOI: 10.1186/s12913-017-2731-0] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background During the last years, Europe experienced an increase in immigration due to a variety of worldwide wars and conflicts, which in turn resulted in a greater number of physical and mental health issues present among the refugees. These factors place high demands not only on the refugees, but also on healthcare professionals who meet the refugees in different situations. Information about the refugees’ experiences of the healthcare systems in their host countries is urgently needed to improve the quality of healthcare delivered, as well as to provide opportunities for better access. The aim of this scoping review is to compile research about the experiences that the refugees have with the healthcare systems in their host countries. Methods This study was conducted as a scoping review and the methodology is derived from Levac et al. and with inspiration from the framework of Arksey & O’Malley. A systematic article search was done in Medline, Cinahl and Psychinfo. A total of 619 articles were found in the search and finally 26 articles met the inclusion criteria and were included. Results The results show that communication between healthcare professionals and refugees is important, however, insufficient language knowledge acts as an effective communication barrier. There is a need for more information to be given to the refugees about the reception country’s healthcare system in both oral and written formats, as well as the right to healthcare. Support from healthcare professionals is also important for refugees to have a positive experience with healthcare. In some of the studies included, refugees experienced discrimination due to low proficiency in the language of the host country, and/or because of their race or accent, which shows that culturally appropriate healthcare is needed for them. Conclusions Since refugees are suffering from poor mental and physical health and could therefore be at a greater risk of morbidity and mortality in comparison to the rest of the population of the host country, there is an urgent need for improvements in communication, interpretation, support, and deliverance of culturally appropriate healthcare.
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Affiliation(s)
- Elisabeth Mangrio
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden. .,MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden.
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,MIM, Malmö Institute for Studies of Migration, Diversity and Welfare, Malmö University, Malmö, Sweden
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26
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Affiliation(s)
- Lisa Merry
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.
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27
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Rink N, Muttalib F, Morantz G, Chase L, Cleveland J, Rousseau C, Li P. The gap between coverage and care-what can Canadian paediatricians do about access to health services for refugee claimant children? Paediatr Child Health 2017; 22:430-437. [PMID: 29479260 DOI: 10.1093/pch/pxx115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction In June 2012, the government of Canada severely restricted the scope of the Interim Federal Health Program that had hitherto provided coverage for the health care needs of refugee claimants. The Quebec government decided to supplement coverage via the provincial health program. Despite this, we hypothesized that refugee claimant children in Montreal would continue to experience significant difficulties in accessing basic health care. Objectives (1) Report the narrative experiences of refugee claimant families who were denied health care services in Montreal following June 2012, (2) describe the predominant barriers to accessing health care services and understanding their impact using thematic analysis and (3) derive concrete recommendations for child health care providers to improve access to care for refugee claimant children. Methods Eleven parents recruited from two sites in Montreal participated in semi-structured interviews designed to elicit a narrative account of their experiences seeking health care. Interviews were recorded, transcribed, coded using NVivo software and subjected to thematic analysis. Results Thematic analysis of the data revealed five themes concerning barriers to health care access: lack of continuous health coverage, health care administrators/providers' lack of understanding of Interim Federal Health Program coverage, refusal of services or fees charged, refugee claimants' lack of understanding about health care rights and services and language barriers, and four themes concerning the impact of denial of care episodes: potential for adverse health outcomes, psychological distress, financial burden and social stigma. Conclusion We propose eight action points for advocacy by Canadian paediatricians to improve access to health care for refugee claimant children in their communities and institutions.
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Affiliation(s)
- N Rink
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
| | - F Muttalib
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
| | - G Morantz
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
| | - L Chase
- School of Oriental and African Studies, University of London, London, UK
| | - J Cleveland
- CSSS de la Montagne - Centre de recherche et de formation, Montreal, Quebec
| | - C Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montreal, Quebec
| | - P Li
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
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Stewart M, Kushner KE, Dennis C, Kariwo M, Letourneau N, Makumbe K, Makwarimba E, Shizha E. Social support needs of Sudanese and Zimbabwean refugee new parents in Canada. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2017. [DOI: 10.1108/ijmhsc-07-2014-0028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine support needs of African refugee new parents in Canada, and identifies support preferences that may enhance the mental health of refugee parents and children.
Design/methodology/approach
In all, 72 refugee new parents from Zimbabwe (n=36) and Sudan (n=36) participated in individual interviews. All had a child aged four months to five years born in Canada. Refugee new parents completed standardized measures on social support resources and support seeking as a coping strategy. Four group interviews (n=30) with refugee new parents were subsequently conducted. In addition, two group interviews (n=30) were held with service providers and policy influencers.
Findings
Separated from their traditional family and cultural supports, refugee new parents reported isolation and loneliness. They lacked support during pregnancy, birth, and postpartum and had limited interactions with people from similar cultural backgrounds. Refugees required support to access services and overcome barriers such as language, complex systems, and limited financial resources. Support preferences included emotional and information support from peers from their cultural community and culturally sensitive service providers.
Research limitations/implications
Psychometric evaluation of the quantitative measures with the two specific populations included in this study had not been conducted, although these measures have been used with ethnically diverse populations by other researchers.
Practical implications
The study findings can inform culturally appropriate health professional practice, program and policy development.
Originality/value
The study bridges gaps in research examining support needs and support intervention preferences of African refugee new parents.
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Riggs E, Muyeen S, Brown S, Dawson W, Petschel P, Tardiff W, Norman F, Vanpraag D, Szwarc J, Yelland J. Cultural safety and belonging for refugee background women attending group pregnancy care: An Australian qualitative study. Birth 2017; 44:145-152. [PMID: 28110517 DOI: 10.1111/birt.12272] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Refugee women experience higher incidence of childbirth complications and poor pregnancy outcomes. Resettled refugee women often face multiple barriers accessing pregnancy care and navigating health systems in high income countries. METHODS A community-based model of group pregnancy care for Karen women from Burma was co-designed by health services in consultation with Karen families in Melbourne, Australia. Focus groups were conducted with women who had participated to explore their experiences of using the program, and whether it had helped them feel prepared for childbirth and going home with a new baby. RESULTS Nineteen women (average time in Australia 4.3 years) participated in two focus groups. Women reported feeling empowered and confident through learning about pregnancy and childbirth in the group setting. The collective sharing of stories in the facilitated environment allowed women to feel prepared, confident and reassured, with the greatest benefits coming from storytelling with peers, and developing trusting relationships with a team of professionals, with whom women were able to communicate in their own language. Women also discussed the pivotal role of the bicultural worker in the multidisciplinary care team. Challenges in the hospital during labor and birth were reported and included lack of professional interpreters and a lack of privacy. CONCLUSION Group pregnancy care has the potential to increase refugee background women's access to pregnancy care and information, sense of belonging, cultural safety using services, preparation for labor and birth, and care of a newborn.
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Affiliation(s)
- Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
| | - Sumaiya Muyeen
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - Wendy Dawson
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Pauline Petschel
- Maternal and Child Health, Wyndham City Council, Werribee, Vic., Australia
| | - Waan Tardiff
- Maternal and Child Health, Wyndham City Council, Werribee, Vic., Australia.,VICSEG New Futures, Coburg, Vic., Australia
| | - Fiona Norman
- Department of Education and Training, State Government of Victoria, East Melbourne, Vic., Australia
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Jo Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Vic., Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Vic., Australia
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Dennis CL, Merry L, Gagnon AJ. Postpartum depression risk factors among recent refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:411-422. [PMID: 28220215 DOI: 10.1007/s00127-017-1353-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective was to examine and compare risk factors for postpartum depression among: (1) recent (≤5 years) migrant and Canadian-born women, and (2) refugee, asylum-seeking, and non-refugee immigrant women. METHODS A sample of 1536 women (1024 migrant and 512 Canadian-born) were recruited from 12 hospitals. Women completed questionnaires at 1-2 and 16 weeks postpartum including questions on socio-demographics, biomedical history, health services, and migration and resettlement factors. Bivariate analyses and multivariate logistic regression were performed to examine and compare risk factors for postpartum depressive symptoms at 16 weeks postpartum. RESULTS Recent migrant women had significantly higher rates (6%) of depressive symptoms at 16 weeks postpartum than Canadian-born women (2.9%). Asylum-seekers had the highest rate (14.3%), followed by refugee (11.5%) and non-refugee immigrant women (5.1%). Migrant women at greatest risk to develop depressive symptoms were those who experienced abuse, had pain post-birth, worried about family members left behind, had food insecurity, and had reduced access to healthcare (limited insurance and/or no regular care-provider). Conversely, those with higher levels of social support and who felt they belonged to a community had a lower risk of developing depressive symptoms. CONCLUSION All childbearing recent migrant women should be considered at risk for postpartum depression. To prevent and support migrant women suffering postpartum depressive symptoms, barriers to healthcare need to be addressed and interventions should include assessments and support/programmes for abuse/violence, lack of social support, food insecurity, and stress/poor mental health. Treatment of pain during the postpartum period is also critical.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
| | - Lisa Merry
- School of Nursing, University of Ottawa, 1 Stewart Street, Rm 127, Ottawa, ON, K1N 6N5, Canada. .,Ingram School of Nursing, McGill University, Montreal, Canada.
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Research Institute, McGill University Health Centre, Montreal, Canada
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Peláez S, Hendricks KN, Merry LA, Gagnon AJ. Challenges newly-arrived migrant women in Montreal face when needing maternity care: Health care professionals' perspectives. Global Health 2017; 13:5. [PMID: 28122630 PMCID: PMC5264303 DOI: 10.1186/s12992-016-0229-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/22/2016] [Indexed: 11/16/2022] Open
Abstract
Background People who leave their country of origin, or the country of habitual residence, to establish themselves permanently in another country are usually referred to as migrants. Over half of all births in Montreal, Canada are to migrant women. To understand healthcare professionals’ attitudes towards migrants that could influence their delivery of care, our objective was to explore their perspectives of challenges newly-arrived migrant women from non-Western countries face when needing maternity care. Method In this qualitative multiple case study, we conducted face-to-face interviews with 63 health care professionals from four teaching hospitals in Montreal, known for providing maternity care to a high volume of migrant women. Interviews were transcribed and thematically analysed. Results Physicians, nurses, social workers, and therapists participated; 90% were female; and 17% were themselves migrants from non-Western countries. According to participants, newly-arrived migrant women face challenges at two levels: (a) direct care (e.g., understanding Canadian health care professionals’ expectations, communicating effectively with health care professionals), and (b) organizational (e.g., access to appropriate health care). Challenges women face are strongly influenced by the migrant woman’s background as well as social position (e.g., general education, health literacy, socio-cultural integration) and by how health care professionals balance women’s needs with perceived requirement to adhere to standard procedures and regulations. Conclusions Health care professionals across institutions agreed that maternity care-related challenges faced by newly-arrived migrant women often are complex in that they are simultaneously driven by conflicting values: those based on migrant women’s sociocultural backgrounds versus those related to the implementation of Canadian guidelines for maternity care in which consideration of migrant women’s particular needs are not priority.
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Affiliation(s)
- Sandra Peláez
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Canada.
| | | | - Lisa A Merry
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Canada
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Woodgate RL, Busolo DS, Crockett M, Dean RA, Amaladas MR, Plourde PJ. A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: it's not easy! Int J Equity Health 2017; 16:5. [PMID: 28068998 PMCID: PMC5223444 DOI: 10.1186/s12939-016-0510-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Immigrant and refugee families form a growing proportion of the Canadian population and experience barriers in accessing primary health care services. The aim of this study was to examine the experiences of access to primary health care by African immigrant and refugee families. Methods Eighty-three families originating from 15 African countries took part in multiple open ended interviews in western Canada. Qualitative data was collected in six different languages between 2013 and 2015. Data analysis involved delineating units of meaning from the data, clustering units of meaning to form thematic statements, and extracting themes. Results African immigrant and refugee families experienced challenges in their quest to access primary health care that were represented by three themes: Expectations not quite met, facing a new life, and let’s buddy up to improve access. On the theme of expectations not quite met, families struggled to understand and become familiar with a new health system that presented with a number of barriers including lengthy wait times, a shortage of health care providers, high cost of medication and non-basic health care, and less than ideal care. On the theme of facing a new life, immigrant and refugee families talked of the difficulties of getting used to their new and unfamiliar environments and the barriers that impact their access to health care services. They talked of challenges related to transportation, weather, employment, language and cultural differences, and lack of social support in their quest to access health care services. Additionally, families expressed their lack of social support in accessing care. Privately sponsored families and families with children experienced even less social support. Importantly, in the theme of let’s buddy up to improve access, families recommended utilizing networking approaches to engage and improve their access to primary health care services. Conclusions African immigrant and refugee families experience barriers to accessing primary health care. To improve access, culturally relevant programs, collaborative networking approaches, and policies that focus on addressing social determinants of health are needed.
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Affiliation(s)
- Roberta Lynn Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada.
| | - David Shiyokha Busolo
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Maryanne Crockett
- Departments of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
| | - Ruth Anne Dean
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
| | - Miriam R Amaladas
- Nor-West Co-op Access Center, 785 Keewatin Street, Winnipeg, MB, Canada
| | - Pierre J Plourde
- Medical Officer of Health, Winnipeg Regional Health Authority, 490 Hargrave Street, Winnipeg, MB, R3A 0X7, Canada
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Quintanilha M, Mayan MJ, Thompson J, Bell RC. Contrasting "back home" and "here": how Northeast African migrant women perceive and experience health during pregnancy and postpartum in Canada. Int J Equity Health 2016; 15:80. [PMID: 27225663 PMCID: PMC4881207 DOI: 10.1186/s12939-016-0369-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022] Open
Abstract
Background International migration and the number of migrant women who experience pregnancy and childbirth in receiving countries have significantly increased in the last two decades. Migrant women often have unmet social and economic needs during pregnancy, and are more likely to have problems unaddressed by health care systems. In this qualitative study, we explored migrant women’s perceptions and experiences of health during pregnancy and postpartum, while participating in a perinatal program offered through a community-based organization. Additionally, we examined sociocultural factors that might have shaped women’s health upon migration to the Canadian city of Edmonton, Alberta. Methods A community-based participatory research approach was used to engage migrant women connected to a community-based perinatal program in Edmonton. A focused ethnography was conducted with four Northeast African communities (Eritrean, Ethiopian, Oromo and Somali), and involved 10 focus groups with women (n = 8, per group) and direct observations of weekly perinatal program activities. Data generation and analysis occurred concurrently, and all generated data were analyzed using qualitative content analysis to inductively derive codes and categories. Results Women expressed their perceptions and experiences of health during pregnancy and postpartum by contrasting their countries of origin with Canada, respectively identified as “back home” and “here”. Differences in social support and the physical environment (both natural and built) between “back home” and “here” were commonly described as factors that shaped their opportunities to eat healthy, be physically active and emotionally well before and after having a baby “here”. Overall, women described that in Canada they lacked the social and environmental factors perceived as key enablers of healthy pregnancies and postpartum. Conclusion A complex network of factors seem to influence Northeast African women’s health during pregnancy and postpartum upon migration to Canada. It is of the utmost importance to provide these women with the immediate sociocultural and environmental factors they need to successfully thrive during pregnancy and postpartum, especially while establishing social and support networks “here”.
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Affiliation(s)
- Maira Quintanilha
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 4-112 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Maria J Mayan
- Faculty of Extension, University of Alberta, 2-281 Enterprise Square, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada.
| | - Jessica Thompson
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
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Ruiz-Casares M, Cleveland J, Oulhote Y, Dunkley-Hickin C, Rousseau C. Knowledge of Healthcare Coverage for Refugee Claimants: Results from a Survey of Health Service Providers in Montreal. PLoS One 2016; 11:e0146798. [PMID: 26789844 PMCID: PMC4720478 DOI: 10.1371/journal.pone.0146798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/21/2015] [Indexed: 12/04/2022] Open
Abstract
Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers' knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40-49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.
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Affiliation(s)
- Mónica Ruiz-Casares
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- SHERPA-Institut Universitaire, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Janet Cleveland
- SHERPA-Institut Universitaire, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Youssef Oulhote
- Harvard School of Public Health, Cambridge, Massachusetts, United States of America
| | - Catherine Dunkley-Hickin
- Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- SHERPA-Institut Universitaire, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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Mota L, Mayhew M, Grant KJ, Batista R, Pottie K. Rejecting and accepting international migrant patients into primary care practices: a mixed method study. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2015. [DOI: 10.1108/ijmhsc-04-2014-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– International migrants frequently struggle to obtain access to local primary care practices. The purpose of this paper is to explore factors associated with rejecting and accepting migrant patients into Canadian primary care practices.
Design/methodology/approach
– Mixed methods study. Using a modified Delphi consensus approach among a network of experts on migrant health, the authors identified and prioritized factors related to rejecting and accepting migrants into primary care practices. From ten semi-structured interviews with the less-migrant-care experienced practitioners, the authors used qualitative description to further examine nuances of these factors.
Findings
– Consensus was reached on practitioner-level factors associated with a reluctance of practitioners to accept migrants − communication challenges, high-hassle factor, limited availability of clinicians, fear of financial loss, lack of awareness of migrant groups, and limited migrant health knowledge – and on factors associated with accepting migrants − feeling useful, migrant health education, third party support, learning about other cultures, experience working overseas, and enjoying the challenge of treating diseases from around the world. Interviews supported use of interpreters, community resources, alternative payment methods, and migrant health education as strategies to overcome the identified challenges.
Research limitations/implications
– This Delphi network represented the views of practitioners who had substantive experience in providing care for migrants. Interviews with less-experienced practitioners were used to mitigate this bias.
Originality/value
– This study identifies the facilitators and challenges of migrants’ access to primary care from the perspective of primary care practitioners, work that complements research from patients’ perspectives. Strategies to address these findings are discussed.
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Higginbottom GMA, Morgan M, Alexandre M, Chiu Y, Forgeron J, Kocay D, Barolia R. Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis. Syst Rev 2015; 4:13. [PMID: 26187687 PMCID: PMC4506414 DOI: 10.1186/2046-4053-4-13] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. METHODS We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. RESULTS Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to configure maternity services and programs appropriately. CONCLUSIONS Although immigrant women in Canada are generally given the opportunity to obtain necessary services, they face many barriers in accessing and utilising these services. These barriers include lack of information about or awareness of the services, insufficient supports to access these services and discordant expectations between the women and their service providers. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42012002185 .
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Affiliation(s)
- Gina M A Higginbottom
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
| | - Myfanwy Morgan
- King's College London, Primary Care and Public Health Sciences London, London, SE1 3QD, UK.
| | - Mirande Alexandre
- Citizenship and Immigration Canada, New Multiculturalism Grants and Contributions Program, Canada Place, Edmonton, AB, T5J 4C3, Canada.
| | - Yvonne Chiu
- Multicultural Health Brokers Co-operative, Edmonton, AB, T5H 2M6, Canada.
| | - Joan Forgeron
- Lois Hole Hospital, Alberta Health Services, Edmonton, AB, T5H 3V9, Canada.
| | - Deb Kocay
- Health Canada, Public Health Agency of Canada, Calgary, AB, T2G 4X3, Canada.
| | - Rubina Barolia
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
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Fortin MC, Williams-Jones B. Should we perform kidney transplants on foreign nationals? JOURNAL OF MEDICAL ETHICS 2014; 40:821-826. [PMID: 24277941 DOI: 10.1136/medethics-2013-101534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians' duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them.
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Affiliation(s)
- Marie-Chantal Fortin
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal, Montreal (CHUM), Canada Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada
| | - Bryn Williams-Jones
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Canada
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Arnold C, Theede J, Gagnon A. A qualitative exploration of access to urban migrant healthcare in Nairobi, Kenya. Soc Sci Med 2014; 110:1-9. [DOI: 10.1016/j.socscimed.2014.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 02/20/2014] [Accepted: 03/20/2014] [Indexed: 11/26/2022]
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Higginbottom GMA, Hadziabdic E, Yohani S, Paton P. Immigrant women's experience of maternity services in Canada: a meta-ethnography. Midwifery 2013; 30:544-59. [PMID: 23948185 DOI: 10.1016/j.midw.2013.06.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/06/2013] [Accepted: 06/11/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE to synthesise data on immigrant women's experiences of maternity services in Canada. DESIGN a qualitative systematic literature review using a meta-ethnographic approach METHODS a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings. FINDINGS the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE in order to implement woman-centered care, to enhance access to maternity services, and to promote immigrant women's health, it is important to consider these women's social position, cultural knowledge and beliefs, and traditional customs in the health care.
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Affiliation(s)
| | - Emina Hadziabdic
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sophie Yohani
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
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Gagnon AJ, Carnevale F, Mehta P, Rousseau H, Stewart DE. Developing population interventions with migrant women for maternal-child health: a focused ethnography. BMC Public Health 2013; 13:471. [PMID: 23672838 PMCID: PMC3733625 DOI: 10.1186/1471-2458-13-471] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature describing effective population interventions related to the pregnancy, birth, and post-birth care of international migrants, as defined by them, is scant. Hence, we sought to determine: 1) what processes are used by migrant women to respond to maternal-child health and psychosocial concerns during the early months and years after birth; 2) which of these enhance or impede their resiliency; and 3) which population interventions they suggest best respond to these concerns. METHODS Sixteen international migrant women living in Montreal or Toronto who had been identified in a previous study as having a high psychosocial-risk profile and subsequently classified as vulnerable or resilient based on indicators of mental health were recruited. Focused ethnography including in-depth interviews and participant observations were conducted. Data were analyzed thematically and as an integrated whole. RESULTS Migrant women drew on a wide range of coping strategies and resources to respond to maternal-child health and psychosocial concerns. Resilient and vulnerable mothers differed in their use of certain coping strategies. Social inclusion was identified as an overarching factor for enhancing resiliency by all study participants. Social processes and corresponding facilitators relating to social inclusion were identified by participants, with more social processes identified by the vulnerable group. Several interventions related to services were described which varied in type and quality; these were generally found to be effective. Participants identified several categories of interventions which they had used or would have liked to use and recommended improvements for and creation of some programs. The social determinants of health categories within which their suggestions fell included: income and social status, social support network, education, personal health practices and coping skills, healthy child development, and health services. Within each of these, the most common suggestions were related to creating supportive environments and building healthy public policy. CONCLUSIONS A wealth of data was provided by participants on factors and processes related to the maternal-child health care of international migrants and associated population interventions. Our results offer a challenge to key stakeholders to improve existing interventions and create new ones based on the experiences and views of international migrant women themselves.
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Affiliation(s)
- Anita J Gagnon
- Ingram School of Nursing, McGill University, 3506 University St., Room 207, Montreal QC H3A 2A7, Canada
- Department of Obstetrics and Gynaecology, McGill University, Montreal H3A 2A7, Canada
- McGill University Health Centre, Montreal QC H3H 2R9, Canada
| | - Franco Carnevale
- Ingram School of Nursing, McGill University, 3506 University St., Room 207, Montreal QC H3A 2A7, Canada
- McGill University Health Centre, Montreal QC H3H 2R9, Canada
| | - Praem Mehta
- Ingram School of Nursing, McGill University, 3506 University St., Room 207, Montreal QC H3A 2A7, Canada
| | - Hélène Rousseau
- McGill University and CSSS de la Montagne 5700 Côte-des-Neiges Montreal QC H3T 2A8 Canada
| | - Donna E Stewart
- University of Toronto and University Health Network 200 Elizabeth St, EN-7-229 Toronto ON M5G 2C4 Canada
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Almeida LM, Caldas J, Ayres-de-Campos D, Salcedo-Barrientos D, Dias S. Maternal Healthcare in Migrants: A Systematic Review. Matern Child Health J 2013; 17:1346-54. [DOI: 10.1007/s10995-012-1149-x] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rethinking the Experience of HIV-Positive Refugee Women in the Context of Pregnancy: Using an Intersectional Approach in Nursing. Res Theory Nurs Pract 2013; 27:240-56. [DOI: 10.1891/1541-6577.27.4.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
When providing care to HIV-positive refugee women in the context of pregnancy, nurses must be able to move beyond the individual experiences of health and illness and acquire a more meaningful understanding of the historical, social, cultural, political, and structural influences that shape women’s health and women’s lives. Intersectionality is a framework that focuses on various dimensions of a refugee woman’s social identity such as race, class, gender, as well as education, citizenships, and geographic location and how these dimensions intersect to influence the experiences of health and illness. In this article, we present a brief overview of the origins and evolution of intersectionality. From there we describe three distinct levels of analysis: (a) micro-level analysis to examine the influences that impact the social identity and social location of women; (b) meso-level analysis to explore informal and formal support systems; and (c) macro-level analysis to interrogate historical, social, cultural, political, and structural influences that shape health outcomes. Finally, we will examine how this framework may be useful for nursing practice, research, and knowledge development. We hope to illustrate how intersectionality is a useful framework to understand the experiences of HIV-positive refugee women in the context of pregnancy.
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Gagnon AJ, Dougherty G, Wahoush O, Saucier JF, Dennis CL, Stanger E, Palmer B, Merry L, Stewart DE. International migration to Canada: the post-birth health of mothers and infants by immigration class. Soc Sci Med 2012. [PMID: 23194747 DOI: 10.1016/j.socscimed.2012.11.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.
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