Influence of maternal birthplace on postpartum health and health services use

Recent Immigrants With Inflammatory Bowel Disease Have Significant Healthcare Utilization From Preconception to Postpartum: A Population Cohort Study

INTRODUCTION

Immigrants with inflammatory bowel disease (IBD) may have increased healthcare utilization during pregnancy compared with non-immigrants, although this remains to be confirmed. We aimed to characterize this between these groups.

METHODS

We accessed administrative databases to identify women (aged 18-55 years) with IBD with a singleton pregnancy between 2003 and 2018. Immigration status was defined as recent (<5 years of the date of conception), remote (≥5 years since the date of conception), and none. Differences in ambulatory, emergency department, hospitalization, endoscopic, and prenatal visits during 12 months preconception, pregnancy, and 12 months postpartum were characterized. Region of immigration origin was ascertained. Multivariable negative binomial regression was performed for adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (CIs).

RESULTS

A total of 8,880 pregnancies were included, 8,304 in non-immigrants, 96 in recent immigrants, 480 in remote immigrants. Compared with non-immigrants, recent immigrants had the highest rates of IBD-specific ambulatory visits during preconception (aIRR 3.06, 95% CI 1.93-4.85), pregnancy (aIRR 2.15, 95% CI 1.35-3.42), and postpartum (aIRR 2.21, 1.37-3.57) and the highest rates of endoscopy visits during preconception (aIRR 2.69, 95% CI 1.64-4.41) and postpartum (aIRR 2.01, 95% CI 1.09-3.70). There were no differences in emergency department and hospitalization visits between groups, although those arriving from the Americas were the most likely to be hospitalized for any reason. All immigrants with IBD were less likely to have a first trimester prenatal visit.

DISCUSSION

Recent immigrants were more likely to have IBD-specific ambulatory care but less likely to receive adequate prenatal care during pregnancy.

African Immigrant Women's Maternal Health Experiences in Clarkston, Georgia: A Qualitative Study

Introduction

The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services.

Methods

Fourteen African immigrant women responded to semistructured interviews. An adapted version of the Andersen health care utilization model explained the predisposing factors, enabling factors, and need factors, which influence the use of maternal health care for African immigrant women.

Results

Findings were presented according to the Andersen health care utilization model. Analysis of the interviews resulted in 11 themes. The themes were as follows: (1) Community social structure, (2) community health beliefs, (3) health organization concerning the use of women, infants, and children, (4) social support at the individual level, (5) limited English proficiency, (6) need for better health education, (7) perception of care, (8) health financing, (9) long wait times and lack of transportation, (10) fear of medication and obstetrical interventions, and (11) impact of Female Genital Mutilation/Cutting.

Discussion

Maternal health practices of African immigrant women are impacted by environmental and cultural factors. Public health interventions should be implemented to advance African immigrant women's health care utilization practices through required health education and tailored care, which will translate to positive maternal health experiences.

Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature

INTRODUCTION

This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model.

METHODS

Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria.

RESULTS

The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors.

DISCUSSION

Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.

The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis

BACKGROUND

There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants.

METHODS

In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291.

FINDINGS

18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I² 98·8%; τ² 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I² 96·8%; τ² 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I² 97·4%; τ² 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I² 96·6%; τ² 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner.

INTERPRETATION

One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants.

FUNDING

UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.

Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota

OBJECTIVE

The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County.

METHODS

We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women.

RESULTS

Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63).

CONCLUSION

The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.

Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018)

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.

Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review

There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.

"COVID affected us all:" the birth and postnatal health experiences of resettled Syrian refugee women during COVID-19 in Canada

BACKGROUND

Prior to COVID-19, postnatal resettled refugee women in Canada reported barriers to healthcare and low levels of social support, contributing to maternal health morbidities. The COVID-19 pandemic appears to be further exacerbating health inequities for marginalized populations. The experiences of resettled refugee women are not fully known.

AIM

To understand Syrian refugee women's experiences accessing postnatal healthcare services and supports during the COVID-19 pandemic.

METHODS

Semi-structured, virtual interviews were conducted with eight resettled Syrian refugee women living in Nova Scotia (Canada) who were postnatal between March and August 2020. Data analysis was informed by constructivist grounded theory.

FINDINGS

Three themes emerged: "the impacts of COVID-19 on postnatal healthcare;" "loss of informal support;" and "grief and anxiety." Women experienced difficult healthcare interactions, including socially and physically isolated deliveries, challenges accessing in-person interpreters, and cancelled or unavailable in-home services (e.g., public health nurse and doula visits). Increased childcare responsibilities and limited informal supports due to pandemic restrictions left women feeling overwhelmed and exhausted. Stay-at-home orders resulted in some women reporting feelings of isolation and loss, as they were unable to share in person postnatal moments with friends and family, ultimately impacting their mental wellness.

CONCLUSIONS

COVID-19 and associated public health restrictions had significant impacts on postnatal Syrian refugee women. Data presented in this study demonstrated the ways in which the pandemic environment and related restrictions amplified pre-existing barriers to care and postnatal health inequalities for resettled refugee women-particularly a lack of postnatal informal supports and systemic barriers to care.

First perinatal psychiatric episode among refugee and family-reunified immigrant women compared to Danish-born women: a register-based study

PURPOSE

This study aimed at examining psychiatric morbidity in the perinatal period among refugees and family-reunified immigrants compared to Danish-born women, including predictors of psychiatric morbidity according to migration history.

METHODS

Inclusion criteria were women who had a residence permit in Denmark and gave birth to a live child between 1 April 1998 and 31 December 2014. The study included 7804 refugee women, 21,257 family-reunified women, and 245,865 Danish-born women. We estimated Odds Ratios (ORs) of having a first-time perinatal psychiatric episode (PPE) and specific risk for affective, psychotic, and neurotic disorders.

RESULTS

Compared with Danish-born women, women family-reunified with immigrants had lower (aOR 0.37, 95% CI 0.22-0.64) and refugees had higher ORs of PPE (OR 1.46, 95% CI 1.22-1.76). In fully adjusted models, refugees no longer presented increased risk of PPE (OR 1.16, 95% CI 0.95-1.42) but showed higher ORs for psychotic (aOR 4.72, 95% CI 2.18-9.84) and neurotic disorders (aOR 1.31, 95% CI 1.01-1.72). Women family-reunified with refugees and to Nordic citizens had higher ORs of psychotic disorders. Among migrants, refugees had higher ORs of PPE.

CONCLUSIONS

Results suggest that elevation in risk of PPE among refugees compared to Danish-born may be related to higher likelihood of poverty and single-parenting among refugees. Still, refugees appear to have increased risk for neurotic and psychotic disorders. In contrast, family-reunified to immigrants may have lower risk of PPE. Maternal health programs need to focus on promotion of mental health and tackle social risks that disproportionately affect immigrant women, particularly refugees.

The postnatal experiences of resettled Syrian refugee women: Access to healthcare and social support in Nova Scotia, Canada

AIM

The purpose of this qualitative study was to understand Syrian refugee women's perceptions and experiences of access to formal health services and informal supports during the postpartum period in Nova Scotia, Canada and to identify valued and missing services and supports in the community.

BACKGROUND

The postnatal period is a critical time when mothers may need access to health services (e.g., family physicians, psychologists) and informal supports (e.g., friends, family) to support their positive mental and physical health after birth. Resettled refugee women commonly encounter barriers when accessing care during the postnatal period and often have limited social supports.

METHODS

Semi-structured, telephone or virtual interviews were conducted with 11 resettled Syrian refugee women who gave birth in Nova Scotia, Canada within the past five years. Data were collected in the summer of 2020. This study was conducted using elements of constructivist grounded theory.

FINDINGS

Four key themes were identified from women's experiences: (i) postpartum social support was critical, but often lacking, (ii) structural barriers (e.g., irregular interpreter services, limited childcare options) impeded women's access to healthcare, (iii) paternalistic healthcare providers limited women's decision-making autonomy, and (iv) the value and need for culturally competent, integrated care (e.g., newcomer specific healthcare centres), in-home services, and family support.

CONCLUSION

Resettled Syrian refugee women in Nova Scotia, Canada experience a range of barriers that limits their access to postnatal healthcare. Policy change, program development, and/or interventions are needed to improve access to postnatal services and supports for resettled Syrian women in Canada.

Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.

Access to Healthcare for Immigrant Children in Canada

Immigrants experience poorer health outcomes than nonimmigrants in Canada for several reasons. A central contributing factor to poor health outcomes for immigrants is access to healthcare. Previous research on access to healthcare for immigrants has largely focused on the experience of immigrant adults. The purpose of this study was to investigate how immigrants access health services for their children in Alberta, Canada. Our study involved a descriptive qualitative design. Upon receiving ethics approval from the University of Alberta Research Ethics Board, we invited immigrant parents to participate in this study. We interviewed 50 immigrant parents, including 17 fathers and 33 mothers. Interviews were audio recorded, transcribed, and analyzed according to the themes that emerged. Findings reveal that systemic barriers contributed to challenges in accessing healthcare for immigrant children. Participants identified several of these barriers-namely, system barriers, language and cultural barriers, relationship with health professionals, and financial barriers. These barriers can be addressed by policymakers and service providers by strengthening the diversity of the workforce, addressing income as a social determinant of health, and improving access to language interpretation services.

Acculturation and Postpartum Depression Among Immigrant Women of Arabic Descent

Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale-EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.

Influences on mental health and health services accessibility in immigrant women with post-partum depression: An interpretive descriptive study

WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women. Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels. To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post-partum health experiences. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study provides unique insights into immigrant women's perceptions of what influences their post-partum mental health and ability to access services for PPD. Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services. Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation. Assessment approaches and organizational wait times created barriers to accessing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Relationship building by providers is foundational to effective care for immigrant women with PPD. Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno-cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services. Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Abstract Introduction Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women yet face multiple barriers to care at individual and system levels. Aim To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno-cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women.

Humanitarian migrant women's experiences of maternity care in Nordic countries: A systematic integrative review of qualitative research

BACKGROUND

Maternal morbidity and sub-optimal maternity care are more common in humanitarian migrants in comparison to country-born population in the Nordic countries. Statistical reviews on the issue are plenty, whereas little synthesis on humanitarian migrants' lived experiences exists.

AIM

This systematic integrative literature review investigated humanitarian migrant women's experiences on maternity care in Nordic countries, aiming to address possible hindrances for optimal care.

METHODS

Electronic search in PubMed, CINAHL, SocIndex, Scopus, PsycINFO and Web of Science yielded 474 papers. PICoS inclusion and exclusion criteria were used. Critical appraisal was conducted utilising 32-item COREQ tool. The findings of the review articles were synthesised through thematic analysis.

FINDINGS

Ten qualitative studies were included in the review. Altogether 198 women in Sweden, Norway and Finland had participated interviews or focus group discussions. Analysis of the women's reported experiences of care emerged three themes: Diminished negotiation power on care, Sense of insecurity, and Experienced care-related discrimination.

KEY CONCLUSION

Humanitarian migrant women's maternal morbidity and sub-optimal care has multiple potential explanations, and their experiences of care reflect those earlier reported.

IMPLICATIONS FOR PRACTICE

Recommendations for tackling the addressed hindrances are: (1) enabling humanitarian migrant women's negotiation power by acknowledging their vulnerability but also competency, (2) increasing the sense of security, and (3) improving care providers' cultural competence.

Gender of Provider-Barrier to Immigrant Women's Obstetrical Care: A Narrative Review

OBJECTIVE

To explore the preference for female obstetrician/gynaecologists among immigrant women, and providers' understandings of these preferences, to identify challenges and potential solutions.

METHODS

Five databases (Medline, Embase, CINAHL, Global Health, and Scopus) were searched using combinations of search terms related to immigrant, refugee, or Muslim women and obstetrics or gynaecological provider gender preference.

STUDY SELECTION

Peer reviewed, English-language articles were included if they discussed either patient or provider perspectives of women's preference for female obstetrics or gynaecological care provider among immigrant women in Western and non-western settings. After screening, 54 met inclusion criteria and were reviewed.

DATA EXTRACTION

Studies were divided first into those specifically focusing on gender of provider, and those in which it was one variable addressed. Each category was then divided into those describing immigrant women, and those conducted in a non-Western settings. The research question, study population, methods, results, and reasons given for preferences in each article were then examined and recorded.

CONCLUSION

Preference for female obstetricians/gynaecologists was demonstrated. Although many will accept a male provider, psychological stress, delays, or avoidance in seeking care may result. Providers' views were captured in only eight articles, with conflicting perspectives on responding to preferences and the health system impact.

Provider Perspectives on Facilitators and Barriers to Accessible Service Provision for Immigrant Women With Postpartum Depression: A Qualitative Study

Background

Immigrant women are at greater risk for postpartum depression than native-born women and face multiple barriers to accessing services. Service providers themselves face challenges in delivering accessible care for immigrant women with postpartum depression.

Purpose

This research explored provider perspectives on facilitators and barriers providers faced in terms of providing accessible services.

Methods

The study used an interpretive descriptive design, shaped by an integrated knowledge user–researcher partnership. Fourteen health and social service providers participated in individual in-depth interviews. Using a socioecological framework as an organizing structure, an inductive thematic content analysis was conducted.

Results

Providers identified attributes that foster relationship building, including building trust, addressing power dynamics, understanding women’s experiences, enacting cultural competence, involving family members, providing adequate time, and facilitating system navigation. Organizational features shaping accessibility included assessment and treatment approaches, wait times, gate keeping, and the ability to address social health determinants. Different organizational approaches could facilitate or discourage service coordination across organizations. Finally, providers believed that health and immigration system mechanisms could work more effectively for optimal postpartum depression support.

Conclusion

Health service providers are critical in supporting immigrant women with postpartum depression and facilitating service accessibility. Organizational and system gaps restrict optimal postpartum depression service provision and integration.

Postpartum self-inflicted injury, suicide, assault and homicide in relation to immigrant status in Ontario: a retrospective population-based cohort study

BACKGROUND

Intentional injury, including suicide and assault, is a leading cause of maternal morbidity and mortality. We aimed to determine whether immigrant and nonimmigrant women differ in their 1-year risk of intentional injury after birth.

METHODS

This population-based retrospective cohort study used administrative data from Ontario from 2002 to 2012. Risk of self-inflicted injury (self-harm or suicide), and injury inflicted by others (assault or homicide), were each analyzed within 1 year after delivery of a live-born infant for immigrant and nonimmigrant mothers. Relative risks (RRs) were adjusted for maternal age, parity, income, resource utilization and psychiatric history.

RESULTS

The study included 327 279 immigrant and 942 502 nonimmigrant mothers. Risk of self-inflicted injury was similar among immigrants and nonimmigrants (adjusted RR 0.91, 95% confidence interval [CI] 0.78-1.04), with no variation by duration of residence or refugee status. Immigrants were at lower risk than nonimmigrants for injury inflicted by others (adjusted RR 0.57, 95% CI 0.51-0.64); that risk was higher among refugees than among nonrefugee immigrants (adjusted RR 1.79, 95% CI 1.33-2.41), and it was higher among long-term (adjusted RR 2.27, 95% CI 1.76-2.91) and medium-term (adjusted RR 1.58, 95% CI 1.19-2.11) immigrants than among recent immigrants. Variability by country of origin was observed for both injury types.

INTERPRETATION

Immigrant mothers have a reported risk for self-inflicted injury after birth similar to that of their Canadian-born counterparts. The extent to which selective underreporting of intentional injury in immigrant women might explain our findings is a key consideration for future research.

Satisfaction with obstetric care in a population of low-educated native Dutch and non-western minority women. Focus group research

Background

Low-educated native Dutch and non-western minority women have inadequate access to obstetric care. Moreover, the care they receive lacks responsiveness to their needs and cultural competences. Gaining a deeper understanding of their experiences and satisfaction with antenatal, birthing and maternity care will help to adjust healthcare responsiveness to meet their needs during pregnancy, childbirth and the postpartum period.

Methods

We combined the World Health Organization conceptual framework of healthcare responsiveness with focus group research to measure satisfaction with antenatal, birthing and maternity care of women with a low-educated native Dutch and non-western ethnic background.

Results

From September 2011 until December 2013, 106 women were recruited for 20 focus group sessions. Eighty-five percent of the women had a non-western immigrant background and 89% a low or intermediate educational attainment. The study population was mostly positive about the provided care during the antenatal phase. They were less positive about the other two phases of care. Moreover, the obstetric healthcare systems’ responsiveness in all phases of care (antenatal, birthing and maternity) did not meet these women’s needs. The ‘respect for persons’ domains ‘autonomy’, ‘communication’ and ‘dignity’ and the ‘client orientation’ domain ‘prompt attention’ were judged most negatively.

Conclusions

The study findings give contextual meaning and starting points for improvement of responsiveness in the provision of obstetric care within a multi-ethnic women’s population.

Determinants of Child Attachment in the Years Postpartum in a High-Risk Sample of Immigrant Women

Our goal was to examine maternal mental health and associated stresses in a sample of high-risk immigrant mothers, and its association with child insecure attachment in the years following childbirth. Mothers and their child (Mage = 37 months) were recruited through a Health and Social Service organization in the Parc-Extension neighborhood in Montreal, Quebec. Mothers completed the Hopkins Symptoms Checklist (HSCL-25), the Multidimensional Scale of Perceived Social Support (MPSS) and a sociodemographic questionnaire that included questions on premature delivery and birth weight. Attachment behaviors were coded out of a videotaped free play sequence using the Preschool and Early School-Age Attachment Rating Scales (PARS). Analysis revealed high levels of clinical anxiety and depression, low social support and low attachment security. Significant mean differences and associations were found between anxiety, depression, social support, preterm delivery and child attachment. These results underscore the importance of screening for anxiety and depression early in the postnatal years, in order to prevent associated consequences such as child insecure attachment. Results also highlight the importance of building positive social networks, especially with immigrant populations.

Acculturation and Postpartum Depressive Symptoms among Hispanic Women in the United States: Systematic Review

PURPOSE

The purpose of this review was to evaluate studies that examined the relationship between acculturation and postpartum depression (PPD) among immigrant and/or refugee women in the United States.

METHODS

A systematic, computer-assisted search of quantitative, English-language, peer-reviewed, published research articles was conducted in the Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Maternity and Infant Care databases using the keyword terms of "postpartum depression" and "perinatal depression" in combination with "acculturation." Studies were included if they were conducted in the United States.

RESULTS

Seven studies met inclusion criteria. Three studies used longitudinal designs and four used cross-sectional designs. All were conducted with Hispanic women. Only one study used a diagnostic tool to measure PPD; the remaining studies used screening tools to measure postpartum depressive symptoms. Most studies used country of birth, country of residence, and language preferences to measure acculturation. Five studies reported acculturation was positively related to risk of postpartum depressive symptoms, and two studies reported no relationship.

CLINICAL IMPLICATIONS

Higher levels of acculturation were related to higher risk of postpartum depressive symptoms in Hispanic women living in the United States. Nurses should have an understanding of stressors of immigrant women to guide their assessment and screening for postpartum depressive symptoms and make appropriate referrals. More research is needed to confirm the relationship between acculturation and PPD among immigrant women from different cultural backgrounds.

Social vulnerability on maternal health in immigrants. A problem of interculturality

The scientific literature indicates how often migrants tend to be the most vulnerable population groups, especially women of childbearing age, that regularly show greater foetal and neonatal mortality, and more complications during pregnancy and postpartum.The study followed a qualitative methodology for collecting and analysing data and was conducted in Porto. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison), contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities and intercultural integration in the host country

A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada

Canadian population-based surveys report comparable access to health care services between immigrant and non-immigrant populations, yet other research reports immigrant-specific access barriers. A scoping review was conducted to explore research regarding Canadian immigrants' unique experiences in accessing health care, and was guided by the research question: "What is currently known about the barriers that adult immigrants face when accessing Canadian health care services?" The findings of this study suggest that there are unmet health care access needs specific to immigrants to Canada. In reviewing research of immigrants' health care experiences, the most common access barriers were found to be language barriers, barriers to information, and cultural differences. These findings, in addition to low cultural competency reported by interviewed health care workers in the reviewed articles, indicate inequities in access to Canadian health care services for immigrant populations. Suggestions for future research and programming are discussed.

Postpartum mental health of immigrant mothers by region of origin, time since immigration, and refugee status: a population-based study

Immigrant women are at high risk for postpartum mental disorders. The purpose of this study was to understand how rates of postpartum mental health contact differ among immigrant women by region of origin, time since immigration, and refugee status. We conducted a population-based cohort study of immigrant mothers in Ontario, Canada, with children born from 2008 to 2012 (N = 123,231). We compared risk for mental health contact (outpatient, emergency department, inpatient hospitalization) in the first postpartum year by region of origin, time since immigration, and refugee status, generating adjusted odds ratios (aOR) and 95% confidence intervals (CI). Immigrants from North Africa and the Middle East were more likely to have outpatient mental health contact than a referent group of immigrants from North America or Europe (aOR 1.07, 95% CI 1.01-1.14); those from East Asia and the Pacific, Southern Asia, and Sub-Saharan Africa were less likely (0.64, 0.61-0.68; 0.78, 0.74-0.83; 0.88, 0.81-0.94). Refugees were more likely to have contact than non-refugees (1.10, 1.04-1.15); those in Canada <5 years were less likely than longer-term immigrants (0.83, 0.79-0.87). Refugees were more likely to have an emergency department visit (1.81, 1.50-2.17) and a psychiatric hospitalization than non-refugees (1.78, 1.31-2.42). These findings have implications for targeted postpartum mental health service delivery targeting certain immigrant groups and particularly refugees.

Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

OBJECTIVES

Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

DESIGN

We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects - two common explanations of migrants' health advantage and deterioration, respectively.

RESULTS

We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants' advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

CONCLUSIONS

There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada's foreign-born population consists mostly of core working age adults.

Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis

This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32-2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57-2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51-0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.

Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration.

OBJECTIVES

This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC).

SEARCH STRATEGY

We systematically searched nine electronic databases and the grey literature using a predefined search strategy.

SELECTION CRITERIA

Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design.

DATA COLLECTION AND ANALYSIS

Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively.

MAIN RESULTS

Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population.

CONCLUSIONS

One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority.

TWEETABLE ABSTRACT

One in three migrant women from low- and middle-income countries has symptoms of perinatal depression.

A Population-Based Study of Postpartum Mental Health Service Use by Immigrant Women in Ontario, Canada

OBJECTIVE

Postpartum mental disorders are twice as common among immigrant women compared to nonimmigrant women in developed countries. Immigrant women may experience barriers to access and use of postpartum mental health services, but little is known about their service use on a population level. We described postpartum mental health service use of immigrant mothers living in Ontario, Canada, comparing to a referent group of mothers who were either born in Canada or had lived in Ontario or another Canadian province since 1985.

METHOD

Among all women in Ontario, Canada, delivering a live infant from 2008 to 2012 (n = 450,622), we described mental health service use within 1 year postpartum, including mental health physician visits, psychiatric emergency department visits, and psychiatric hospitalization. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) comparing immigrant women to the referent group were adjusted for maternal age, parity, income, rurality, mental health services in prior 2 years, and maternal and newborn health.

RESULTS

Immigrant women (n = 123,231; 27%) were less likely to use mental health services than women in the referent group (14.1% vs. 21.4%; aOR, 0.59; 95% CI, 0.58 to 0.61), including for physician-based (13.9% vs. 21.1%; aOR, 0.59; 95% CI, 0.58 to 0.61) and emergency department (0.6% vs. 1.3%; aOR, 0.63; 95% CI, 0.57 to 0.68) services. Hospitalization risk was lower among immigrants (0.20% vs. 0.33%) but became similar after covariate adjustment (aOR, 0.92; 95% CI, 0.79 to 1.06).

CONCLUSIONS

Underuse of postpartum mental health services may be contributing to the high burden of postpartum mental disorders among immigrant women.

Migrant women's perceptions of healthcare during pregnancy and early motherhood: addressing the social determinants of health

Recent guidelines from the World Health Organization emphasize the need to monitor the social determinants of health, with particular focus on the most vulnerable groups. With this in mind, we evaluated the access, use and perceived quality of care received by migrant women during pregnancy and early motherhood, in a large urban area in northern Portugal. We performed semi-structured interviews in 25 recent mothers, contacted through welfare institutions, who had immigrated from Eastern European countries, Brazil, or Portuguese-speaking African countries. Six native-Portuguese women of equal economic status were also interviewed for comparison. Misinformation about legal rights and inadequate clarification during medical appointments frequently interacted with social determinants, such as low social-economic status, unemployment, and poor living conditions, to result in lower perceived quality of healthcare. Special attention needs to be given to the most vulnerable populations in order to improve healthcare. Challenges reside not only in assuring access, but also in promoting equity in the quality of care.

Accessibility and use of primary healthcare for immigrants living in the Niagara Region

Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers.

Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis

The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.

Immigrant Mental Health, A Public Health Issue: Looking Back and Moving Forward

The Mental Health Commission of Canada's (MHCC) strategy calls for promoting the health and wellbeing of all Canadians and to improve mental health outcomes. Each year, one in every five Canadians experiences one or more mental health problems, creating a significant cost to the health system. Mental health is pivotal to holistic health and wellbeing. This paper presents the key findings of a comprehensive literature review of Canadian research on the relationship between settlement experiences and the mental health and well-being of immigrants and refugees. A scoping review was conducted following a framework provided by Arskey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). Over two decades of relevant literature on immigrants' health in Canada was searched. These included English language peer-reviewed publications from relevant online databases Medline, Embase, PsycInfo, Healthstar, ERIC and CINAHL between 1990 and 2015. The findings revealed three important ways in which settlement affects the mental health of immigrants and refugees: through acculturation related stressors, economic uncertainty and ethnic discrimination. The recommendations for public health practice and policy are discussed.

Immigrant Afghan women's emotional well-being after birth and use of health services in Melbourne, Australia

OBJECTIVE

to investigate immigrant Afghan women's emotional well-being and experiences of postnatal depression after childbirth and their use of health services.

DESIGN

telephone interviews were conducted at four months after birth, using a semi-structured questionnaire; and a further in-depth face-to-face interview with a small number of women approximately one year after the birth. Women's emotional health was assessed at four months using the Edinburgh Postnatal Depression Scale (EPDS), as well as women's own descriptions of their emotional well-being since the birth.

SETTING

women were recruited from four hospital antenatal clinics or postnatal wards in Melbourne, Australia, between October 2006 and May 2007.

PARTICIPANTS

Immigrant women who were born in Afghanistan, spoke Dari/Persian or English, and had given birth to a live and healthy baby.

FINDINGS

Thirty nine women were interviewed at four months after birth; 41% reported feeling depressed or very unhappy since the birth and 31% scored as probably depressed on the EPDS. Ten women participated in further in-depth face-to-face interviews. Isolation, lack of support and being overwhelmed by life events were the most frequently reported contributing factors to women's emotional distress, and for many being a migrant appeared to intensify their experiences. The themes that emerged from both the telephone and face-to-face interviews revealed that some women were reluctant to discuss their emotional difficulties with health professionals and did not expect that health professionals could necessarily provide assistance.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

in this study a significant proportion of immigrant Afghan women experienced emotional distress after childbirth. Women's experiences of emotional distress and help-seeking were at times affected by their status as immigrants and their perceptions of possible causes and treatment for their emotional health problems. Understanding the effects of migration on women's lives and paying careful attention to individual needs and preferences are critically important in providing care for immigrant Afghan women.

Perceptions and Challenges

PURPOSE: This study aims to obtain the understanding of Korean immigrants’ postpartum care expectations and experiences as they tend to differ from the dominant culture in the United States. DESIGN: Using an interpretative qualitative method, 305 questions and 1,224 replies on a bulletin board forum in a major Korean online community were examined. The postings were identified through a keyword search and a subsequent categorization of the resulting questions. FINDINGS: A qualitative analysis provided descriptive knowledge regarding postpartum care and the associated beliefs widespread among Korean Americans, struggles with the issues they face during postpartum care, and the vulnerability of new Korean mothers to the negative effects of experiencing unmet needs. DISCUSSION: The results pointed to the significance of understanding the concerns regarding postpartum care needs among the Korean immigrant women. Furthermore, the outcomes illustrate the variations in cultural beliefs and practices of postpartum care needed for health care providers.

Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence

BACKGROUND

Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries.

METHODS

Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched.

RESULTS

Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9-52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8-2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers.

LIMITATIONS

The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses.

CONCLUSIONS

Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.

Assessing maternal healthcare inequities among migrants: a qualitative study

Considering pregnancy and motherhood as periods of increased vulnerability in migrant women, to characterize the healthcare provided to this collective, we sought to identify and understand patterns of satisfaction and demand of maternal and child healthcare, assessing women’s perceptions about its quality. The study followed a qualitative methodology (semi-structured interviews) for collecting and analysing data (content analysis) and was conducted in Porto, the second largest city of Portugal. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison), contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities. Equitable public health action must provide individuals and groups the equal opportunity to meet their needs, which may not be achieved by providing the same standard if care to all.

Migration and maternal health: experiences of brazilian women in Portugal

OBJECTIVES: to characterize maternal and neonatal healthcare provided to Brazilian population, assessing key factors: access, use and quality of care received during this period. The goal was to assess possible differences regarding women's perceptions regarding the quality and appropriateness of care received, providing qualitative information, as part of a holistic perspective. METHODS: the present study adopted a qualitative methodology (semi-structured interviews) for collecting and analyzing data. Possible differences in women's perceptions regarding the quality and appropriateness of care received were assessed, providing qualitative information, as part of a holistic perspective. The present study was based on privileged information obtained from Brazilian women, residing in the metropolitan area of Porto, regardless of their legal status. RESULTS: a certain dissatisfaction emerged among Brazilian women regarding the quality of information provided by health professionals, the communications skills of these professionals, in addition to a perception of reduced access to medical specialties, especially in primary care. Misinformation about legal rights and inappropriate clarification during medical appointments were frequently reported and interacted with social determinants to result in poorer medical care. CONCLUSIONS: special attention should be given to the specific needs and understanding of immigrants during pregnancy and motherhood in order to improve healthcare. New challenges tend to lie not only in ensuring access, but mostly in promoting equity, as away of providing high-quality care for all.

Immigrant women's experiences of postpartum depression in Canada: a protocol for systematic review using a narrative synthesis

BACKGROUND

Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women's reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada?

METHODS/DESIGN

Our synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors.

DISCUSSION

The narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.

Issues in the evaluation and treatment of anxiety and depression in migrant women in the perinatal period

OBJECTIVES

Perinatal depression and anxiety are prevalent in migrant women. The main aims of this literature review were to understand the psychosocial determinants of depression and anxiety in migrant women antenatally and to explore common clinical presentations. In addition, we aimed to identify barriers and facilitating factors for help-seeking and treatment, in order to identify directions for service development and improvement.

METHODS

A review of the literature was performed using electronic databases.

RESULTS

Depression and anxiety are over represented in migrant women in the perinatal period. Somatic symptoms are common presentations for emotional distress. An identified difficulty is a perceived lack of support, often as a result of cultural dislocation and social isolation. Significant barriers to help-seeking include the perception that limited assistance is available and reluctance to share personal information with an unknown clinician. Preferred therapeutic approaches include the use of clinical consultants from the same or similar culture, as well as practical and emotional support rather than medical management of symptoms.

CONCLUSION

Clinicians should be aware of psychosocial issues in this vulnerable population. Group programmes with a focus on education about mental and physical health, available supports, and socialisation are effective in engaging and assisting pregnant migrant women.