Adverse birth outcomes among Korean Americans: The impactof nativity and social proximity to other Koreans

Caregiver Decision-Making: Household Response to Child Illness in sub-Saharan Africa

We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.

Neonatal outcomes for immigrant vs. native-born mothers in Taiwan: an epidemiological paradox

In Taiwan, immigrant women by marriage face social discrimination due to widespread impressions that they give birth to low birth weight, high-risk, high cost babies due to their lower socioeconomic status, shorter stature, and lower pre-pregnant weight than native-born Taiwanese women. This study compared crude and adjusted birth outcomes of immigrant mothers (Chinese and Vietnamese) relative to native-born Taiwanese, and tested for the phenomenon of an epidemiological paradox of favorable neonatal outcomes among immigrants. Data from patient charts of all singleton live births during 2002-2007, weighing ≥500 and <4,000 g, and ≥20 weeks gestational age at a regional hospital in Kaohsiung, Taiwan, were used. Multiple regression analysis was used to test the hypothesis controlling for maternal characteristics (demographics, national origin, obstetric and prenatal factors) and neonatal characteristics (birth weight, gestational age). Of 3,267 births satisfying the inclusion criteria, 19.0% were to Chinese and Vietnamese mothers. Crude birth weight was lowest for Taiwanese mothers, who also had the highest rate of preterm delivery (<37 weeks). The adjusted birth weight for Chinese and Vietnamese mothers was 87.7 and 74.7 g higher, respectively than native-born Taiwanese (both P < 0.001). Chinese and Vietnamese mothers also had lower odds of preterm birth (ORs 0.46 and 0.47, respectively). Findings support paradoxically better neonatal outcomes among Chinese and Vietnamese immigrant mothers in Taiwan. Findings can be used to initiate public education to reverse the widespread negative perceptions and attitudes towards immigrant spouses in Taiwan.

Birth outcomes of Koreans by birthplace of infants and their mothers, the United States versus Korea, 1995-2004

The acculturation effect of immigrant women on birth outcomes varies by race. We examined birth outcomes of three groups of births for the period 1995-2004, USA births to the USA-born Korean mothers, USA births to the non-USA-born Korean mothers, and births in Korea. In singleton USA births to both Korean parents, average birth weight was 3,294 g for the USA-born Korean mothers and 3,323 g for the non-USA-born Korean mothers. However, this difference was not significant, once controlled for other maternal sociodemographic, obstetric and medical factors. Low birth weight and prematurity prevalence were not different by maternal nativity between these two singleton groups. Average birth weight of all births including multiplets in Korea was 3,270 g, compared to 3,297 g for all USA-born infants including multiplets and births either to both or one Korean parents. This difference might have reflected a significantly lower educational attainment of mothers in Korea compared to Korean mothers in the USA. Low birth weight rate was consistently lower in infants born in Korea compared to the USA-born, but this difference became less, 4.2% and 4.6% respectively by 2004. These observations suggest that in the USA acculturation effect of Korean immigrants on birth outcomes is negligible.

Perinatal outcomes among foreign-born and US-born Chinese Americans, 1995-2000

This paper examines nativity differences in adverse perinatal outcomes of Chinese-American mothers. Singleton live births to US-resident Chinese women (150,620 foreign-born, 15,040 US-born) and a random sample of 150,620 non-Hispanic White mothers were selected from 1995 to 2000 national linked birth/infant death certificate files. Associations between maternal nativity status and adverse perinatal outcomes were assessed using multivariable logistic regressions. Compared to US-born Chinese mothers, foreign-born Chinese mothers were less likely to be unmarried, teen mothers, have a non-Hispanic White or other race partner, be rural residents, and more likely to be less educated, or utilize prenatal care inadequately. Controlling for these factors, foreign-born Chinese-American mothers had significantly lower risks for low birth weight, preterm birth, and small-for-gestational age, whereas risks for infant mortality, neonatal mortality, and post-neonatal mortality did not differ significantly from those of infants of US-born Chinese mothers. Chinese Americans exhibited clear nativity differentials for adverse birth outcomes.