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Eick F, Vallersnes OM, Fjeld HE, Sørbye IK, Valberg M, Dahl C. Perinatal mortality among pregnant undocumented migrants in Norway 1999-2020: A register-based population study. Soc Sci Med 2024; 353:117055. [PMID: 38897075 DOI: 10.1016/j.socscimed.2024.117055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/11/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register. METHODS We included women 18-49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as 'undocumented migrants' (without an identity number), 'documented migrants' (with an identity number and born abroad), and 'non-migrants' (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin. ETHICAL APPROVAL Regional Ethical Committee (REK South East, case number 68329). RESULTS We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly. CONCLUSION Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance.
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Affiliation(s)
- Frode Eick
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.
| | - Odd Martin Vallersnes
- Department of General Practice, Institute of Health and Society, University of Oslo, Norway; Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Norway
| | - Heidi E Fjeld
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway
| | - Ingvil K Sørbye
- Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Norway
| | - Morten Valberg
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Cecilie Dahl
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Norway
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Solhaug AK, Oppedal B, Røysamb E, Calam R. Life Satisfaction among Unaccompanied Refugee Minors: Associations with Traumatic Events and Daily Hassles. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:597-610. [PMID: 38938943 PMCID: PMC11199432 DOI: 10.1007/s40653-023-00579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 06/29/2024]
Abstract
While there is a growing literature about mental health problems among unaccompanied asylum-seeking and refugee minors (URMs), far less is known about their wellbeing. Such information is important as a subjective sense of wellbeing is associated with a variety of positive health and psychosocial outcomes. The aim of this study was to examine life satisfaction and the association with traumatic events, daily hassles, and asylum status among URMs in Norway. We collected self-report questionnaire data from URMs living in Norway (n = 173, 90.80% male, 71.1% from Afghanistan). Mean age was 16.62 (SD = 1.74) years, and they reported clinically relevant post-traumatic stress symptoms. We explored variation in life satisfaction, URM-specific daily hassles and traumatic events. We also investigated a mediation model, in which we assumed that daily hassles mediated the association between traumatic events and life satisfaction. The participants reported low life satisfaction (M = 4.28, SD = 2.90, 0-10 scale). A negative outcome of the asylum process and URM-specific daily hassles were associated with reduced life satisfaction. URM-specific daily hassles accounted for the relation between traumatic events and life satisfaction. The youth had been exposed to several traumatic events yet the effect of these on life satisfaction appeared indirect, via an increase in URM-specific daily hassles. Reducing the number of, or help URM cope with, URM-specific daily hassles may increase their life satisfaction.
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Affiliation(s)
- Anne Kristine Solhaug
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Brit Oppedal
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Espen Røysamb
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Rachel Calam
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Okuyan CB, Bilgili N. Assessment of health perceptions, use of health services and traditional health practices of Afghan immigrants in Türkiye. Glob Health Promot 2024:17579759241243365. [PMID: 38822634 DOI: 10.1177/17579759241243365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Immigration, as a social determinant of health, encompasses several social and economic transformations. Neglecting to adequately address this issue could potentially worsen pre-existing challenges within health systems and in the management of migration. In the present study, we aim to evaluate the health perceptions, traditional health practices and use of health services of Afghan immigrants. We enrolled 1597 Afghan immigrants over 18 years old in the descriptive cross-sectional research. The mean age of the immigrants was 49.19 ± 1.6 years. The smallest number of points that can be achieved on the health perception scale is 15, while the greatest number is 75. We found that the health perception scale average score is 37.61 ± 7.32. Some factors, such as age 65 and over, female gender, postgraduate education level, good social insurance and economic status, being a public officer, not having any infectious diseases, and having a good Turkish level, have positively affected the health perception levels (p < 0.05). Moreover, we observed that cultural differences, expensive health care, a lack of social insurance, fear and anxiety, lack of language skills, waiting times and traditional health practices were the most common barriers to accessing healthcare services. Considering these issues in the health system, identifying the factors that negatively affect the perception of health and related to the use of health services can help immigrants increase their use of health services and improve their health.
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Affiliation(s)
- Canan Birimoglu Okuyan
- Department of Public Health Nursing, Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Naile Bilgili
- 2Department of Public Health Nursing, Faculty of Nursing, Gazi University, Ankara, Türkiye
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Barreto MDS, Sanguino GZ, Vieira VCDL, Furlan MCR, Flavio GG, Gutiérrez-Carmona A, Marcon SS. Challenges of nursing research with immigrant and refugee populations: methodological and pragmatic considerations. Rev Esc Enferm USP 2024; 58:e20230417. [PMID: 38767848 PMCID: PMC11110891 DOI: 10.1590/1980-220x-reeusp-2023-0417en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/20/2024] [Indexed: 05/22/2024] Open
Abstract
The objective of the study was to identify the main challenges in conducting research with immigrants and refugees and to provide seven methodological and pragmatic strategies. The analyses presented, based on the Theory of Culture Care Diversity and Universality, are extracted from insights of the authors' experiences as researchers and the literature. The main challenges are related to cultural, moral, political, and educational differences between researcher and researched; identification of the universe and sampling; access to informants through the barrier of distrust; and communication and language difficulties. Strategies to make research more successful involve: developing a thorough research protocol; creatively recruiting participants; developing strategies to facilitate communication; having a sensitive look; offering a structure of reciprocity; increasing trust, and triangulating research. The main methodological and pragmatic issues in studies with immigrants and refugees were explored, providing valuable guidance for future projects. However, in different migration situations, researchers must be aware of the possibility of other challenges arising during the investigative process.
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Affiliation(s)
| | | | | | | | | | | | - Sonia Silva Marcon
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brazil
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Andersson LMC, Punzi E. Caring for Undocumented Migrants: Significance of Recognition and Respect during Healthcare Encounters. Issues Ment Health Nurs 2024; 45:365-370. [PMID: 38564680 DOI: 10.1080/01612840.2024.2319640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Undocumented migrants are often in a position of extreme vulnerability and experience many barriers to accessing mental health care. It is crucial that health professionals understand this and quickly establish trust and respect. If the stressful living conditions that contribute to the distress of undocumented migrants are recognized, compassionate and trauma-informed care is enhanced. In this regard, it is important that health professionals understand the fear of being expelled from a country. This paper discusses problems that arise when health professionals interact with undocumented migrants and the need to quickly convey recognition to establish trust and respect. We argue that insights from Axel Honneth's social philosophical theory of recognition and disrespect can further enhance health professionals strategies to improve their verbal and non-verbal communication and thereby increase access to health care for undocumented migrants. We suggest ideas for codifying this knowledge in health care policies and guidelines.
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Affiliation(s)
| | - Elisabeth Punzi
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
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Voldner N, Eick F, Vangen S. 'Goodbye and good luck' Midwifery care to pregnant undocumented migrants in Norway: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100878. [PMID: 37369145 DOI: 10.1016/j.srhc.2023.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To explore community midwives' experiences caring for pregnant undocumented migrants seeking prenatal care in Norway. METHOD Due to the relatively limited previous research and number of pregnant undocumented migrants we used an explorative approach through qualitative method. Ten community midwives were interviewed after snowball sampling in Oslo, the capital of Norway. The main themes emerged through a qualitative analysis of the transcripts, and meaning units were extracted. RESULTS Midwives with no prior experience with pregnant undocumented migrants expressed uncertainty regarding the women's rights. In contrast, those midwives who had had prior experience with this group, developed their own solutions and enacted certain strategies to help them without any guidelines from their employer. All the midwives found it challenging to provide follow-up care to the undocumented migrants during pregnancy and postpartum. They also expressed concerns regarding increasing challenges creating clinical trusting relationships and restrictions and practices at public hospitals. CONCLUSIONS To ensure adequate perinatal care, it is needed to reassure pregnant undocumented migrants free and safe care at all stages in the birth giving process. Community midwives need professional support in establishing trusting clinical relationships with pregnant undocumented migrants to reduce maternal stress and facilitate continuity in perinatal care.
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Affiliation(s)
- Nanna Voldner
- Faculty of Health Studies, VID specialized university, Diakonveien 16, 0370 Oslo, Norway
| | - Frode Eick
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway.
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynaecology, Oslo University Hospital, Rikshospitalet, PO box 4950, Nydalen, 0424 Oslo, Norway
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Eick F, Vallersnes OM, Fjeld HE, Sørbye IK, Storkås G, Ekrem M, Børmer M, Løberg SA, Ebbing C, Voldner N, Dahl C. Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway. BMC Pregnancy Childbirth 2022; 22:789. [PMID: 36280826 PMCID: PMC9589618 DOI: 10.1186/s12884-022-05112-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway's two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. METHODS In this historic cohort study we included pregnant women aged 18-49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. RESULTS We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1-3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. CONCLUSION Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.
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Affiliation(s)
- Frode Eick
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
| | - Odd Martin Vallersnes
- grid.5510.10000 0004 1936 8921Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Heidi E. Fjeld
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
| | - Ingvil Krarup Sørbye
- grid.55325.340000 0004 0389 8485Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Guro Storkås
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marthe Ekrem
- grid.5510.10000 0004 1936 8921Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Børmer
- grid.7914.b0000 0004 1936 7443Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Sara Andrea Løberg
- grid.411279.80000 0000 9637 455XDivision of Gynaecology and Obstetrics, Akershus University Hospital, Oslo, Norway
| | - Cathrine Ebbing
- grid.7914.b0000 0004 1936 7443Department of Obstetrics and Gynaecology, Haukeland University Hospital, and Department of clinical medicine, University of Bergen, Bergen, Norway
| | - Nanna Voldner
- grid.463529.f0000 0004 0610 6148Faculty of Health Studies, VID specialized university, Oslo, Norway
| | - Cecilie Dahl
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
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How Did the COVID-19 Pandemic Affect Migrant Populations in Lisbon, Portugal? A Study on Perceived Effects on Health and Economic Condition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031786. [PMID: 35162809 PMCID: PMC8835335 DOI: 10.3390/ijerph19031786] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/18/2022]
Abstract
Increasing evidence on the effects of the COVID-19 pandemic suggests that its social and health impacts are being disproportionately shouldered by socioeconomically disadvantaged populations, including migrants. Knowledge of how these populations are experiencing the COVID-19 crisis is scarce. We examined the effects of the pandemic on the perceived individual financial situation and health condition of migrants in Lisbon, Portugal, and described the most affected subgroups. A cross-sectional survey was conducted with a diverse community-based sample of 1126 migrants. A worsening of their financial situation since the pandemic was reported by 55.6% of the participants and a worsening of their health condition by 19.9%. A worsened financial situation was most often reported by those ≥45 years old and with a lower income (<EUR 650). Likewise, a worsened health condition was most often reported by older and lower-income migrants, as well as by women and those with a lower level of education. Migration-related factors such as length of stay and migration status were not associated with worsened health conditions. Socioeconomic characteristics appear to be more important when assessing differences in perceived effects of the pandemic among migrants. The social impact of the pandemic both exacerbates economic and gender inequalities and may lead to worse health conditions within the population in the medium and long terms.
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Kvamme E, Voldner N. Public health nurses' encounters with undocumented migrant mothers and children. Public Health Nurs 2021; 39:286-295. [PMID: 34897781 DOI: 10.1111/phn.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/05/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Undocumented migrant children (UMC) are often affected by policies and practices that do not take their best interests into account. The aim of this study was to describe how public health nurses (PHNs) experienced challenges and dilemmas in ensuring the best interests of the undocumented migrant child. DESIGN This study had a qualitative descriptive design. SAMPLE Focus group interviews and semi-structured interviews were conducted with seven PHNs in four different child health centers (CHCs). RESULTS Qualitative content analysis was applied. Three main themes were identified: building trust, ensuring the best interests of the child, and dilemmas and challenges in ensuring the best interests of the child. The study revealed examples of immigration policy being prioritized over the best interests of the child. PHNs experienced frustration when the best interests of the child were not taken into account. Strategies for managing these conflicting demands were identified. CONCLUSION Conflicting demands appeared when national immigration policies collided with fundamental human rights and ethical standards. Rules that exclude certain groups are incompatible with PHNs professional ethics.
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Affiliation(s)
- Eli Kvamme
- VID Specialized University, Faculty of Health Studies, Oslo, Norway
| | - Nanna Voldner
- VID Specialized University, Faculty of Health Studies, Oslo, Norway
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Ponce-Blandón JA, Romero-Castillo R, Jiménez-Picón N, Palomo-Lara JC, Castro-Méndez A, Pabón-Carrasco M. Lived Experiences of African Migrants Crossing the Strait of Gibraltar to Europe: A Cross-Cultural Approach to Healthcare from a Qualitative Methodology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9379. [PMID: 34501968 PMCID: PMC8431138 DOI: 10.3390/ijerph18179379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The migratory flow from the African continent to Europe is intense and the European countries should apply a humanitarian, health and social response to this emerging problem. Migrants coming from Africa to Europe are a very vulnerable population. Healthcare professionals should be prepared for answering their needs from a transcultural approach, which requires a better understanding of this phenomenon. Thus, the aim of this study was to improve nursing and healthcare professionals' awareness and better understanding of migrant life experiences during the migration journey. An exploratory descriptive qualitative research was conducted. In-depth interviews were conducted involving four key informants and content analysis were performed with the transcriptions. RESULTS Three themes merged: life situations in their countries of origin; motivations that led them to undertake the migratory journey; and experiences they lived during the migratory journey. The results described the dramatic experience and motivations for crossing the strait of Gibraltar from Africa to Europe, including feelings, fears, hopes and lived experiences. The determination of immigrants to fight for a better life opportunity and the physical damage and psychological consequences they suffer were revealed. CONCLUSIONS This study would help healthcare professionals to better understand this complex reality and deliver culturally adapted care. Knowledge of the starting reality of these populations can help health professionals to incorporate a cross-cultural approach that improves the relational, ethical and affective competences to provide quality care to the migrant population, as well as the development of health measures to fight against inequalities suffered by these population groups.
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Affiliation(s)
- José Antonio Ponce-Blandón
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| | - Rocío Romero-Castillo
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
| | - Nerea Jiménez-Picón
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
| | - Juan Carlos Palomo-Lara
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
| | - Aurora Castro-Méndez
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
| | - Manuel Pabón-Carrasco
- Red Cross Nursing University Center, University of Seville, 41009 Seville, Spain; (N.J.-P.); (J.C.P.-L.); (M.P.-C.)
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain;
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