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Thiel de Bocanegra H, Goliaei Z, Khan N, Banna S, Behnam R, Mody SK. Refugee Women's Receptiveness for Virtual Engagement on Reproductive Health During the COVID-19 Pandemic. Int J Behav Med 2022; 30:366-375. [PMID: 35554855 PMCID: PMC9097561 DOI: 10.1007/s12529-022-10097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
Background Refugee women who leave their country due to persecution and violence have multiple barriers to sexual and reproductive health (SRH) services. The COVID-19 pandemic added an additional barrier to in-person reproductive health education, dialogue, and clinical care. This study aimed to assess the potential of using virtual group meetings as a forum for refugee women to learn about and discuss reproductive health concerns such as cervical cancer screening, family planning, childbirth, and postpartum care. Method We conducted semi-structured interviews with 36 refugee women and stakeholders to assess factors that impact refugee women’s receptiveness for virtual platforms to obtain information and engage in discussions on reproductive health. Thematic analysis was conducted using the software Dedoose. Results Openness to engage in virtual platforms varied by refugee community, women’s demographic, and life experience. The women’s involvement with local refugee groups facilitated their engagement with virtual platforms. Furthermore, individuals’ family structure and marital relationship, along with literacy and English proficiency, and access to and familiarity with technology impacted engagement. Virtual groups needed to mirror confidentiality and women expressed a strong preference that groups were all-women. Conclusion Refugee women are receptive to virtual groups on SRH when they are offered in a culturally appropriate manner that considers the living situations and access to technology after arrival to the USA. Findings from this study provide a framework to develop and tailor effective virtual or hybrid virtual-in-person programs for women in refugee communities.
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Affiliation(s)
- Heike Thiel de Bocanegra
- Department of Obstetrics and Gynecology, School of Medicine, University of California, UCIMC - Chapman Pavilion, 3rd Floor, suite 3400, Irvine, Orange, CA, 92868, USA. .,Department of Obstetrics and Gynecology, University of California, Irvine, Orange, USA.
| | - Zahra Goliaei
- Public Health, School of Social Sciences, University of California, Merced, Merced, USA
| | - Nossin Khan
- Department of Obstetrics and Gynecology, School of Medicine, University of California, UCIMC - Chapman Pavilion, 3rd Floor, suite 3400, Irvine, Orange, CA, 92868, USA.,California Department of Health, Office of Refugee Health, Sacramento, Sacramento, USA
| | - Sereen Banna
- Department of Obstetrics and Gynecology, School of Medicine, University of California, UCIMC - Chapman Pavilion, 3rd Floor, suite 3400, Irvine, Orange, CA, 92868, USA
| | - Rawnaq Behnam
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Diego, San Diego, USA
| | - Sheila K Mody
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Diego, San Diego, USA
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Iliadou M, Papadakaki M, Sioti E, Giaxi P, Leontitsi E, Petelos E, den Muijsenbergh MV, Tziaferi S, Mastroyiannakis A, Vivilaki VG. Addressing mental health issues among migrant and refugee pregnant women: A call for action. Eur J Midwifery 2019; 3:9. [PMID: 33537588 PMCID: PMC7839133 DOI: 10.18332/ejm/108626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 12/22/2022] Open
Abstract
Migrant and refugee pregnant women constitute a highly vulnerable group to mental disorders. The rates of mental illness of migrants and refugees are higher than those of host populations, with migrant women being more likely to suffer from prenatal depression. A Policy Paper was developed based on a literature review conducted in Medline, Scopus and Google Scholar. Filtering criteria were: year of publication (2002–2017), study topic relevance, and English language. A total of 63 documents were identified. Most of the documents were scientific papers while a large number of documents were reports of EU committees and networks on migrant issues or annual reports of international bodies. From the analysis of existing evidence, four major topics emerged for the perinatal health of migrant women: 1) Prevalence and risk factors for antenatal mental disorders, 2) Assessment of mental disorders, 3) Healthcare professionals’ training on supporting migrant and refugee pregnant women, and 4) Interventions for the mental health of migrant women. Midwives and other members of interdisciplinary teams have to be trained and culturally competent to successfully meet the needs of migrant and refugee pregnant women.
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Affiliation(s)
- Maria Iliadou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece.,Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece
| | - Maria Papadakaki
- Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece
| | - Eirini Sioti
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Paraskevi Giaxi
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Evangelia Leontitsi
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Elena Petelos
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Maria Van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Styliani Tziaferi
- Department of Nursing, Laboratory of Integrated Health Care, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparti, Greece
| | | | - Victoria G Vivilaki
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
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3
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Mahon A, Merry L, Lu O, Gagnon AJ. Postpartum Pain in the Community Among Migrant and Non-migrant Women in Canada. J Immigr Minor Health 2018; 19:407-414. [PMID: 26883029 DOI: 10.1007/s10903-016-0364-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
International migrant women of childbearing age represent a large proportion of immigrants to high-income countries, yet research focusing on their postpartum health is limited. We investigated predictive factors for breast and non-breast pain 1 week post-birth in migrant and non-migrant women in Canada. Among migrant women, difficulty accessing health services; being from a middle-or high-income country; poor functionality in English and French; living with the father of their infant; and having no regular care provider were predictive of breast pain. Among non-migrant women, difficulties accessing health services, multiparity and prenatal education were predictive of breast pain, while receiving an epidural and having no regular care provider were predictive of non-breast pain. Among both groups, difficulties accessing health services and having no regular care provider were predictive of breast pain, while second degree or higher perineal tearing was predictive of non-breast pain. Migration-specific indicators should be considered in postpartum care planning.
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Affiliation(s)
- Abbey Mahon
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Lisa Merry
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Olivia Lu
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, 3506 University Street, Montreal, QC, H3A 2A7, Canada.
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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4
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Dennis CL, Merry L, Gagnon AJ. Postpartum depression risk factors among recent refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:411-422. [PMID: 28220215 DOI: 10.1007/s00127-017-1353-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective was to examine and compare risk factors for postpartum depression among: (1) recent (≤5 years) migrant and Canadian-born women, and (2) refugee, asylum-seeking, and non-refugee immigrant women. METHODS A sample of 1536 women (1024 migrant and 512 Canadian-born) were recruited from 12 hospitals. Women completed questionnaires at 1-2 and 16 weeks postpartum including questions on socio-demographics, biomedical history, health services, and migration and resettlement factors. Bivariate analyses and multivariate logistic regression were performed to examine and compare risk factors for postpartum depressive symptoms at 16 weeks postpartum. RESULTS Recent migrant women had significantly higher rates (6%) of depressive symptoms at 16 weeks postpartum than Canadian-born women (2.9%). Asylum-seekers had the highest rate (14.3%), followed by refugee (11.5%) and non-refugee immigrant women (5.1%). Migrant women at greatest risk to develop depressive symptoms were those who experienced abuse, had pain post-birth, worried about family members left behind, had food insecurity, and had reduced access to healthcare (limited insurance and/or no regular care-provider). Conversely, those with higher levels of social support and who felt they belonged to a community had a lower risk of developing depressive symptoms. CONCLUSION All childbearing recent migrant women should be considered at risk for postpartum depression. To prevent and support migrant women suffering postpartum depressive symptoms, barriers to healthcare need to be addressed and interventions should include assessments and support/programmes for abuse/violence, lack of social support, food insecurity, and stress/poor mental health. Treatment of pain during the postpartum period is also critical.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada
| | - Lisa Merry
- School of Nursing, University of Ottawa, 1 Stewart Street, Rm 127, Ottawa, ON, K1N 6N5, Canada. .,Ingram School of Nursing, McGill University, Montreal, Canada.
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Research Institute, McGill University Health Centre, Montreal, Canada
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5
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Dennis CL, Merry L, Stewart D, Gagnon AJ. Prevalence, continuation, and identification of postpartum depressive symptomatology among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Arch Womens Ment Health 2016; 19:959-967. [PMID: 27185244 DOI: 10.1007/s00737-016-0633-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/30/2016] [Indexed: 11/29/2022]
Abstract
This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8-17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4-6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0-7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3-19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, Ontario, M5T 1P8, Canada. .,Women's College Research Institute Toronto, Toronto, Canada.
| | - Lisa Merry
- School of Nursing, University of Ottawa, Ottawa, Canada. .,Ingram School of Nursing, McGill University, Montreal, Canada.
| | - Donna Stewart
- Department of Psychiatry, University of Toronto, University Health Network, Toronto, Canada.,Toronto General Research Institute, Toronto, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Canada.,Research Institute, McGill University Health Centre, Montreal, Canada
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Wanigaratne S, Cole DC, Bassil K, Hyman I, Moineddin R, Urquia ML. Contribution of HIV to Maternal Morbidity Among Refugee Women in Canada. Am J Public Health 2015; 105:2449-56. [PMID: 26469648 DOI: 10.2105/ajph.2015.302886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared severe maternal morbidity (SMM) and SMM subtypes, including HIV, of refugee women with those of nonrefugee immigrant and nonimmigrant women. METHODS We linked 1,154,421 Ontario hospital deliveries (2002-2011) to immigration records (1985-2010) to determine the incidence of an SMM composite indicator and its subtypes. We determined SMM incidence according to immigration periods, which were characterized by lifting restrictions for all HIV-positive immigrants (in 1991) and refugees who may place "excessive demand" on government services (in 2002). RESULTS Refugees had a higher risk of SMM (17.1 per 1000 deliveries) than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among SMM subtypes, refugees had a much higher risk of HIV than did immigrants (risk ratio [RR] = 7.94; 95% confidence interval [CI] = 5.64, 11.18) and nonimmigrants (RR = 17.37; 95% CI = 12.83, 23.53). SMM disparities were greatest after the 2002 policy came into effect. After exclusion of HIV cases, SMM disparities disappeared. CONCLUSIONS An apparent higher risk of SMM among refugee women in Ontario, Canada is explained by their high prevalence of HIV, which increased over time parallel to admission policy changes favoring humanitarian protection.
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Affiliation(s)
- Susitha Wanigaratne
- At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Donald C Cole
- At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kate Bassil
- At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilene Hyman
- At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rahim Moineddin
- At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
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7
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Ratcliff BG, Sharapova A, Suardi F, Borel F. Factors associated with antenatal depression and obstetric complications in immigrant women in Geneva. Midwifery 2015; 31:871-8. [PMID: 26026198 DOI: 10.1016/j.midw.2015.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 12/17/2014] [Accepted: 04/22/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE immigrant women are at increased risk for health problems during pregnancy, and for antenatal and postnatal depression. This study aimed to identify sociodemographic and specific psychosocial risk factors of antenatal depression and obstetric complications in an economically and culturally heterogeneous sample. DESIGN prospective cross-sectional design. SETTING the study was conducted in a midwifery office. PARTICIPANTS the community sample included 228 immigrant pregnant women with low French proficiency referred to birth preparation classes between 2006 and 2014 in Geneva, Switzerland. MEASUREMENT depressive symptoms were measured during the third trimester of pregnancy using the Edinburgh Postnatal Depression Scale. A cut-off score ≥12 was considered to be indicative of antenatal depression. FINDINGS more than half of the participants had been living in Switzerland for less than five years and had a short-term residence permit. Thirty-seven per cent of women scored above the clinical cut-off score. Women with several risk factors, such as a precarious legal status, lack of marital support, difficult living conditions and being a newcomer to Switzerland, were at higher risk of depression. Women who encountered difficult living conditions were at higher risk of obstetric complications. IMPLICATIONS FOR PRACTICE these results confirm the findings of previous research, and highlight the need for early detection. Public health prevention policies should consist of multidimensional programmes to address simultaneously psychosocial, cultural and obstetric issues in pregnant immigrant women.
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Affiliation(s)
- Betty Goguikian Ratcliff
- Department of Psychology and Education, University of Geneva, Uni Mail, Boulevard du Pont d'Arve 40, 1205 Geneva, Switzerland.
| | - Anna Sharapova
- Department of Psychology and Education, University of Geneva, Uni Mail, Boulevard du Pont d'Arve 40, 1205 Geneva, Switzerland
| | - Francesca Suardi
- Department of Psychology and Education, University of Geneva, Uni Mail, Boulevard du Pont d'Arve 40, 1205 Geneva, Switzerland
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8
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Merry L, Low A, Carnevale F, Gagnon AJ. Participation of childbearing international migrant women in research: the ethical balance. Nurs Ethics 2014; 23:61-78. [PMID: 25527352 DOI: 10.1177/0969733014557134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Fear of burdening or harming childbearing, migrant women, particularly refugees or others who have experienced war, torture, abuse, or rape, can result in their exclusion from research. This exclusion prohibits health issues and related solutions to be identified for this population. For this reason, while it may be challenging to include these women in studies, it is ethically problematic not to do so. Using ethical guidelines for research involving humans as a framework, and drawing on our research experiences. This discussion article proposes a number of strategies to improve the conditions for childbearing migrant women to participate in health research. What emerged as key for studying this diverse population and ensuring an ethically responsible approach are the use of methods that are adapted to the circumstances of childbearing migrant women and the involvement and support from "migrant-friendly" organizations. Ensuring migrant women are involved in the research process and knowledge produced is also critical. The more researchers working in this field communicate their experiences, the more will be learnt about how best to approach research with migrants. More migration and health research will enable a greater contribution to the knowledge base upon which the needs of this population can be met and their strengths maximized.
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Affiliation(s)
| | - Amy Low
- McGill University Health Centre (MUHC), Canada
| | | | - Anita J Gagnon
- McGill University, Canada; The Research Institute of the McGill University Health Centre (RI-MUHC), Canada
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9
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Hankivsky O, Grace D, Hunting G, Giesbrecht M, Fridkin A, Rudrum S, Ferlatte O, Clark N. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity. Int J Equity Health 2014; 13:119. [PMID: 25492385 PMCID: PMC4271465 DOI: 10.1186/s12939-014-0119-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts - an Intersectionality-Based Policy Analysis (IBPA) Framework. METHODS Developed over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies. RESULTS The analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks. CONCLUSION The aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.
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Affiliation(s)
- Olena Hankivsky
- School of Public Policy, Simon Fraser University, Vancouver, British Columbia (BC), Canada.
| | - Daniel Grace
- London School of Hygiene & Tropical Medicine, London, UK. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Gemma Hunting
- Institute for Intersectionality Research & Policy, Vancouver, BC, Canada.
| | | | - Alycia Fridkin
- Interdisciplinary Studies Graduate Program, University of British Columbia (UBC), Vancouver, BC, Canada.
| | - Sarah Rudrum
- Institute for Gender, Race, Sexuality and Social Justice, UBC, Vancouver, BC, Canada.
| | - Olivier Ferlatte
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
| | - Natalie Clark
- School of Social Work, UBC, Vancouver, BC, Canada. .,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada.
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10
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Brown-Bowers A, McShane K, Wilson-Mitchell K, Gurevich M. Postpartum depression in refugee and asylum-seeking women in Canada: A critical health psychology perspective. Health (London) 2014; 19:318-35. [PMID: 25389234 DOI: 10.1177/1363459314554315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canada has one of the world's largest refugee resettlement programs in the world. Just over 48 percent of Canadian refugees are women, with many of them of childbearing age and pregnant. Refugee and asylum-seeking women in Canada face a five times greater risk of developing postpartum depression than Canadian-born women. Mainstream psychological approaches to postpartum depression emphasize individual-level risk factors (e.g. hormones, thoughts, emotions) and individualized treatments (e.g. psychotherapy, medication). This conceptualization is problematic when applied to refugee and asylum-seeking women because it fails to acknowledge the migrant experience and the unique set of circumstances from which these women have come. The present theoretical article explores some of the consequences of applying this psychiatric label to the distress experienced by refugee and asylum-seeking women and presents an alternative way of conceptualizing and alleviating this distress.
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11
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Resilience in international migrant women following violence associated with pregnancy. Arch Womens Ment Health 2014; 17:303-10. [PMID: 24221406 DOI: 10.1007/s00737-013-0392-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 10/20/2013] [Indexed: 10/26/2022]
Abstract
Exposure to violence associated with pregnancy (VAP) is an underrecognized public health and social problem that has an enormous impact on the physical and mental health of women and their children. Our recent study of 1,127 new mothers living in two urban areas of Canada found refugees and asylum-seekers to be more likely to have experienced VAP than immigrant or Canadian-born women. Interestingly, some migrants who had experienced VAP had low rates of postpartum depression risk on the Edinburgh Postpartum Depression Scale, suggesting that resilience may play an important role in maintaining their mental health. Hence, we sought to explore processes which enhance migrants' resilience to VAP. We conducted in-depth interviews with ten women who had been identified as experiencing VAP and having low risk of postpartum depression and performed thematic analyses. International migrant women found internal psychological and coping resources, external social supports, and systemic factors including government policies to be vital to their resilience. Participants perceived differences in resilience by gender and immigration status. International migrant women used a range of processes to maintain and enhance their resilience after VAP, and these may be helpful to less resilient women who are vulnerable to postpartum depression.
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12
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Gagnon AJ, DeBruyn R, Essén B, Gissler M, Heaman M, Jeambey Z, Korfker D, McCourt C, Roth C, Zeitlin J, Small R. Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process. BMC Pregnancy Childbirth 2014; 14:200. [PMID: 24916892 PMCID: PMC4088918 DOI: 10.1186/1471-2393-14-200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 04/30/2014] [Indexed: 02/06/2023] Open
Abstract
Background Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. Methods This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. Results A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) – in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth. Conclusions A 4-stage process of questionnaire development with international experts in migrant reproductive health and research resulted in the MFMCQ, a questionnaire measuring key aspects of migrant-sensitive maternity care. The MFMCQ is available for further translation and use to examine and compare care and perceptions of care within and across countries, and by key socio-demographic, migration, and obstetrical characteristics of migrant women.
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Affiliation(s)
- Anita J Gagnon
- Ingram School of Nursing and Department of Obstetrics and Gynaecology, McGill University, 3506 University St,, Room 207, Montreal, Quebec H3A 2A7, Canada.
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Lacaze-Masmonteil T, Leis A, Lauriol E, Normandeau J, Moreau D, Bouchard L, Vaillancourt C. Perception du contexte linguistique et culturel minoritaire sur le vécu de la grossesse. CANADIAN JOURNAL OF PUBLIC HEALTH 2013. [DOI: 10.17269/cjph.104.3515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wilson-Mitchell K, Rummens JA. Perinatal outcomes of uninsured immigrant, refugee and migrant mothers and newborns living in Toronto, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2198-213. [PMID: 23727901 PMCID: PMC3717732 DOI: 10.3390/ijerph10062198] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/22/2013] [Accepted: 05/24/2013] [Indexed: 11/28/2022]
Abstract
Canadian healthcare insurance is not universal for all newcomer populations. New immigrant, refugee claimant, and migrant women face various barriers to healthcare due to the lack of public health insurance coverage. This retrospective study explored the relationships between insurance status and various perinatal outcomes. Researchers examined and compared perinatal outcomes for 453 uninsured and provincially insured women who delivered at two general hospitals in the Greater Toronto Area between 2007 and 2010. Data on key perinatal health indicators were collected via chart review of hospital medical records. Comparisons were made with regional statistics and professional guidelines where available. Four-in-five uninsured pregnant women received less-than-adequate prenatal care. More than half of them received clearly inadequate prenatal care, and 6.5% received no prenatal care at all. Insurance status was also related to the type of health care provider, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced a higher percentage of caesarian sections due to abnormal fetal heart rates and required more neonatal resuscitations. No significant difference was found for low birth weight, preterm birth, NCIU admissions, postpartum hemorrhage, breast feeding, or intrapartum care provided.
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Affiliation(s)
- Karline Wilson-Mitchell
- Midwifery Education Program, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Joanna Anneke Rummens
- Community Health Systems Resource Group, The Hospital for Sick Children & Department of Psychiatry, University of Toronto; 555 University Avenue, Toronto, ON M5G 1X8, Canada; E-Mail:
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Gagnon AJ, Carnevale F, Mehta P, Rousseau H, Stewart DE. Developing population interventions with migrant women for maternal-child health: a focused ethnography. BMC Public Health 2013; 13:471. [PMID: 23672838 PMCID: PMC3733625 DOI: 10.1186/1471-2458-13-471] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature describing effective population interventions related to the pregnancy, birth, and post-birth care of international migrants, as defined by them, is scant. Hence, we sought to determine: 1) what processes are used by migrant women to respond to maternal-child health and psychosocial concerns during the early months and years after birth; 2) which of these enhance or impede their resiliency; and 3) which population interventions they suggest best respond to these concerns. METHODS Sixteen international migrant women living in Montreal or Toronto who had been identified in a previous study as having a high psychosocial-risk profile and subsequently classified as vulnerable or resilient based on indicators of mental health were recruited. Focused ethnography including in-depth interviews and participant observations were conducted. Data were analyzed thematically and as an integrated whole. RESULTS Migrant women drew on a wide range of coping strategies and resources to respond to maternal-child health and psychosocial concerns. Resilient and vulnerable mothers differed in their use of certain coping strategies. Social inclusion was identified as an overarching factor for enhancing resiliency by all study participants. Social processes and corresponding facilitators relating to social inclusion were identified by participants, with more social processes identified by the vulnerable group. Several interventions related to services were described which varied in type and quality; these were generally found to be effective. Participants identified several categories of interventions which they had used or would have liked to use and recommended improvements for and creation of some programs. The social determinants of health categories within which their suggestions fell included: income and social status, social support network, education, personal health practices and coping skills, healthy child development, and health services. Within each of these, the most common suggestions were related to creating supportive environments and building healthy public policy. CONCLUSIONS A wealth of data was provided by participants on factors and processes related to the maternal-child health care of international migrants and associated population interventions. Our results offer a challenge to key stakeholders to improve existing interventions and create new ones based on the experiences and views of international migrant women themselves.
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Affiliation(s)
- Anita J Gagnon
- Ingram School of Nursing, McGill University, 3506 University St., Room 207, Montreal QC H3A 2A7, Canada
- Department of Obstetrics and Gynaecology, McGill University, Montreal H3A 2A7, Canada
- McGill University Health Centre, Montreal QC H3H 2R9, Canada
| | - Franco Carnevale
- Ingram School of Nursing, McGill University, 3506 University St., Room 207, Montreal QC H3A 2A7, Canada
- McGill University Health Centre, Montreal QC H3H 2R9, Canada
| | - Praem Mehta
- Ingram School of Nursing, McGill University, 3506 University St., Room 207, Montreal QC H3A 2A7, Canada
| | - Hélène Rousseau
- McGill University and CSSS de la Montagne 5700 Côte-des-Neiges Montreal QC H3T 2A8 Canada
| | - Donna E Stewart
- University of Toronto and University Health Network 200 Elizabeth St, EN-7-229 Toronto ON M5G 2C4 Canada
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Gagnon AJ, Merry L, Haase K. Predictors of emergency cesarean delivery among international migrant women in Canada. Int J Gynaecol Obstet 2013; 121:270-4. [DOI: 10.1016/j.ijgo.2012.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/19/2012] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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Merry L, Small R, Blondel B, Gagnon AJ. International migration and caesarean birth: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013; 13:27. [PMID: 23360183 PMCID: PMC3621213 DOI: 10.1186/1471-2393-13-27] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/23/2013] [Indexed: 12/18/2022] Open
Abstract
Background Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences. Methods Reports were identified by searching 12 literature databases (from inception to January 2012; no language limits) and the web, by bibliographic citation hand-searches and through key informants. Studies that compared caesarean rates between international migrants and non-migrants living in industrialized countries and that did not have a ‘fatal flaw’ according to the US Preventative Services Task Force criteria were included. Studies were summarized, analyzed descriptively and where possible, meta-analyzed. Results Seventy-six studies met inclusion criteria. Caesarean rates between migrants and non-migrants differed in 69% of studies. Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, GDM/high BMI, feto-pelvic disproportion, and inadequate prenatal care. Suggested protective factors included: a healthy immigrant effect, preference for a vaginal birth, a healthier lifestyle, younger mothers and the use of fewer interventions during childbirth. Conclusion Certain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.
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Dennis CL, Gagnon A, Van Hulst A, Dougherty G, Wahoush O. Prediction of duration of breastfeeding among migrant and Canadian-born women: results from a multi-center study. J Pediatr 2013; 162:72-9. [PMID: 22878112 DOI: 10.1016/j.jpeds.2012.06.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/14/2012] [Accepted: 06/20/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine and compare predictors of breastfeeding duration among migrant and Canadian-born women. STUDY DESIGN As part of a longitudinal study, a sample of 1503 mothers was recruited from 12 hospitals in Canada who completed questionnaires at 1 and 16 weeks postpartum. Following bivariate analysis, multivariate logistic regression analyses were completed to examine and compare predictors of continued breastfeeding at 16 weeks postpartum among migrant and Canadian-born women. RESULTS Among migrant women, factors predictive of breastfeeding duration included maternal age ≥ 35 years, primiparity, and breast engorgement pain at 1 week postpartum. Factors predictive of discontinued breastfeeding in this group included maternal age <20 years, higher gender-related development index of country of origin, no previous breastfeeding experience, breastfeeding duration of peers <6 months, planned duration of exclusive breastfeeding <6 months, and not exclusively breastfeeding at 1 week postpartum. Among Canadian-born women, factors predictive of breastfeeding duration included residence in Vancouver and maternal age ≥ 35 years. Factors predictive of discontinued breastfeeding included residence in Toronto, maternal age <20 years, smoking at 16 weeks postpartum, primiparity, planned duration of exclusive breastfeeding <6 months, and not exclusively breastfeeding at 1 week postpartum. CONCLUSIONS Although certain predictors for breastfeeding duration were similar between migrant and Canadian-born women, several were dissimilar, suggesting that these groups might benefit from different strategies to optimize breastfeeding outcomes.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada.
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Mothering here and mothering there: international migration and postbirth mental health. Obstet Gynecol Int 2012; 2012:593413. [PMID: 23213337 PMCID: PMC3504459 DOI: 10.1155/2012/593413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/11/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022] Open
Abstract
Over 125,000 women immigrate to Canada yearly-most in their childbearing years and many having given birth before immigrating. We sought to (1) examine the background characteristics and mental health profile of women separated from their children due to migration and subsequently giving birth in Canada ("dual-country (DC) mothers") and (2) contrast these with those of "non-dual-country" migrant mothers. Of 514 multiparous migrant women giving birth, one-fifth (18%) reported being separated from their children due to migration. Over one-third of DC mothers were living in poverty (36.0% versus 18.6%, P = 0.001), and one in seven was experiencing household food insecurity (16.3% versus 7.6%, P = 0.01). Over one-third had no partner (40.2% versus 11.4%, P = 0.00), and nearly one-quarter reported no available support (23.1% versus 12.2%, P = 0.007). Over three-quarters were asylum seekers or refugees (83.7% versus 51%, P = 0.00). More DC than non-DC mothers had symptoms of postpartum depression (28.3% versus 18.6%, P = 0.04), symptoms of clinical depression (23.1% versus 13.5%, P = 0.02), and anxiety related to trauma (16.5% versus 9.4%, P = 0.04). Results suggest that identifying DC mothers is a rapid approach to enable clinicians to target a subgroup of women needing special attention.
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Dennis CL, Gagnon A, Van Hulst A, Dougherty G. Predictors of breastfeeding exclusivity among migrant and Canadian-born women: results from a multi-centre study. MATERNAL AND CHILD NUTRITION 2012; 10:527-44. [PMID: 22974539 DOI: 10.1111/j.1740-8709.2012.00442.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to examine and compare predictors of breastfeeding exclusivity among migrant and Canadian-born women. As part of a longitudinal study, a sample of 1184 mothers were recruited from 12 hospitals in Canada and completed questionnaires at 1 and 16 weeks post-partum that included diverse questions from the following domains: demographic, social, migration, obstetrical, breastfeeding and maternal mood. After bivariate analysis, multivariate logistic regression analysis was completed to examine and compare predictors of exclusive breastfeeding at 16 weeks post-partum. Among migrant women, factors predictive of breastfeeding exclusivity included non-refugee immigrant or asylum-seeking status, residence in Toronto or Vancouver, maternal age of ≥35 years, feels most comfortable in the country of origin or nowhere and higher Gender-related Development Index of the country of origin. Factors predictive of not exclusively breastfeeding included maternal age of <20 years, not planning to exclusively breastfeed, not making the decision to breastfeed before pregnancy and not exclusively breastfeeding at 1 week post-partum. Among Canadian-born women, factors predictive of a lower likelihood of breastfeeding exclusivity included not living with father of infant, infant neonatal intensive care unit admission, planned duration of exclusive breastfeeding for <6 months, not exclusively breastfeeding at 1 week post-partum and Edinburgh Postnatal Depression Scale score of ≥10. The only similar risk factor predicting a lower likelihood of breastfeeding exclusivity between migrant and Canadian-born women was not exclusively breastfeeding at 1 week post-partum; all other risk factors were dissimilar, suggesting that these groups might benefit from different strategies to optimise breastfeeding outcomes.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Stewart DE, Gagnon AJ, Merry LA, Dennis CL. Risk factors and health profiles of recent migrant women who experienced violence associated with pregnancy. J Womens Health (Larchmt) 2012; 21:1100-6. [PMID: 22900928 DOI: 10.1089/jwh.2011.3415] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Violence associated with pregnancy is a major public health concern, but little is known about it in recent migrant women. This study looked at (1) risk factors for violence associated with pregnancy among newly arrived migrant women in Canada and (2) if those who experienced violence associated with pregnancy had a different health profile or use of healthcare services for themselves or their infants during pregnancy and up to 4 months postpartum compared to other childbearing migrant women. METHODS Pregnant migrant women in Canada <5 years were recruited in 12 hospitals in 3 large cities between 2006 and 2009 and followed to 4 months postpartum. Data were collected on maternal background, migration history, violence associated with pregnancy, maternal and infant physical and mental health, and services used. RESULTS Of a total of 774 pregnant migrant women, 59 (7.6%) women reported violence associated with pregnancy. Migrant women who experienced violence, compared to those who did not, were at increased risk of violence if they lived without a partner, were asylum seekers, migrated <2 years ago, or had less than high school education. Women who reported violence were less likely to have up-to-date vaccinations, take folic acid before pregnancy, more likely to commence prenatal care after 3 months gestation and to not use contraceptives after birth. They were also more likely to have a history of miscarriage and report more postpartum pain and increased bleeding. They were also more likely to have inadequate social support and report more depression, anxiety, somatization, and posttraumatic stress disorder (PTSD) on standardized tests. No differences were found in the health status of the infants of women who experienced violence compared to those who did not. CONCLUSIONS Clinicians should sensitively ask recent migrant women (asylum seekers, refugees, and nonrefugee immigrants) about violence associated with pregnancy and appropriately assess, treat, and refer them.
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Affiliation(s)
- Donna E Stewart
- University Health Network and University of Toronto, Ontario, Canada.
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Patil CL, Maripuu T, Hadley C, Sellen DW. Identifying Gaps in Health Research among Refugees Resettled in Canada. INTERNATIONAL MIGRATION 2012. [DOI: 10.1111/j.1468-2435.2011.00722.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Merry L, Gagnon AJ, Hemlin I, Clarke H, Hickey J. Cross-border movement and women's health: how to capture the data. Int J Equity Health 2011; 10:56. [PMID: 22104395 PMCID: PMC3235058 DOI: 10.1186/1475-9276-10-56] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 11/21/2011] [Indexed: 11/28/2022] Open
Abstract
Introduction The movement of women across international borders is occurring at greater rates than ever before, yet the relationship between migration and women's health has been under-explored. One reason may be difficulty measuring migration variables including country of birth, length of time in country, immigration status, language ability, and ethnicity. A range of social, environmental, cultural, and medical characteristics associated with the pre-, during- and post-migration phases are also important to consider. The objective of this paper is to present challenges and solutions in measuring migration and related variables via survey-like questionnaires administered to international migrant women. Methods The development, validation, and translation of two questionnaires subsequently applied in studies of migrant women during pregnancy, birth and postpartum were used as case examples to highlight related measurement issues. Results Challenges: (1) Measuring socio-cultural, medical and environmental variables across the pre-during-post migration phases (since questions must be framed so that data relating to each phase of migration are captured); (2) Obtaining data for complex patterns of migration (i.e., multiple movements between multiple destinations); and (3) answering long questions across a time continuum. Solutions: (1) Using interviewer-assisted rather than self-administered questions; (2) Adding probes and explanations to 'walk' participants through their migration experiences; (3) Identifying variables (e.g., trafficking) better captured using non-questionnaire data collection methods or better not collected (e.g., ethnicity) due to extreme variations in meaning. Conclusion Carefully constructed and translated survey questionnaires are practical tools for the collection of a breadth of migrant data. These data, including detailed accounts of countries lived in, length of time in those countries, immigration status, change in status, language fluency, and health insurance eligibility offer rich descriptions of the population under study and make research findings with regards to migration more interpretable. Analyses by a range of migration indicators are facilitated through survey-like questionnaire data of this type.
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Affiliation(s)
- Lisa Merry
- School of Nursing, McGill University, 3506 University St,, Montreal, QC, H3A 2A7, Canada.
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Merry LA, Gagnon AJ, Kalim N, Bouris SS. Refugee claimant women and barriers to health and social services post-birth. Canadian Journal of Public Health 2011. [PMID: 21913584 DOI: 10.1007/bf03404050] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Access to services for international migrants living in Canada is especially important during the postpartum period when additional health services and support are key to maternal and infant health. Recent studies found refugee claimant women to have a high number of postpartum health and social concerns that were not being addressed by the Canadian health care system. The current project aimed to gain greater understanding of the barriers these vulnerable migrant women face in accessing health and social services postpartum. METHODS Qualitative text data on services that claimant women received post-birth and notes (recorded by research nurses) about their experiences in accessing and receiving services were examined. Thematic analysis was conducted to identify common themes related to access barriers. RESULTS Of particular concern were the refusal of care for infants of mothers covered under IFHP, maternal isolation and difficulty for public health nurses to reach women postpartum. Also problematic was the lack of assessment, support and referrals for psychosocial concerns. CONCLUSIONS Better screening and referral for high-risk claimant women and education of health care providers on claimants' coverage and eligibility for services may improve the addressing of health and social concerns. Expansion of claimants' health benefits to include psychotherapy without prior approval by Citizenship and Immigration Canada is also recommended. Interventions aimed at social determinants underlying health care access issues among childbearing refugee claimants should also be explored. These might include providing access to subsidized language courses, social housing and government-sponsored benefits for parents, which currently have restrictive eligibility that limits or excludes claimants' access.
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Affiliation(s)
- Lisa A Merry
- Department of Nursing, McGill University, Montreal, QC.
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Kingston D, Heaman M, Chalmers B, Kaczorowski J, O’Brien B, Lee L, Dzakpasu S, O’Campo P. Comparison of Maternity Experiences of Canadian-Born and Recent and Non-Recent Immigrant Women: Findings From the Canadian Maternity Experiences Survey. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:1105-1115. [DOI: 10.1016/s1701-2163(16)35078-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hayes I, Enohumah K, McCaul C. Care of the migrant obstetric population. Int J Obstet Anesth 2011; 20:321-9. [DOI: 10.1016/j.ijoa.2011.06.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 11/24/2022]
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Strohschein FJ, Merry L, Thomas J, Gagnon AJ. Strengthening data quality in studies of migrants not fluent in host languages: a Canadian example with reproductive health questionnaires. Res Nurs Health 2010; 33:369-79. [PMID: 20572094 DOI: 10.1002/nur.20390] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The need to collect health data from refugees and asylum seekers often requires that questionnaires be translated. Verifying the clarity, meaning, and acceptability of translated questionnaires with monolingual persons, individuals from the target population who primarily speak and understand only the test language, is one important step in the translation process. Reproductive health questionnaires were tested with persons monolingual in Hindi, Tamil, Urdu, Spanish, and French. Testing revealed problematic questions and how culture, education, and migration experience can affect perceptions of questions. Bilingual liaisons from the communities of interest facilitated recruitment of participants, but liaisons' vulnerable status and lack of familiarity with research posed challenges to the testing process. When conducting monolingual testing it is important to: carefully select liaisons (consider their gender, host-language fluency, knowledge of research processes, and comfort with the subject matter of the research); recruit monolingual persons with characteristics representative of the research population; ensure adequate researcher involvement in all aspects of the testing process to triangulate data collection from various sources.
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Affiliation(s)
- Fay J Strohschein
- School of Nursing, McGill University, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada
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Pregnancy health status of sub-Saharan refugee women who have resettled in developed countries: a review of the literature. Midwifery 2010; 26:407-14. [DOI: 10.1016/j.midw.2008.11.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 09/22/2008] [Accepted: 11/02/2008] [Indexed: 11/19/2022]
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