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Schönborn C, Castetbon K, De Spiegelaere M. Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey. Midwifery 2024; 138:104139. [PMID: 39154598 DOI: 10.1016/j.midw.2024.104139] [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: 09/29/2022] [Revised: 07/18/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Patient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics. METHODS We surveyed mothers born in Belgium, North-Africa, and Sub-Saharan Africa (n = 877) using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. Two patient experience scores were created using multiple correspondence analyses: a) information and communication with healthcare professionals and overall satisfaction with pregnancy care, and b) patient-centred aspects and satisfaction with delivery care. Through descriptive analyses and multivariable logistic regressions we estimated the associations of maternal characteristics with each score. RESULTS Overall, positive experiences were reported in terms of communication (83 %) and patient-centred care (86 %). North African immigrants with low language proficiency had higher odds of negative communication experience (especially problems understanding information) (ORa: 2.30, 95 %CI 1.17-4.50), regardless of socioeconomic position. Among women with language barriers, 88 % were never offered a professional interpreter, relying on family members for translation. Patient-centred care was not associated with maternal birth region but was rated more negatively by older mothers, those with longer residence in Belgium, and higher majority-language proficiency. CONCLUSION In Belgium, perinatal care experiences were generally positive, although communication with immigrants was suboptimal. Language barriers, single motherhood, and unstable housing increased communication issues. Our findings underline the necessity to improve information-exchange with immigrants and socioeconomically vulnerable women.
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Affiliation(s)
- Claudia Schönborn
- Research Centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Research Centre in Health Systems and Policies, School of Public Health, Université libre de Bruxelles, Brussels, Belgium.
| | - Katia Castetbon
- Research Centre in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam De Spiegelaere
- Research Centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Research Centre in Health Systems and Policies, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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Agarwal-Harding P, Ruscitti B, Shepard DS, Roa AH, Bowser DM. Disparities in healthcare-seeking behaviors and associated costs between Venezuelan migrants and Colombians residing in Colombia. Int J Equity Health 2024; 23:202. [PMID: 39375754 PMCID: PMC11460058 DOI: 10.1186/s12939-024-02289-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 09/24/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events. METHODS We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories. RESULTS Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more). CONCLUSIONS While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.
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Affiliation(s)
- Priya Agarwal-Harding
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02457, USA.
- The Heller School of Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA.
| | - Brielle Ruscitti
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02457, USA
| | - Donald S Shepard
- The Heller School of Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
| | - Arturo Harker Roa
- School of Government Alberto Lleras Camargo, Universidad de los Andes, Carrera 1° N° 19-27, Bloque AU, piso 2, Bogotá, Colombia
| | - Diana M Bowser
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02457, USA
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Weigel MM, Armijos RX. Obstetrical Complications in Venezuelan Refugee and Migrant Women: Analysis of Ecuadorian National Hospital Discharge Data, 2018-2021. J Immigr Minor Health 2024; 26:830-840. [PMID: 38700574 DOI: 10.1007/s10903-024-01600-x] [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] [Accepted: 04/17/2024] [Indexed: 09/20/2024]
Abstract
An estimated 7.7 million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018-2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group.
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Affiliation(s)
- M Margaret Weigel
- Department of Environmental & Occupational Health, Innovation Center 130E, Indiana University School of Public Health, Bloomington, IN, USA.
- Global Environmental Health Research Laboratory, School of Public Health, Bloomington, IN, USA.
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, IN, USA.
- IU Center for Global Health Equity, Indianapolis, IN, USA.
| | - Rodrigo X Armijos
- Department of Environmental & Occupational Health, Innovation Center 130E, Indiana University School of Public Health, Bloomington, IN, USA
- Global Environmental Health Research Laboratory, School of Public Health, Bloomington, IN, USA
- Center for Latin American & Caribbean Studies, Indiana University, Bloomington, IN, USA
- IU Center for Global Health Equity, Indianapolis, IN, USA
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Shirvanifar M, Ahlqvist VH, Lundberg M, Kosidou K, Herraiz-Adillo Á, Berglind D, Magnusson C, Henriksson P. Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: a Swedish population-based cohort study. Lancet Public Health 2024; 9:e776-e786. [PMID: 39366732 DOI: 10.1016/s2468-2667(24)00188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/24/2024] [Accepted: 08/05/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Whether there are differences in the contribution of overweight and obesity to adverse pregnancy outcomes between migrant and non-migrant women in high-income countries, which might increase health inequalities, remains unclear. Therefore, in this study, we aimed to estimate the contribution (including the proportion and number of attributable cases) of overweight and obesity to a wide range of adverse pregnancy outcomes in Swedish-born and migrant women. METHODS This population-based cohort study used nationwide population registries in Sweden. All outcomes and covariates were collected from the Medical Birth Register (delivery and maternal characteristics), National Patient Register (inpatient and specialised outpatient care), the Cause of Death Register (all deaths in Sweden), the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (socioeconomic data), and the Total Population Register (maternal birth country data). Women with missing records of BMI at the first antenatal visit, country of birth, or covariates, were excluded from the study. BMI was measured during the first antenatal visit. Maternal country of birth was categorised into Sweden and seven super-regions. The proportion (ie, population attributable fractions [PAFs]) and the number of adverse pregnancy outcomes attributable to overweight and obesity were calculated, adjusting for maternal age, gestational age at first antenatal visit, maternal parity, smoking status, maternal somatic conditions, child's sex, socioeconomic and demographic variables. FINDINGS We identified 2 228 416 singleton pregnancies between Jan 1, 2000, and Dec 31, 2020 of 1 245 273 women. 254 778 (11·4%) pregnancies with missing records of BMI at the first antenatal visit, country of birth, or covariates were excluded, which resulted in a final analytical cohort of 1 973 638 pregnancies carried by 1 164 783 women. The overall mean maternal age of the study population was 30·8 years (SD 5·1). As estimated by PAFs, overweight and obesity contributed to a large proportion of adverse pregnancy outcomes: gestational diabetes (52·1% [95% CI 51·0-53·2]), large-for-gestational age (36·9% [36·2-37·6]), pre-eclampsia (26·5% [25·7-27·3]), low Apgar score (14·7% [13·5-15·9]), infant mortality (12·7% [9·8-15·7]), severe maternal morbidity (henceforth referred to as a near-miss event; 8·5% [6·0-11·0]), and preterm birth (5·0% [4·4-5·7]) in the total study population. PAFs varied between maternal birth regions. INTERPRETATION Interventions to reduce overweight and obesity have the potential to mitigate the burden of adverse pregnancy outcomes and possibly reduce inequalities in reproductive health. Therefore, public health practice and policy should prioritise efforts to prevent overweight and obesity among women of childbearing age. FUNDING Swedish Research Council.
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Affiliation(s)
- Maryam Shirvanifar
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Viktor H Ahlqvist
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael Lundberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Berbres M, Hesselman S, Ternström E, Schytt E. Women's use of Swedish health care during the postpartum period in relation to maternal country of birth-A population-based study. Acta Obstet Gynecol Scand 2024; 103:2101-2111. [PMID: 39113351 PMCID: PMC11426225 DOI: 10.1111/aogs.14935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Migrant women are a heterogenous group with both higher and lower risk for pregnancy complications and adverse birth outcomes compared with women in the receiving countries. This study aimed to investigate women's use of Swedish healthcare postpartum, in terms of hospital stay >48 h, readmission to hospital, and specialized out-patient clinic visits, in relation to maternal country of birth. MATERIAL AND METHODS A population-based register study including 278 219 primiparous and 367 776 multiparous women in Sweden (2014-2019) using data from Swedish Pregnancy Register, National Patient Register and Statistics Sweden. Multivariable logistic regression analyses were used to estimate associations between maternal country of birth and outcomes, adjusting for year of birth, maternal age, education, pre-gestational hypertension and diabetes, and healthcare region, presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI) with Swedish-born women as reference. RESULTS Subgroups of migrant women had higher odds of postpartum hospital stays > 48 h, particularly women from Eritrea (primiparous aOR 2.80, CI 2.49-3.15; multiparous aOR 2.78, CI 2.59-2.98), Somalia (primiparous aOR 2.61, CI 2.34-2.92; multiparous aOR 1.87, CI 1.79-1.97), and India (primiparous aOR 2.52, CI 2.14-2.97; multiparous aOR 2.61, CI 2.33-2.93), compared to Swedish-born women. Primiparous women from Afghanistan (aOR 1.32, CI 1.08-1.6), Iraq (aOR 1.30, CI 1.16-1.46), and Iran (aOR 1.23, CI 1.04-1.45) had slightly higher odds of hospital readmission, along with multiparous women from India (aOR 1.34, CI 1.02-1.76) and Somalia (aOR 1.24, CI 1.11-1.38). Specialized out-patient clinic visits were most common in primiparous women from Somalia (aOR 1.47, CI 1.35-1.59), Iran (aOR 1.31, CI 1.22-1.42) and Afghanistan (aOR 1.31, CI 1.18-1.46), and in multiparous women from Iran (aOR 1.30, CI 1.20-1.41) and Iraq (aOR 1.15, CI 1.11-1.20), however less common in women from some other countries. CONCLUSIONS The use of Swedish health care during the postpartum period varied among women, depending on their country of birth. Women from certain countries had particularly high odds of postpartum hospital stays exceeding 48 h, compared to Swedish-born women, regardless of parity and pre-gestational medical disorders. Further studies are needed to determine whether the individual needs of migrant women are being met during the postpartum period or not.
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Affiliation(s)
- Malin Berbres
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Research and DevelopmentUppsala UniversityGävleSweden
| | - Susanne Hesselman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Clinical Research DalarnaUppsala UniversityFalunSweden
| | - Elin Ternström
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- School of Health and WelfareDalarna UniversityFalunSweden
| | - Erica Schytt
- Center for Clinical Research DalarnaUppsala UniversityFalunSweden
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
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Mæland KS, Morken NH, Schytt E, Aasheim V, Nilsen RM. Associations between non-registered ultrasound examination in pregnancy and adverse perinatal outcomes in immigrant and non-immigrant women: a Norwegian population-based study 1999-2016. Scand J Public Health 2024:14034948241274596. [PMID: 39279205 DOI: 10.1177/14034948241274596] [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: 09/18/2024]
Abstract
BACKGROUND Prenatal ultrasound examinations are important to detect placental dysfunction. Several ultrasound-detected abnormalities can be managed during pregnancy or childbirth, thus improve health outcomes. Maternal birth country is known to influence the risk of placental dysfunction, but little is known about the possible mechanisms of this relation. AIMS (a) To estimate the proportion of non-registered prenatal ultrasound examinations; (b) to examine associations between non-registered ultrasound examinations and adverse perinatal outcomes, by migrant-related factors, in women giving birth in Norway. METHODS Individually linked data from the Medical Birth Registry of Norway and Statistics Norway, 1999-2016, comprising 999,760 singleton pregnancies to immigrants (n=196,220) and non-immigrants (n=803,540). Crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard error estimations, adjusted for year of childbirth, maternal age, parity, maternal smoking, educational level and Norwegian health region at birth. RESULTS Compared with non-immigrants, immigrant women had a higher proportion of non-registered ultrasound examinations (2.3% vs. 4.3%; aOR 2.0 (95% CI 1.9, 2.0)). Compared with women with ultrasound examination, the aOR for perinatal mortality for women with non-registered ultrasound was 2.27 (95% CI 1.85, 2.79) for immigrants and 3.61 (3.21, 4.07) for non-immigrants. Non-registered ultrasound examination was also associated with placental abruption (aOR 1.32 (1.08, 1.63)) for non-immigrant women, but it was not associated with preeclampsia. Compared with non-immigrants, immigrant women have a higher proportion of non-registered data on prenatal ultrasound examinations. Both immigrants and non-immigrants with non-registered ultrasound examinations have an increased aOR of perinatal mortality. Non-immigrant women also had an increased aOR for placental abruption.
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Affiliation(s)
- Karolina S Mæland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Norway
| | - Erica Schytt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
- Centre for Clinical Research Dalarna, Uppsala University, Sweden
| | - Vigdis Aasheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | - Roy M Nilsen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Norway
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Aanstad KJ, Pripp AH, Dalbye R, Pay AD, Staff AC, Kaasen A, Blix E. Intrapartum fetal monitoring practices in Norway: A population-based study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101006. [PMID: 38986340 DOI: 10.1016/j.srhc.2024.101006] [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: 06/04/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To describe intrapartum fetal monitoring methods used in all births in Norway in 2019-2020, assess adherence to national guidelines, investigate variation by women's risk status, and explore associations influencing monitoring practices. METHODS A nationwide population-based study. We collected data about all pregnancies with a gestational age ≥ 22 weeks during 2019-2020 from the Medical Birth Registry of Norway. We used descriptive analyses, stratified for risk status, to examine fetal monitoring methods used in all deliveries. Univariable and multivariable logistic regression models were used to determine factors associated with monitoring with cardiotocography (CTG) in low-risk, straightforward births. RESULTS In total, 14 285 (14%) deliveries were monitored with only intermittent auscultation (IA), 46214 (46%) with only CTG, and 33417 (34%) with IA and CTG combined. Four percent (2 067/50 533) of women with risk factors were monitored with IA only. Half (10589/21 282) of the low-risk women with straightforward births were monitored with CTG. Maternal and fetal characteristics, size of the birth unit and regional practices influenced use of CTG monitoring in this group. CONCLUSIONS Most births are monitored with CTG only, or combined with IA. Half the women with low-risk pregnancies and straightforward births were monitored with CTG although national guidelines recommending IA.
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Affiliation(s)
- Kristin Jerve Aanstad
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Rebecka Dalbye
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department of Gynaecology and Obstetrics, Østfold Hospital Trust, Grålum, Norway
| | - Aase Devold Pay
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department og Gynecology and Obstetrics, Vestre Viken Hospital Trust, Bærum, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Kaasen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ellen Blix
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
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Purandare R, Ådahl K, Stillerman M, Schytt E, Tsekhmestruk N, Lindgren H. Migrant women's experiences of community-based doula support during labor and childbirth in Sweden. A mixed methods study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101000. [PMID: 38959680 DOI: 10.1016/j.srhc.2024.101000] [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: 02/05/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To describe migrant women's experiences of bilingual community-based doulas (CBD) contribution to care in relation to labor and birth. METHODS Mixed methods study combining quantitative data from 82 women who received CBD-support within a randomized controlled trial and qualitative data from semi-structured interviews with a sub-sample of 12 women from the same study arm. Descriptive analyses were used for quantitative data and content analysis for the manifest and latent content of the qualitative data. Quantitative findings were categorized according to qualitative findings. RESULTS The women expressed how CBDs played an essential role in the response to their basic emotional, informational, and physical support needs, when no other female family member was available. Three main categories emerged from the analysis of interviews: The doulas help women feel safe and calm - providing support before, during and after childbirth; The doulas' support role fills the void left by a deeply missed family, mother or sister; and The doulas assist women in achieving autonomy through communication support and advocacy. More than half of women reported feeling involved during labor and birth (56.8%), most valued CBD positively (such as being competent, calm, secure, considerate, respectful, encouraging, supportive) (40.8%-80.3%), that CBD had interpreted (75.6%), facilitated communication with the midwife (60,3%), comforted the woman (57.7%) and reduced anxiety (48,7%). Few reported negative CBD-characteristics (1.3-9.2%). Nevertheless, 61.7% of women felt frightened sometime during labor and birth, which made it even more important to them that the doula was there. Few women (21.8%) reported that the CBD had supported her partner but expressed so in the interviews. CONCLUSION Through an essential contribution in responding to migrant women's basic emotional, informational, and physical needs, bilingual community-based doulas have the potential to improve migrant women's experience of care during labour and birth. However, more focus on the quality of CBD-support to partners seem necessary.
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Affiliation(s)
- Radhika Purandare
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Kajsa Ådahl
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Maria Stillerman
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Erica Schytt
- Centre for Clinical Research Dalarna - Uppsala University, Falun, Sweden; Western Norway University of Applied Sciences Norway, Faculty of Health and Social Sciences, Bergen, Norway.
| | | | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Sweden; Department for Health Promotion, Sophiahemmet University, Sweden
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Markey K, Moloney M, O'Donnell CA, Noonan M, O'Donnell C, Tuohy T, MacFarlane A, Huschke S, Mohamed AH, Doody O. Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review. Healthcare (Basel) 2024; 12:1742. [PMID: 39273766 PMCID: PMC11395031 DOI: 10.3390/healthcare12171742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/27/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.
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Affiliation(s)
- Kathleen Markey
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Mairead Moloney
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Catherine A O'Donnell
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, 90 Byres Road, Glasgow G12 8TB, UK
| | - Maria Noonan
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Claire O'Donnell
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Teresa Tuohy
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Anne MacFarlane
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Susann Huschke
- School of Medicine, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | | | - Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
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10
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Pérez-Sánchez M, Immordino P, Romano G, Giordano A, García-Gil C, Morales F. Access of migrant women to sexual and reproductive health services: A systematic review. Midwifery 2024; 139:104167. [PMID: 39243595 DOI: 10.1016/j.midw.2024.104167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/14/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The number of people living in a different place from their place of birth is increasing year by year. Although women have always been involved in migratory movements, today they are increasingly doing so independently. Women are migrating from the Global South to higher-income countries. One of the challenges they face is access to sexual and reproductive health (SRH) services. AIM To identify the policy-level barriers that limit the access of migrant women to SRH services, their consequences, and strategies implemented to overcome these barriers. METHODS A systematic review of the literature was undertaken in accordance with the PRISMA statement. A search was undertaken for articles published between 2018 and 2023 focusing on migrant women's experiences of SRH services. In total, 462 articles were retrieved from PubMed (n = 135), Scopus (n = 94) and Web of Science (n = 233); of these, 28 articles were included in this review. FINDINGS The most common barrier to SRH services identified in the reviewed articles was lack of information (57 %), followed by language issues (43 %), cultural differences (39 %), economic status (25 %), administrative barriers (25 %) and discrimination (14 %). These barriers led to under-utilisation of maternity services and contraceptive methods. Strategies used by migrant women to overcome these barriers were primarily based on seeking help within their own community or family settings. CONCLUSION Strategies at institutional level to improve the access of migrant women to SRH services need to reduce existing barriers, promote health literacy, and train health workers to be culturally sensitive and responsive to the needs of migrant women.
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Affiliation(s)
- María Pérez-Sánchez
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Palmira Immordino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Gaetano Romano
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA; Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
| | - Antonio Giordano
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA; Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
| | - Carmen García-Gil
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Fátima Morales
- Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain; Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA.
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11
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Tankink J, Bertens L, de Graaf J, van den Muijsenbergh M, Struijs J, Goodarzi B, Franx A. Pregnancy outcomes of forced migrants in the Netherlands: A national registry-based study. J Migr Health 2024; 10:100261. [PMID: 39309072 PMCID: PMC11416604 DOI: 10.1016/j.jmh.2024.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/12/2024] [Accepted: 07/27/2024] [Indexed: 09/25/2024] Open
Abstract
Background The rise of global forced migration urges healthcare systems to respond to the needs of forced migrants (FM) during pregnancy and childbirth. Yet, comprehensive data on the health outcomes of pregnant FM in destination countries remain scarce. This study aimed to describe the characteristics and maternal and perinatal outcomes of pregnancy in this specific migrant population on a national scale in the Netherlands and to explore differences from other populations. Methods The Dutch perinatal registry was linked to national migration data to analyze pregnancy outcomes in FM (2014-2019), using non-migrants (NM) and resident migrants (RM) as reference populations. We reported outcome rates (% [95 % CI]) for a range of primary and secondary pregnancy outcomes. Primary outcomes included perinatal mortality, small for gestational age infants (SGA), preterm birth, and emergency cesarean section (CS), for which we also calculated the crude relative risk (RR [95 % CI]) of FM compared to NM and RM. In addition, we conducted binary logistic regression analyses on primary outcomes to report adjusted odds ratios (aORs [95 % CIs]) while controlling for multiple births, maternal age and parity. Findings Compared to the NM group, the FM group had increased risks of perinatal mortality (RR 1.50 [95 % CI 1.20-1.88]), SGA (1.65 [1.59-1.71], and emergency CS (1.19 [1.13-1.25]). Compared to RM, FM still had elevated risks of SGA (1.17 [1.13-1.22]). In contrast, the risk of preterm birth was lower in FM than in NM (0.81 [0.76-0.86]) and RM (0.83 [0.77-0.88]). These differences were confirmed in the adjusted analysis. Differences in secondary outcomes included higher rates of late antenatal care in FM (29.4 % [28.5-30.3]) than in NM (6.7 % [6.6-6.9]) and RM (15.5 % [15.1-15.9]). Rates of planned CS were similarly elevated (14.3 % [95 % CI 13.7-14.8] versus 7.·8 % [7.7-7.8] and 9.6 % [9.5-9.7]), while FM had lower rates of postpartum hemorrhage (3.9 % [3.6-4.2]) versus 6.8 % [6.8-6.9] and 5.7 % [5.6-5.9]). Conclusion This first Dutch registry-based study demonstrated increased risks of multiple, though not all, adverse pregnancy outcomes in forced migrants. Our results emphasize the imperative to further unravel and address migration-related disparities, dismantle structural barriers to health among forced migrants, and improve the inclusivity of data systems. Collaborative policy, clinical practice, and research efforts are essential to ensure equitable care for every individual, regardless of migration status.
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Affiliation(s)
- J.B. Tankink
- Department of Obstetrics and Gynaecology, Erasmus Medical University Centre, Rotterdam, the Netherlands
| | - L.C.M. Bertens
- Department of Obstetrics and Gynaecology, Erasmus Medical University Centre, Rotterdam, the Netherlands
| | - J.P. de Graaf
- Department of Obstetrics and Gynaecology, Erasmus Medical University Centre, Rotterdam, the Netherlands
| | - M.E.T.C. van den Muijsenbergh
- Radboudumc University Medical Center, Nijmegen, the Netherlands
- Pharos, Centre of Expertise on Health Disparities, Utrecht, the Netherlands
| | - J.N. Struijs
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Leiden University, Department of Public Health and Primary Care, Health Campus The Hague, The Hague, the Netherlands
| | - B. Goodarzi
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - A. Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical University Centre, Rotterdam, the Netherlands
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12
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McGranahan M, Augarde E, Schoenaker D, Duncan H, Mann S, Bick D, Boardman F, Oyebode O. Preconception health among migrant women in England: A cross-sectional analysis of maternity services data 2018-2019. J Migr Health 2024; 10:100250. [PMID: 39156886 PMCID: PMC11327935 DOI: 10.1016/j.jmh.2024.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/17/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024] Open
Abstract
Background Perinatal outcomes are poor among migrant women in vulnerable situations, but little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrant women. Methods This national cross-sectional study used data from the NHS Maternity Services Data Set (MSDS) version 1.5, incorporating NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Migration category data were available for 66.2 % (n = 432,022). Odds ratios were calculated comparing preconception indicators among probable migrants in vulnerable situations (English not their first language with complex social factors (CSF)), probable migrants not in vulnerable situations (English not their first language without CSF), probable non-migrants in vulnerable situations (English their first language with CSF) and probable non-migrants not in vulnerable situations (English their first language without CSF). CSF include recent migrants, asylum seekers, refugees, difficulty reading/speaking English; alcohol and/or drugs misuse; aged under 20; and/or experiencing domestic abuse. Findings We identified 3.8 % (25,070 women) of the study population as probable migrants in vulnerable situations, 10.2 % (66,783 women) as probable migrants not in vulnerable situations, 5.6 % (36,433 women) as probable non-migrants in vulnerable situations, 46.5 % (303,737 women) as probable non-migrants not in vulnerable situations, and 33.8 % as having missing migration category data. Probable migrants in vulnerable situations (n = 25,070) had over twice the odds of not taking folic acid preconception compared to probable non-migrants not in vulnerable situations (odds ratio 2.15, 95 % confidence interval 2.06-2.25). They had increased odds of previous obstetric complications and being underweight, but lower odds of physical and mental health conditions (apart from diabetes and hepatitis b), smoking and overweight or obesity. Interpretation Inequalities exist across many preconception indicators, highlighting opportunities to improve preconception health in this population to reduce health inequalities and improve perinatal and neonatal outcomes. Funding Medical Research Council.
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Affiliation(s)
- Majel McGranahan
- University of Warwick Medical School, Medical School Building, Coventry CV4 7HL, UK
| | - Elizabeth Augarde
- Office for Health Improvement and Disparities (OHID), 39 Victoria Street, Westminster, London SW1H 0EU, UK
| | - Danielle Schoenaker
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Tremona Road SO16 6YD, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, SO16 6YD, Southampton, UK
| | - Helen Duncan
- Office for Health Improvement and Disparities (OHID), 39 Victoria Street, Westminster, London SW1H 0EU, UK
| | - Sue Mann
- NHS England and Improvement, Wellington House, London SE1 8UG, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Felicity Boardman
- University of Warwick Medical School, Medical School Building, Coventry CV4 7HL, UK
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, EC1M 6BQ, UK
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Andrén A, Lindgren H, Akselsson A, Rådestad I, Erlandsson K. One size does not fit all: Perspectives from Swedish midwives on fetal movement counselling. Women Birth 2024; 37:101621. [PMID: 38688145 DOI: 10.1016/j.wombi.2024.101621] [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: 11/24/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PROBLEM Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden. BACKGROUND Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities. AIM To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings. METHODS Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis. FINDINGS The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures. DISCUSSION Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy. CONCLUSION To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.
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Affiliation(s)
- Anna Andrén
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden.
| | - Helena Lindgren
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden; Department of Women's and Children's Health, Karolinska Institute, Tomtebodavägen 18A, Solna SE-171 77, Sweden
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden
| | - Ingela Rådestad
- Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, Stockholm SE-114 28, Sweden
| | - Kerstin Erlandsson
- School of Health and Welfare, Dalarna University, Högskolegatan 2, Falun SE-791 88, Sweden
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14
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Verschuuren AEH, Tankink JB, Postma IR, Bergman KA, Goodarzi B, Feijen-de Jong EI, Erwich JJHM. Suboptimal factors in maternal and newborn care for refugees: Lessons learned from perinatal audits in the Netherlands. PLoS One 2024; 19:e0305764. [PMID: 38935661 PMCID: PMC11210813 DOI: 10.1371/journal.pone.0305764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Refugees and their healthcare providers face numerous challenges in receiving and providing maternal and newborn care. Research exploring how these challenges are related to adverse perinatal and maternal outcomes is scarce. Therefore, this study aims to identify suboptimal factors in maternal and newborn care for asylum-seeking and refugee women and assess to what extent these factors may contribute to adverse pregnancy outcomes in the Netherlands. METHODS We conducted a retrospective analysis of national perinatal audit data from 2017 to 2019. Our analysis encompassed cases with adverse perinatal and maternal outcomes in women with a refugee background (n = 53). Suboptimal factors in care were identified and categorized according to Binder et al.'s Three Delays Model, and the extent to which they contributed to the adverse outcome was evaluated. RESULTS We identified 29 suboptimal factors, of which seven were related to care-seeking, six to the accessibility of services, and 16 to the quality of care. All 53 cases contained suboptimal factors, and in 67.9% of cases, at least one of these factors most likely or probably contributed to the adverse perinatal or maternal outcome. CONCLUSION The number of suboptimal factors identified in this study and the extent to which they contributed to adverse perinatal and maternal outcomes among refugee women is alarming. The wide range of suboptimal factors identified provides considerable scope for improvement of maternal and newborn care for refugee populations. These findings also highlight the importance of including refugee women in perinatal audits as it is essential for healthcare providers to better understand the factors associated with adverse outcomes to improve the quality of care. Adjustments to improve care for refugees could include culturally sensitive education for healthcare providers, increased workforce diversity, minimizing the relocation of asylum seekers, and permanent reimbursement of professional interpreter costs.
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Affiliation(s)
- A. E. H. Verschuuren
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
| | - J. B. Tankink
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands
| | - I. R. Postma
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | - K. A. Bergman
- Department of Paediatrics Beatrix Children’s Hospital, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
| | - B. Goodarzi
- Department of Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Primary Care and Longterm Care, University Medical Center Groningen & University of Groningen, Groningen, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
| | - E. I. Feijen-de Jong
- Department of Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Department of Primary Care and Longterm Care, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Groningen, the Netherlands
| | - J. J. H. M. Erwich
- Department of Obstetrics and Gynecology, University Medical Centre Groningen & University of Groningen, Groningen, the Netherlands
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15
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Hüning BM, Jaekel J, Jaekel N, Göpel W, Herting E, Felderhoff-Müser U, Spiegler J, Härtel C. Perinatal Outcomes of Immigrant Mothers and Their Infants Born Very Preterm across Germany. Healthcare (Basel) 2024; 12:1211. [PMID: 38921324 PMCID: PMC11204027 DOI: 10.3390/healthcare12121211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND In Germany, more than 40% of infants are born to immigrant parents. Increased survival rates of very preterm (below 32 weeks gestation at birth; VP) infants have not resulted in equally improved life chances and quality of life. More information on perinatal variations in outcomes according to social inequalities, migration background, and language barriers is needed. We tested whether mothers' immigrant status and language barriers are associated with perinatal health and short-term neonatal outcomes. METHODS The data are from the national multi-centre German Neonatal Network (GNN) cohort, including VP births from 2009 onwards. In total, 3606 (n = 1738 female) children were assessed, and 919 (n = 449 female) of these children had immigrant backgrounds. Immigrant status was operationalised as a binary variable based on the children's mothers' countries of birth (born in Germany vs. foreign-born). Self-reported home language (L1) was used to calculate the average linguistic distance to German as one continuous variable. RESULTS Mixed-effects models showed that two out of fourteen effects of interest survived the adjustment for known confounders and accounting for the nestedness of data within birth hospitals. Linguistic distance from mothers' L1s to German was independently associated with diagnoses of preeclampsia (OR = 1.01, 95% CI = [1.00, 1.01]). Infants of foreign-born mothers had higher odds for amniotic infection syndrome (AIS; OR = 1.45 [1.13, 1.86]) than infants of German mothers. CONCLUSIONS Our findings from this large multi-centre longitudinal cohort of VP-born children indicate that maternal immigrant status and language barriers have limited impact on perinatal health and severe neonatal outcomes. This suggests that, regardless of background or language skills, there may be few inequalities in the perinatal health of pregnant women and their newborn preterm infants.
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Affiliation(s)
- Britta M. Hüning
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care, Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.M.H.); (U.F.-M.)
- Center of Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Julia Jaekel
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care, Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.M.H.); (U.F.-M.)
- Faculty of Education and Psychology, University of Oulu, 90570 Oulu, Finland;
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK;
- Public Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Department of Psychology, University of Copenhagen, DK-1165 Copenhagen, Denmark
| | - Nils Jaekel
- Faculty of Education and Psychology, University of Oulu, 90570 Oulu, Finland;
- Public Health Unit, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Department of English, German and Romance Studies, Faculty of Humanities, University of Copenhagen, DK-2300 Copenhagen, Denmark
| | - Wolfgang Göpel
- Department of Pediatrics, University Hospital Lübeck, 23538 Lübeck, Germany; (W.G.); (E.H.)
| | - Egbert Herting
- Department of Pediatrics, University Hospital Lübeck, 23538 Lübeck, Germany; (W.G.); (E.H.)
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I, Neonatology, Paediatric Intensive Care, Paediatric Neurology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.M.H.); (U.F.-M.)
- Center of Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Juliane Spiegler
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK;
- Department of Pediatrics, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Christoph Härtel
- Department of Pediatrics, University Hospital Würzburg, 97080 Würzburg, Germany;
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Stevens AJ, Boukari Y, English S, Kadir A, Kumar BN, Devakumar D. Discriminatory, racist and xenophobic policies and practice against child refugees, asylum seekers and undocumented migrants in European health systems. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100834. [PMID: 39119094 PMCID: PMC11306214 DOI: 10.1016/j.lanepe.2023.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 08/10/2024]
Abstract
Child refugees, asylum seekers and undocumented migrants who have been forcibly displaced from their countries of origin have heightened health needs as a consequence of their migration experiences. Host countries have a duty to respond to these needs, yet across Europe we are seeing a rise in potentially harmful discriminative, hostile and restrictive migration policies and practices. Research exploring the role racism, xenophobia and discrimination in European health systems may play in child migrant health inequities is lacking. This Personal View seeks to highlight this knowledge gap and stimulate discourse on how discrimination in health information systems, data sharing practices, national health policy, healthcare entitlements, service access, quality of care, and healthcare workers attitudes and behaviours may infringe upon the rights of, and impact the health of child refugees, asylum-seekers and undocumented migrants. It calls for action to prevent and mitigate against potentially harmful policies and practices.
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Affiliation(s)
| | - Yamina Boukari
- Institute of Health Informatics, University College London, UK
| | - Sonora English
- Institute for Global Health, University College London, London, UK
| | - Ayesha Kadir
- Save the Children International, St Vincent House, London, UK
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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17
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Erhardt RM, Jafflin K, Zepro N, Abongomera C, Chernet A, Paris DH, Merten S. Obstetric Outcomes of Eritrean Immigrants in Switzerland: A Comparative Study. Int J Public Health 2024; 69:1606745. [PMID: 38778832 PMCID: PMC11110796 DOI: 10.3389/ijph.2024.1606745] [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: 10/20/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives: This study aims to compare obstetric outcomes between Eritrean and Swiss women in Switzerland, focusing on instrumental or surgical interventions and analgesia use. Methods: The study included data from 45,412 Swiss and 1,132 Eritrean women who gave birth in Swiss hospitals (2019-2022). Mixed-effects logistic regression was used to assess the effect of nationality on mode of delivery and analgesia use and multinomial mixed-effects logistic regression to assess the effect of nationality on mode of delivery in women intended for spontaneous vaginal delivery. Results: Compared with Swiss, Eritrean women had a lower rate of primary C-section (Adj. OR 0.73, 95% CI [0.60, 0.89]) but a higher risk of initially planned vaginal deliveries ending in emergency C-section (RRR 1.31, 95% CI [1.05, 1.63]). Eritrean women were less likely to receive epidural analgesia (Adj. OR 0.53, 95% CI [0.45, 0.62]) and more likely to not receive any analgesia (Adj. OR 1.73, 95% CI [1.52, 1.96]). Conclusion: This study reveals disparities in obstetric care, notably in higher emergency C-section rates and lower analgesia use among Eritrean women. For promoting equitable healthcare practices deeper understanding of obstetrics decision-making is needed.
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Affiliation(s)
- Rahel M. Erhardt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nejimu Zepro
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Charles Abongomera
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Afona Chernet
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel Henry Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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18
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Yeshitila YG, Gold L, Riggs E, Abimanyi-Ochom J, Sweet L, Le HND. Trends and disparities in perinatal health outcomes among women from refugee backgrounds in Victoria, Australia: A population-based study. Midwifery 2024; 132:103980. [PMID: 38547597 DOI: 10.1016/j.midw.2024.103980] [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: 11/05/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Women from refugee backgrounds generally experience poorer pregnancy-related outcomes compared to host populations. AIM To examine the trend and disparities in adverse perinatal outcomes among women of refugee background using population-based data from 2003 to 2017. METHODS A population-based cross-sectional study of 754,270 singleton births in Victoria compared mothers of refugee backgrounds with Australian-born mothers. Inferential statistics, including Pearson chi-square and binary logistic regression, were conducted. Multiple logistic regression was conducted to explore the relationship between adverse perinatal outcomes and the women's refugee status. FINDINGS Women of refugee background had higher odds of adverse neonatal and maternal outcomes, including stillbirth, neonatal death, low APGAR score, small for gestational age, postpartum haemorrhage, abnormal labour, perineal tear, and maternal admission to intensive care compared to Australian-born women. However, they had lower odds of neonatal admission to intensive care, pre-eclampsia, and maternal postnatal depression. The trend analysis showed limited signs of gaps closing over time in adverse perinatal outcomes. DISCUSSION AND CONCLUSION Refugee background was associated with unfavourable perinatal outcomes, highlighting the negative influence of refugee status on perinatal health. This evidences the need to address the unique healthcare requirements of this vulnerable population to enhance the well-being of mothers and newborns. Implementing targeted interventions and policies is crucial to meet the healthcare requirements of women of refugee backgrounds. Collaborative efforts between healthcare organisations, government agencies and non-governmental organisations are essential in establishing comprehensive support systems to assist refugee women throughout their perinatal journey.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia; School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia; Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Lisa Gold
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of General Practice, The University of Melbourne, Victoria, Melbourne, Australia
| | - Julie Abimanyi-Ochom
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Institute for Health Transformation, Victoria, Australia
| | - Ha N D Le
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
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Creswell L, Leahy C, McNamee E, Lindow SW, O'Connell MP. Homelessness in pregnancy. Eur J Obstet Gynecol Reprod Biol 2024; 296:239-243. [PMID: 38484615 DOI: 10.1016/j.ejogrb.2024.03.007] [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: 11/08/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital. METHODS A retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements. RESULTS Women in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001). They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01-2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001). CONCLUSION Women in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements.
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Affiliation(s)
| | - C Leahy
- The Coombe Hospital, Dublin, Ireland
| | - E McNamee
- The Coombe Hospital, Dublin, Ireland
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20
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Jolof L, Rocca P, Carlsson T. Women's experiences of trauma-informed care for forced migrants: A qualitative interview study. Heliyon 2024; 10:e28866. [PMID: 38596047 PMCID: PMC11002685 DOI: 10.1016/j.heliyon.2024.e28866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/11/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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21
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Hearn F, Brown SJ, Szwarc J, Toke S, Alqas Alias M, Essa M, Hydari S, Baget A, Riggs E. Perceptions and Experiences of Inequity for Women of Refugee Background Having a Baby during the COVID-19 Pandemic in Melbourne, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:481. [PMID: 38673392 PMCID: PMC11049987 DOI: 10.3390/ijerph21040481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Listening to What Matters is an exploratory descriptive qualitative study that aimed to (1) understand how women of refugee background in Melbourne, Australia experienced access to health information and maternity and/or early parenting care during the COVID-19 pandemic and (2) whether pandemic health directives had an impact on structural inequities for women of refugee background who received maternity and/or early parenting care during the COVID-19 pandemic. Semi-structured interviews were conducted with 41 participants including 17 women of refugee background, who identified as belonging to the Karen, Assyrian Chaldean, Iraqi, Syrian, Afghan, Sudanese, or South Sudanese communities and 24 health and social care professionals who identified as providing pregnancy or early parenting care during the pandemic in the north western suburbs of Melbourne. Interviews with women were conducted in preferred languages by community researchers. Interviews with professionals were conducted in English by researchers. Reflexive thematic data analysis included constructivist positionality and a trauma and violence informed approach. The results reported in this paper include three themes, with four accompanying subthemes, as follows: theme (1), 'Structural inequities and the toll of the pandemic'; theme (2), 'Supportive infrastructure'; and theme (3), 'Cultural safety during the pandemic'. The results demonstrate that cumulative negative impacts such as unequal access to health information, family separation and isolation, inadequate household income, and mental and social health concerns had the potential to amplify pre-existing structural inequities for women of refugee background. Community engagement facilitated by bicultural workers, interpreters, and trusted care providers facilitated fast-paced, two-way communication that built capacity and health literacy for women who were unable to speak English and unfamiliar with the health care system and, improved experiences of care. More research is needed to understand how the intersectional cumulative impacts of structural inequities have affected maternal and neonatal health outcomes for women of refugee background during the pandemic, as well as any differences in maternal and neonatal health outcomes between Australian-born and refugee background women and babies.
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Affiliation(s)
- Fran Hearn
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Stephanie J. Brown
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of General Practice, University of Melbourne, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
- South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia
| | - Josef Szwarc
- The Victorian Foundation for Survivors of Torture Inc., Brunswick, VIC 3056, Australia
| | - Shadow Toke
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of General Practice, University of Melbourne, Parkville, VIC 3052, Australia
| | - May Alqas Alias
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Maryaan Essa
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Shogoufa Hydari
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Ashay Baget
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of General Practice, University of Melbourne, Parkville, VIC 3052, Australia
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22
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Yang S, Shapiro GD, Ng E, Vissandjée B, Vang ZM. Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study. CMAJ 2024; 196:E394-E409. [PMID: 38565234 PMCID: PMC10984700 DOI: 10.1503/cmaj.230878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. METHODS We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993-2017) and infant deaths (1993-2018), linked to parental immigration data (1960-2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. RESULTS Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01-1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10-1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90-0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00-1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. INTERPRETATION Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities.
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Affiliation(s)
- Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis.
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
| | - Edward Ng
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
| | - Bilkis Vissandjée
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
| | - Zoua M Vang
- Department of Epidemiology, Biostatistics and Occupational Health (Yang, Shapiro), McGill University, Montréal, Que.; Health Analysis Division (Ng), Statistics Canada, Ottawa, Ont.; School of Nursing (Vissandjée), Université de Montréal; School of Human Ecology (Vang), University of Wisconsin-Madison, Madison, Wis
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23
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Im H, George N, Swan LET. Gendered Health Outcome Among Somali Refugee Youth in Displacement: A Role of Social Support and Religious Belief. J Immigr Minor Health 2024; 26:341-350. [PMID: 37733168 DOI: 10.1007/s10903-023-01546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
This study examines the factors influencing physical health status, specifically focusing on the gender differences in risk and promotive factors affecting health outcomes among Somali refugee youth displaced in Nairobi, Kenya (n = 227). A survey was used to assess participants' physical health along with psychosocial factors, somatic symptoms, and demographic characteristics. The study shows that religious belief and somatic symptoms among the total sample were significant predictors in influencing the outcome of physical health. A moderated mediation analysis and logistic regression analyses also revealed gender differences in associated factors as well as health status; female participants reported higher somatic symptoms, associated with a decline in physical health, whereas the protective effect of social support and religious belief promote was found only among male counterparts. Future studies and interventions would be benefited from a gender-specific approach to health promotion and coping mechanisms in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA.
| | - Nicole George
- Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, USA
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, USA
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24
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Lee SA, Corbett GA, McAuliffe FM. Obstetric care for environmental migrants. Ir J Med Sci 2024; 193:797-812. [PMID: 37715828 PMCID: PMC10961262 DOI: 10.1007/s11845-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/26/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Migration due to environmental factors is an international crisis affecting many nations globally. Pregnant people are a vulnerable subgroup of migrants. AIM This article explores the potential effects of environmental migration on pregnancy and aims to draw attention to this rising concern. METHODS Based on the study aim, a semi-structured literature review was performed. The following databases were searched: MEDLine (PubMed) and Google Scholar. The search was originally conducted on 31st January 2021 and repeated on 22nd September 2022. RESULTS Pregnant migrants are at increased risk of mental health disorders, congenital anomalies, preterm birth, and maternal mortality. Pregnancies exposed to natural disasters are at risk of low birth weight, preterm birth, hypertensive disorders, gestational diabetes, and mental health morbidity. Along with the health risks, there are additional complex social factors affecting healthcare engagement in this population. CONCLUSION Maternity healthcare providers are likely to provide care for environmental migrants over the coming years. Environmental disasters and migration as individual factors have complex effects on perinatal health, and environmental migrants may be at risk of specific perinatal complications. Obstetricians and maternity healthcare workers should be aware of these challenges and appreciate the individualised and specialised care that these patients require.
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Affiliation(s)
- Sadhbh A Lee
- National Maternity Hospital, Holles St., Dublin 2, Ireland
| | | | - Fionnuala M McAuliffe
- National Maternity Hospital, Holles St., Dublin 2, Ireland.
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
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Pařízková A, Clausen JA, Balaam MC, Haith-Cooper M, Roosalu T, Migliorini L, Kasper A. Inclusiveness of Access Policies to Maternity Care for Migrant Women Across Europe: A Policy Review. Matern Child Health J 2024; 28:470-480. [PMID: 37843787 PMCID: PMC10914866 DOI: 10.1007/s10995-023-03785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Despite the interconnectedness of the European Union, there are significant variations in pregnant women's legal status as migrants and therefore their ability to access maternity care. Limited access to maternity care can lead to higher morbidity and mortality rates in migrant women and their babies. This study aimed to investigate and compare maternal health access policies and the context in which they operate across European countries for women who have migrated and are not considered citizens of the host country. METHODS The study adopted a mixed-methods research design exploring policies on migrant women's access to maternity care across the migration regimes. Data were extracted from legal documents and research reports to construct a new typology to identify the inclusiveness of policies determining access to maternity care for migrant women. RESULTS This study found inconsistency in the categorisation of migrants across countries and significant disparities in access to maternity care for migrant women within and between European countries. A lack of connection between access policies and migration regimes, along with a lack of fit between policies and public support for migration suggests a low level of path dependency and leaves space for policy innovation. DISCUSSION Inequities and inconsistencies in policies across European countries affect non-citizen migrant women's access to maternity care. These policies act to reproduce structural inequalities which compromise the health of vulnerable women and newborns in reception countries. There is an urgent need to address this inequity, which discriminates against these already marginalised women.
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Affiliation(s)
- Alena Pařízková
- Department of Sociology and social work, Faculty of Arts, University of West Bohemia, Univerzitní 8, Plzeň, 30100, Czech Republic.
| | | | - Marie-Clare Balaam
- Research in Childbirth and Health Unit (REACH), School of Nursing and Midwifery., University of Central Lancashire, Preston, PR1 2HE 01772 893885, UK
| | - Melanie Haith-Cooper
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, West Yorkshire, UK
| | - Triin Roosalu
- School of Governance, Law and Society, Institute of International and Social Studies, Tallinn University, Uus-Sadama 5, Tallinn, 10120, Estonia
| | - Laura Migliorini
- Department of Education Sciences, University of Genoa, C.so Podestà 2, Genoa, 16156, Italy
| | - Anne Kasper
- Health Campus Göttingen - Faculty of Engineering and Health, HAWK University in Hildesheim, Holzminden and Göttingen, 31134, Hohnsen 4, Hildesheim, Germany
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Sacks E, Brizuela V, Javadi D, Kim Y, Elmi N, Finlayson K, Crossland N, Langlois EV, Ziegler D, Parmar SM, Bonet M. Immigrant women's and families' views and experiences of routine postnatal care: findings from a qualitative evidence synthesis. BMJ Glob Health 2024; 8:e014075. [PMID: 38351019 PMCID: PMC10897958 DOI: 10.1136/bmjgh-2023-014075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Uptake of postnatal care (PNC) is low and inequitable in many countries, and immigrant women may experience additional challenges to access and effective use. As part of a larger study examining the views of women, partners, and families on routine PNC, we analysed a subset of data on the specific experiences of immigrant women and families. METHODS This is a subanalysis of a larger qualitative evidence synthesis. We searched MEDLINE, PUBMED, CINAHL, EMBASE, EBM-Reviews and grey literature for studies published until December 2019 with extractable qualitative data with no language restrictions. For this analysis, we focused on papers related to immigrant women and families. Two reviewers screened each study independently; inclusion was agreed by consensus. Data abstraction and quality assessment were carried out using a study-specific extraction form and established quality assessment tools. Study findings were identified using thematic analysis. Findings are presented by confidence in the finding, applying the GRADE-CERQual approach. FINDINGS We included 44 papers, out of 602 full-texts, representing 11 countries where women and families sought PNC after immigrating. All but one included immigrants to high-income countries. Four themes were identified: resources and access, differences from home country, support needs, and experiences of care. High confidence study findings included: language and communication challenges; uncertainty about navigating system supports including transportation; high mental health, emotional, and informational needs; the impact of personal resources and social support; and the quality of interaction with healthcare providers. These findings highlight the importance of care experiences beyond clinical care. More research is also needed on the experiences of families migrating between low-income countries. CONCLUSIONS Immigrant families experience many challenges in getting routine PNC, especially related to language, culture, and communication. Some challenges may be mitigated by improving comprehensive and accessible information on available services, as well as holistic social support. TRIAL REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Dena Javadi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoona Kim
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Nika Elmi
- School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Finlayson
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn, and Child Health, World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | | | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Claudia Lopes A, Lousada M. Breastfeeding knowledge, attitudes, beliefs and practices of refugee, migrant and asylum seeker women in Portugal. BMC Public Health 2024; 24:394. [PMID: 38321425 PMCID: PMC10848452 DOI: 10.1186/s12889-024-17849-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The World Health Organization recommends exclusive breastfeeding for the first six months after childbirth. However, breastfeeding is influenced by organizational, social, geopolitical, and cultural factors, which are understudied in the migrant population. This study aimed to assess the knowledge, attitudes, beliefs, and practices of refugee, migrant, and asylum-seeking mothers living in Lisbon. METHODS A sociodemographic questionnaire and a Breastfeeding Knowledge, Attitudes, and Beliefs, and Practices questionnaire were used to gather information regarding baseline breastfeeding knowledge, attitudes and beliefs, and practices towards breastfeeding. RESULTS Only 40% of the mothers received antenatal counselling regarding the benefits and management of breastfeeding. Of the 20 responses, 10 (50%) mothers were found to have fair breastfeeding knowledge, 14 (70%) had fair attitudes and beliefs, and 12 (60%) had fair breastfeeding practices. Correlation analysis indicated a positive correlation between mothers' breastfeeding attitudes (r = 0.531, p < 0.05) and their breastfeeding knowledge. There was no statistically significant correlation between the mothers' breastfeeding attitudes, beliefs, and practices. CONCLUSIONS The findings of this study suggest that healthy breastfeeding behaviours can be stimulated by receiving proper counselling from health professionals. Countries must focus on improving breastfeeding practices, as they still fail to do all they can to promote, protect, and support breastfeeding globally. Universal interventions are necessary to improve breastfeeding, regardless of migrant or refugee status.
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Affiliation(s)
- Ana Claudia Lopes
- Center for Health Technology and Services Research (CINTESIS.UA@RISE), University of Aveiro, Aveiro, Portugal
| | - Marisa Lousada
- Center for Health Technology and Services Research (CINTESIS.UA@RISE), University of Aveiro, Aveiro, Portugal
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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Zaidi M, Fantasia HC, Penders R, Koren A, Enah C. Increasing U.S. Maternal Health Equity Among Immigrant Populations Through Community Engagement. Nurs Womens Health 2024; 28:11-22. [PMID: 38072010 DOI: 10.1016/j.nwh.2023.09.004] [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: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024]
Abstract
Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.
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Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, Jayaratne K, Osoti A, Vogel JP, Campbell O, Mugerwa KY, Lumbiganon P, Tunçalp Ö, Cresswell J, Say L, Moran AC, Oladapo OT. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Health 2024; 12:e306-e316. [PMID: 38070536 DOI: 10.1016/s2214-109x(23)00468-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 01/22/2024]
Abstract
The reduction of maternal mortality and the promotion of maternal health and wellbeing are complex tasks. This Series paper analyses the distal and proximal determinants of maternal health, as well as the exposures, risk factors, and micro-correlates related to maternal mortality. This paper also examines the relationship between these determinants and the gradual shift over time from a pattern of high maternal mortality to a pattern of low maternal mortality (a phenomenon described as the maternal mortality transition). We conducted two systematic reviews of the literature and we analysed publicly available data on indicators related to the Sustainable Development Goals, specifically, estimates prepared by international organisations, including the UN and the World Bank. We considered 23 frameworks depicting maternal health and wellbeing as a multifactorial process, with superdeterminants that broadly affect women's health and wellbeing before, during, and after pregnancy. We explore the role of social determinants of maternal health, individual characteristics, and health-system features in the production of maternal health and wellbeing. This paper argues that the preventable deaths of millions of women each decade are not solely due to biomedical complications of pregnancy, childbirth, and the postnatal period, but are also tangible manifestations of the prevailing determinants of maternal health and persistent inequities in global health and socioeconomic development. This paper underscores the need for broader, multipronged actions to improve maternal health and wellbeing and accelerate sustainable reductions in maternal mortality. For women who have pregnancy, childbirth, or postpartum complications, the health system provides a crucial opportunity to interrupt the chain of events that can potentially end in maternal death. Ultimately, expanding the health sector ecosystem to mitigate maternal health determinants and tailoring the configuration of health systems to counter the detrimental effects of eco-social forces, including though increased access to quality-assured commodities and services, are essential to improve maternal health and wellbeing and reduce maternal mortality.
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Affiliation(s)
- João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil; BIREME, Department of Evidence and Intelligence for Action in Health, Pan American Health Organization (PAHO)-World Health Organization Americas Regional Office, São Paulo, Brazil.
| | - Louise Tina Day
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Clara Rezende-Gomes
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jun Zhang
- Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute for Health Sciences (IRSS), Ouagadougou, Burkina Faso
| | | | - Alfred Osoti
- Department of Obstetrics, University of Nairobi, Nairobi, Kenya; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Oona Campbell
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kidza Y Mugerwa
- Department of Obstetrics and Gynecology, Makerere University, Kampala, Uganda
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynecology, Khon Kaen University, Khon Kaen, Thailand
| | - Özge Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jenny Cresswell
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn Carol Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Jolof L, Rocca P, Carlsson T. Support interventions to promote health and wellbeing among women with health-related consequences following traumatic experiences linked to armed conflicts and forced migration: a scoping review. Arch Public Health 2024; 82:8. [PMID: 38225672 PMCID: PMC10790529 DOI: 10.1186/s13690-023-01235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Women exposed to armed conflicts and forced migration face significant health-related risks and consequences. Consequently, there is a need to identify and develop effective interventions that provide tailored support for them. The aim of this scoping review was to examine research evaluating support interventions promoting the health and well-being among women with traumatic experiences linked to armed conflict and/or forced migration. METHODS A scoping review of empirical studies evaluating non-pharmacologic/non-surgical interventions promoting health and well-being among adult women with traumatic experiences linked to armed, torture, and/or forced migration, identified through systematic searches in February 2022 within five databases (AMED, CINAHL, Cochrane Library, PsycINFO, and PubMed). Methodological characteristics and results were extracted and analyzed with narrative analysis using tabulations, descriptive statistics, text-based summaries, and thematization. RESULTS Assessment of 16 748 records resulted in 13 included reports. The methodological approaches were quantitative (n = 9), qualitative (n = 2), and mixed methods (n = 2), with most reports being feasibility/pilot studies (n = 5) and/or randomized controlled trials (n = 4). The most common recruitment strategy was non-probability sampling (n = 8). Most interventions were conducted in North America (n = 4), Asia (n = 3) or Middle East (n = 3). Thirteen intra-intervention techniques and five categories of components utilized within the interventions were identified, the most common being skill building (n = 12). Ten developed the interventions through theoretical frameworks or manuals/therapy, while five developed interventions through public or stakeholder involvement. Eleven studies evaluated outcomes related to psychological health, disorders, or distress. A large proportion of the investigated outcomes showed post-exposure improvements and improvements when compared with controls. Qualitative findings highlighted improved mental and physical health, empowerment and stigma reduction, and enhanced knowledge. CONCLUSION Few studies have developed and evaluated tailored support interventions for this population, containing a range of components and intra-intervention techniques. No clear focus was identified regarding outcome measures, and most studies used non-probability sampling. Few developed interventions through public contribution in collaboration with women. While limited studies show promising effects on women's mental health, more empirical intervention research that closely corresponds to women's needs are needed.
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Affiliation(s)
- Linda Jolof
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Patricia Rocca
- The Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Tommy Carlsson
- The Department of Health Sciences, The Swedish Red Cross University, Huddinge, Sweden.
- The Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Crankshaw TL, Freedman J, Mutambara VM, Rajah Y. "I still don't know how someone gets pregnant": determinants of poor reproductive health among young female refugees in South Africa. BMC Womens Health 2024; 24:10. [PMID: 38172790 PMCID: PMC10765558 DOI: 10.1186/s12905-023-02847-6] [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: 07/14/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies exploring the sexual and reproductive health (SRH) of refugee women have focused primarily on first generation refugees in humanitarian and crisis settings. There is a paucity of research exploring the reproductive health of girls and young women who are born to refugee parents in a host country or who have migrated with their parents at a very young age and who have since reached sexual maturity. We conducted a qualitative study which aimed to explore the reproductive health and rights' needs and challenges amongst young refugee women in South Africa. METHODS The study was carried out in the city of eThekwini (Durban) in South Africa in 2021 and 2022. A total of 35 semi-structured, in person interviews were conducted amongst young refugee women between the ages of 18 and 24 years living in the city centre. RESULTS Twenty-five participants were 17 years or younger on arriving in South Africa, one of whom was born in South Africa. Eleven of these women had experienced one or more pregnancies while living in South Africa and all of these women had experienced at least one unintended pregnancy. Participants had poor reproductive health knowledge of the role of menstruation and how conception occurs. Economic, social, and legal insecurities intersected in complex ways as determinants of poor reproductive health outcomes. Despite availability, contraceptive use was poor and linked to lack of knowledge, myths and unwanted side effects. There were negative economic and social impacts for young refugee women experiencing early pregnancies irrespective of whether they were intended or not. Being unable to conceive or experiencing an unintended pregnancy negatively impacted sexual relationships which were entered primarily for material support. Desire for confidentiality shaped lack of access to legal termination of pregnancy in the public health sector. CONCLUSION Participants experienced specific vulnerabilities resulting from their position as refugees despite length of stay in South Africa. It is important to better understand these specificities in the design of programmes and policies aimed at ensuring positive health outcomes for these young women. Peer education amongst refugee communities may be an important tool in the provision of culturally acceptable SRH education.
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Affiliation(s)
- Tamaryn L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Jane Freedman
- Centre for Sociological and Political Research (CRESPPA), Université Paris 8, Paris, France
| | - Victoria M Mutambara
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. EClinicalMedicine 2024; 67:102264. [PMID: 38314056 PMCID: PMC10837549 DOI: 10.1016/j.eclinm.2023.102264] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 02/06/2024] Open
Abstract
Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.
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Affiliation(s)
- Jameela Sheikh
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John Allotey
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Tania Kew
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Halimah Khalil
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, College of Health Sciences, Bayero University, Kano, Nigeria
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana
- University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- BIREME, Evidence and Intelligence for Action in Health Department, Pan America Health Organization/World Health Organization, São Paulo, Brazil
| | - Inderjeet Kaur
- Fernandez Hospital Educational & Research Foundation, Hyderabad, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- National Institute of Health and Care Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom
- Birmingham Women’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
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Wallace M, Hiam L, Aldridge R. Elevated mortality among the second-generation (children of migrants) in Europe: what is going wrong? A review. Br Med Bull 2023; 148:5-21. [PMID: 37933157 PMCID: PMC10724460 DOI: 10.1093/bmb/ldad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION The 'second-generation' (i.e. the children of migrants) represent one of the fastest growing subpopulations of the child and young adult populations in Europe today. The research so far appears to indicate that their mortality risk is elevated relative to people with non-migrant backgrounds. SOURCES OF DATA Peer-reviewed publications. AREAS OF AGREEMENT Second-generation status is a clear marker of elevated mortality risk in Europe in early life (including stillbirth, perinatal, neonatal and infant mortality) and adulthood, particularly if the parent(s) were born outside of Europe. Socioeconomic inequality plays an important, albeit rarely defining, role in these elevated risks. AREAS OF CONTROVERSY It remains unclear what causes-of-death are driving these elevated mortality risks. The exact influence of (non-socioeconomic) explanatory factors (e.g. health care, racism & discrimination, and factors related to integration) on the elevated mortality risks of the second-generation also remains unclear. GROWING POINTS The second-generation will continue to grow and diversify in Europe; we must intervene to address these inequalities now. AREAS TIMELY FOR DEVELOPING RESEARCH Place more emphasis on the complexity of migration background, specific causes-of-death, and understanding the roles of explanatory factors beyond socioeconomic background.
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Affiliation(s)
- Matthew Wallace
- Sociology Department, Stockholm University, Frescativägen, Stockholm 114 19, Sweden
| | - Lucinda Hiam
- School of Geography and the Environment, Oxford University Centre for the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, 222 Euston Road London, NW1 2DA, UK
- The Institute for Health Metrics and Evaluation, Hans Rosling Center for Population Health, 3980 15th Ave NE, Seattle WA 98195, United States
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Parviainen H, Kiviruusu O, Lämsä R, Skogberg N, Castaneda AE, Santalahti P. Psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived asylum-seeking children in Finland. Child Psychiatry Hum Dev 2023; 54:1699-1709. [PMID: 35587841 PMCID: PMC10582122 DOI: 10.1007/s10578-022-01371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 03/11/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
This study examined psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived accompanied asylum-seeking children in the age groups of 2-6 years (n = 93) and 7-12 years (n = 91). Children and parents were assessed using mental health and trauma measures (SDQ, HSCL-25 and PROTECT). The prevalence of total difficulties was 34.9% among 2-6-year-olds and 29.6% among 7-12-year-olds. The most common symptoms in both age groups were peer problems, followed by conduct problems among 2-6-year-olds and emotional symptoms among 7-12-year-olds. In both age groups, the children's emotional symptoms were associated with the parents' anxiety and depression as well as the trauma symptoms, while the conduct problems were only associated with the parents' trauma symptoms. In conclusion, peer problems as well as conduct problems and emotional symptoms are common among recently arrived asylum-seeking children. To support the mental health of these children, both children and parents need adequate support.
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Affiliation(s)
- Heidi Parviainen
- Department of Public Health, University of Turku, FI-20014, Turku, Finland.
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Olli Kiviruusu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Riikka Lämsä
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Natalia Skogberg
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anu E Castaneda
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Päivi Santalahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
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Sundaresan A, Uddin R, Sorensen C. The impacts of climate migration on perinatal health and opportunities to safeguard perinatal well-being. Semin Perinatol 2023; 47:151845. [PMID: 37865558 DOI: 10.1016/j.semperi.2023.151845] [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: 10/23/2023]
Abstract
The disparate health consequences of climate change and migration have been separately explored, and the gendered impacts of climate change have been previously established. Nonetheless, there is limited research on the specific nexus of climate change-migration-sexual and reproductive health (SRH). This chapter reviews specific vulnerabilities faced by women and infants throughout the perinatal period, and how these are affected by climate change-induced migration in different migratory contexts. The available literature refers to antenatal and postnatal care utilization, access to water, sanitation, and hygiene facilities, childbirth and delivery challenges, and infant feeding barriers, amongst other concerns. The discussion explored in this chapter highlights the need to develop disaster frameworks that reflect the heterogeneity of outcomes related to specific and unique climate migration contexts.
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Affiliation(s)
| | - Raisa Uddin
- University of Utah Global, Rural and Underserved Child Health Fellowship, United States
| | - Cecilia Sorensen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, United States; Department of Emergency Medicine, Columbia Irving Medical Center, United States; Global Consortium on Climate and Health Education, Columbia University, United States.
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Verschuuren AEH, Tankink JB, Franx A, van der Lans PJA, Erwich JJHM, Jong EIFD, de Graaf JP. Community midwives' perspectives on perinatal care for asylum seekers and refugees in the Netherlands: A survey study. Birth 2023; 50:815-826. [PMID: 37326307 DOI: 10.1111/birt.12727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/24/2022] [Accepted: 05/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The rise of forced migration worldwide compels birth care systems and professionals to respond to the needs of women giving birth in these vulnerable situations. However, little is known about the perspective of midwifery professionals on providing perinatal care for forcibly displaced women. This study aimed to identify challenges and target areas for improvement of community midwifery care for asylum seekers (AS) and refugees with a residence permit (RRP) in the Netherlands. METHODS For this cross-sectional study, data were collected through a survey aimed at community care midwives who currently work or who have worked with AS and RRP. We evaluated challenges identified through an inductive thematic analysis of respondents' responses to open-ended questions. Quantitative data from close-ended questions were analyzed descriptively and included aspects related to the quality and organization of perinatal care for these groups. RESULTS Respondents generally considered care for AS and RRP to be of lower quality, or at best, equal quality compared to care for the Dutch population, while the workload for midwives caring for these groups was considered higher. The challenges identified were categorized into five main themes, including: 1) interdisciplinary collaboration; 2) communication with clients; 3) continuity of care; 4) psychosocial care; and 5) vulnerabilities among AS and RRP. CONCLUSIONS Findings suggest that there is considerable opportunity for improvement in perinatal care for AS and RRP, while also providing direction for future research and interventions. Several concerns raised, especially the availability of professional interpreters and relocations of AS during pregnancy, require urgent consideration at legislative, policy, and practice levels.
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Affiliation(s)
- A E H Verschuuren
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen & University of Groningen, Groningen, the Netherlands
| | - J B Tankink
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Franx
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P J A van der Lans
- Department of Obstetrics and Gynecology, Hospital Twente ZGT/MST, Enschede, The Netherlands
| | - J J H M Erwich
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - E I Feijen-de Jong
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Groningen, the Netherlands
| | - J P de Graaf
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Salameh TN, Nyakeriga DB, Hall LA. Telehealth Care for Perinatal Depression in Immigrant and Refugee Women: A Scoping Review. Issues Ment Health Nurs 2023; 44:1216-1225. [PMID: 37832145 DOI: 10.1080/01612840.2023.2258222] [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: 10/15/2023]
Abstract
Immigrant and refugee women have higher rates of perinatal depression compared to native-born women. Innovative telehealth interventions provide opportunities for prevention and treatment of perinatal depression. However, little is known about telehealth for perinatal immigrant and refugee women with depression. The aims of this scoping review were to identify available literature addressing the use of telehealth care for perinatal depression in immigrant and refugee women, and to determine the content, mode of delivery, and outcomes of telehealth care when provided for this population. A systematic literature search from 2000 to July 2023 was conducted in six databases and grey literature. The initial search resulted in 988 articles which were screened for their titles and abstracts. Eighty-one full-text articles were reviewed, yielding five articles included in this review. One quantitative study (a feasibility descriptive study), three qualitative studies, and a commentary supported the user satisfaction and potential effectiveness of telehealth care, delivered via telephone and text messaging, in improving perinatal depression symptoms. This review revealed a dearth of data-based studies on the outcomes of telehealth care for perinatal depression among immigrant and refugee women. Collaboration among researchers, healthcare providers, and technology engineers is required to improve telehealth care for this population.
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Affiliation(s)
- Taghreed N Salameh
- School of Nursing Women's Health Department, Koç University, İstanbul, Turkey
| | | | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
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Lewtak K, Poznańska A, Kanecki K, Tyszko P, Goryński P, Jankowski K, Nitsch-Osuch A. Ukrainian migrants' and war refugees' admissions to hospital: evidence from the Polish Nationwide General Hospital Morbidity Study, 2014-2022. BMC Public Health 2023; 23:2336. [PMID: 38001432 PMCID: PMC10675912 DOI: 10.1186/s12889-023-17202-5] [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: 06/27/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Considering the rapid influx of Ukrainian migrants and war refugees into Poland, the knowledge of their health condition is becoming increasingly important for health system policy and planning. The aim of the study was to assess war-related changes in the frequency and structure of hospitalizations among Ukrainian migrants and refugees in Poland. METHODS The study is based on the analysis of hospital admission records of Ukrainian patients, which were collected in the Nationwide General Hospital Morbidity Study from 01.01.2014 to 31.12.2022. RESULTS In the study period, 13,024 Ukrainians were hospitalized in Poland, 51.7% of whom had been admitted to hospital after February 24, 2022. After the war broke out, the average daily hospital admissions augmented from 2.1 to 21.6 person/day. A noticeable increase in the share of women (from 50% to 62%) and children (from 14% to 51%) was also observed. The average age of patients fell from 33.6 ± 0.2 years to 24.6 ± 0.3 years. The most frequently reported hospital events among the migrants until 23.02.2022 were injuries (S00-T98) - 26.1%, pregnancy, childbirth and the puerperium (O00-O99) - 18.4%, and factors influencing health status and contact with health services (Z00-Z99) - 8.4%. After the war started, the incidence of health problems among migrants and war refugees changed, with pregnancy, childbirth and the puerperium (O00-O99) being the most common - 14.9%, followed by abnormal clinical and lab findings (R00-R99) - 11.9%, and infectious and parasitic diseases (A00-B99) - 11.0%. CONCLUSIONS Our findings may support health policy planning and delivering adequate healthcare in refugee-hosting countries.
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Affiliation(s)
- Katarzyna Lewtak
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH - National Research Institute, 24 Chocimska Street, 00-791, Warsaw, Poland.
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland.
| | - Anna Poznańska
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
- Institute of Rural Health in Lublin, Lublin, Poland
| | - Paweł Goryński
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Krzysztof Jankowski
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
- National Geriatrics, Rheumatology and Rehabilitation Institute, Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
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Lazo-Porras M, Penniecook T. Health equity: access to quality services and caring for underserved populations. Health Policy Plan 2023; 38:ii1-ii2. [PMID: 37995262 PMCID: PMC10666925 DOI: 10.1093/heapol/czad073] [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: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 11/25/2023] Open
Abstract
Barriers to access to quality services and caring for underserved populations are a call to action for researchers and other key partners to achieve health equity. In order to accomplish this, several key partners play important roles. More participation of younger generations, women and people of color from different contexts should be encouraged and facilitated. This editorial serves to present this journal issue that includes the articles of young women from low- and middle-income countries. Different methodologies are used to demonstrate the problem of access to quality services and care in a comprehensive way. After understanding the public health problems using an equity lens, we need to implement evidence-based interventions to improve the health system response.
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Affiliation(s)
- Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Lima 15074, Perú
| | - Tricia Penniecook
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, United States
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Rowe A, Bhardwaj M, McCauley M. Maternal multimorbidity - experiences of women seeking asylum during pregnancy and after childbirth: a qualitative study. BMC Pregnancy Childbirth 2023; 23:789. [PMID: 37957595 PMCID: PMC10641960 DOI: 10.1186/s12884-023-06054-x] [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: 04/19/2022] [Accepted: 10/07/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Many women seeking asylum during pregnancy and after childbirth have ill-health but detection and assessment of all physical, psychological, and social health needs (maternal multimorbidity) are often difficult as part of routine maternity care. Healthcare providers are key for the early identification and management of vulnerable pregnant women who have additional physical, psychological, and social health needs. We sought to explore the impact of the asylum-seeking process, understanding of wellbeing, expressed health needs (in terms of maternal multimorbidity), and the experiences of maternity care of women seeking asylum during pregnancy and after childbirth in Liverpool, United Kingdom. Enabling factors and barriers to access woman-centred care were also explored. METHODS Key informant interviews (n = 10) and one focus group discussion (n = 4) were conducted with women attending a non-profit charitable pregnancy support group. Transcribed interviews were coded by topic and then grouped into categories. Thematic framework analysis was undertaken to identify emerging themes. RESULTS The asylum-seeking process negatively impacted women making them feel anxious and depressed with little control or choice over their future. Women reported feeling stressed regarding poor standard of accommodation, low income, dispersal and the uncertainty of their asylum application outcome. Wellbeing during pregnancy and after childbirth was understood to be multifactorial and women understood that their physical health needs were interlinked and negatively impacted by complex psychological and social factors. Women reported that their expectations of maternity services were often exceeded, but information giving, and the use of language interpreters needed to be improved. Women expressed the need for more psychological and social support throughout pregnancy and after childbirth. CONCLUSIONS A multidisciplinary team, with links and effective referral pathways to maternal mental health and social services, are necessary for women seeking asylum, to ensure a more integrated, comprehensive assessment of maternal multimorbidity and to provide maternity care in a way that meets all health needs.
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Affiliation(s)
- Anna Rowe
- Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, United Kingdom.
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
| | - Minakshi Bhardwaj
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- College of Nursing, Midwifery and Health Care, University of West London, London, United Kingdom
| | - Mary McCauley
- Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, United Kingdom
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Rogers HJ, Ao CSEH, Henry A. Perspectives of women and partners from migrant and refugee backgrounds accessing the Cross Cultural Worker Service in maternity and early childhood services-a survey study. BMC Health Serv Res 2023; 23:1233. [PMID: 37946230 PMCID: PMC10636916 DOI: 10.1186/s12913-023-10194-3] [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: 06/15/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Women from migrant and refugee backgrounds living in high-income countries have increased risk of adverse perinatal outcomes and report lower satisfaction with perinatal healthcare. In Sydney, Australia, a new service known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service) was implemented to support such women and families from pregnancy to the early parenting period. This study aimed to ascertain the experiences of women and their partners engaging with the CCW Service. METHODS A survey study was undertaken. Women accessing the CCW Service were recruited during pregnancy and were asked to complete surveys at three time points: in the third trimester of pregnancy, at 6 and 12 months postpartum. Their partners were invited to complete a survey at 6 months postpartum. Survey data were analysed to compare satisfaction, usefulness, number of CCW interactions, cultural sensitivity, and service improvement recommendations across all three survey timepoints. RESULTS A total of 231 surveys were received: 113 during pregnancy, 50 at 6-months postpartum, 44 at 12-months postpartum, and 24 partner surveys. Participants in all surveys reported the CCW Service to be useful (84-94%), stating that it increased their understanding of pregnancy, birth and parenting (95-100%), and that they would recommend the CCW Service (92-98%). Participants experienced a high level of satisfaction (88-95%) irrespective of the number of CCW interactions (p = 0.42). Thoughts on becoming a mother or parent were more positive after meeting the CCW than before for both women (p = 0.01) and partners (p = 0.12). Suggestions for CCW Service improvement were to 1) increase the provision of information, specifically financial entitlements, postnatal depression, and support services, 2) increase involvement of partners in care, 3) increase the CCW workforce/or number of CCWs. CONCLUSION The CCW Service was associated with positive experiences and high rates of satisfaction at all timepoints. This service has the potential to inform the implementation of similar models of care that improve accessibility, the perinatal experience, and respond to the unique needs of women and families from migrant and refugee backgrounds.
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Affiliation(s)
- Helen J Rogers
- Child, Youth & Family Services, South Eastern Sydney Local Health District, Sydney, NSW, 2010, Australia.
- Discipline of Women's Health, School of Clinical Medicine, University of NSW (UNSW), Sydney, NSW, 2000, Australia.
| | - Caroline S E Homer Ao
- Maternal and Child Health, Burnet Institute, Melbourne, Vic, 3004, Australia
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney), Sydney, NSW, 2007, Australia
| | - Amanda Henry
- Discipline of Women's Health, School of Clinical Medicine, University of NSW (UNSW), Sydney, NSW, 2000, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, NSW, 2217, Australia
- Australia Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, 2042, Australia
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Miranda J, Sanabria MF, Annicchiarico W, Alfieri N, Cortes MS. Maternal and perinatal health among pregnant patients in the context of a migratory crisis. Int J Gynaecol Obstet 2023; 163:416-422. [PMID: 37439260 DOI: 10.1002/ijgo.14991] [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: 04/11/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To compare maternal and perinatal outcomes of migrant Venezuelan women with local pregnant patients in a Colombian institution in the context of a migratory crisis. STUDY DESIGN This cross-sectional study included 11 304 deliveries from the Clínica de Maternidad Rafael Calvo in Cartagena de Indias, Colombia, a tertiary referral center on the north coast of Colombia. Data on maternal demographics and perinatal outcomes were obtained by chart review. RESULTS In total, 595 patients were identified as Venezuelan migrants, and their perinatal outcomes were compared against those of 10 709 local pregnant patients. Despite similar baseline maternal conditions in both groups, poorer prenatal follow-up care (3 [1-5] vs. 5 [4-7] visits; P < 0.001) and severe complications were more common in Venezuelan migrant pregnant patients and their children. In addition, maternal hypertension was significantly more common in migrants (11.4% [68/595] vs. 8.3% [887/10709]; P = 0.009). Furthermore, in the group of pregnant migrant patients, the rates of severe maternal morbidity (13.4% [80/575] vs. 9.45%, [1013/10709]; P = 0.002), neonatal respiratory distress syndrome (22/595 [3.7%] vs. 237/10709 [2.23%]; P = 0.03), and perinatal mortality (11/586 [1.88%] vs. 67/10651 [0.63%]; P = 0.003) were significantly higher than in the local pregnant population. CONCLUSION Forced migration during pregnancy may be associated with poorer prenatal care, which may predispose women and their newborns to more frequent adverse maternal and perinatal outcomes.
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Affiliation(s)
- Jezid Miranda
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Department of Obstetrics and Gynecology, Centro Hospitalario Serena del Mar, Cartagena de Indias y Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - María F Sanabria
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Walter Annicchiarico
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Nikita Alfieri
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, Universita degli Studi di Milano, Milan, Lombardia, Italy
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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DiMeo A, Karlage A, Schoenherr K, Spigel L, Chakraborty S, Bazan M, Molina RL. Cultural brokering in pregnancy care: A critical review. Int J Gynaecol Obstet 2023; 163:357-366. [PMID: 37681939 DOI: 10.1002/ijgo.15063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
People who speak languages other than English face structural barriers in accessing the US healthcare system. With a growing number of people living in countries other than their countries of birth, the impact of language and cultural differences between patients and care teams on quality care is global. Cultural brokering presents a unique opportunity to enhance communication and trust between patients and clinicians from different cultural backgrounds during pregnancy care-a critical window for engaging families in the healthcare system. This critical review aims to synthesize literature describing cultural brokering in pregnancy care. We searched keywords relating to cultural brokering, pregnancy, and language in PubMed, Embase, and CINAHL and traced references of screened articles. Our search identified 33 articles. We found that cultural brokering is not clearly defined in the current literature. Few of the articles provided information about language concordance between cultural brokers and patients or clinicians. No article described the impact of cultural brokering on health outcomes. Facilitators of cultural brokering included: interprofessional collaboration within the care team, feeling a family connection between the cultural broker and patients, and cultivating trust between the cultural broker and clinicians. Barriers to cultural brokering included: misunderstanding the responsibilities, difficulty maintaining personal boundaries, and limited availability and accessibility of cultural brokers. We propose cultural brokering as interactions that cover four key aims: (1) language support; (2) bridging cultural differences; (3) social support and advocacy; and (4) navigation of the healthcare system. Clinicians, researchers, and policymakers should develop consistent language around cultural brokering in pregnancy care and examine the impact of cultural brokers on health outcomes.
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Affiliation(s)
- Amanda DiMeo
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ami Karlage
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karen Schoenherr
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lauren Spigel
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Saugata Chakraborty
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria Bazan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Rose L Molina
- Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Ramadan M, Rukh-E-Qamar H, Yang S, Vang ZM. Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review. PLoS One 2023; 18:e0287617. [PMID: 37883411 PMCID: PMC10602334 DOI: 10.1371/journal.pone.0287617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. METHODS Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. RESULTS In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. CONCLUSION Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.
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Affiliation(s)
- Marwa Ramadan
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Hani Rukh-E-Qamar
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Zoua M. Vang
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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SantiÁ P, de Montgomery CJ, Pedersen TP, Marti-Castaner M. Differences in postpartum mental healthcare among women with identified needs: The role of migration status. Scand J Public Health 2023:14034948231178337. [PMID: 37837218 DOI: 10.1177/14034948231178337] [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: 10/15/2023]
Abstract
AIMS The aim of this study was to examine the association between women's migrant status (majority, immigrant, descendant) and use of postpartum mental healthcare and investigate whether migration characteristics are associated with mental healthcare use. METHODS Retrospective cohort study. We included all mothers of children born between 2002 and 2018 in 34 municipalities of Denmark who had an identified mental health need as clinically assessed by a child health visitor (CHV) or by a score of 11 or more on the Edinburgh Postpartum Depression Scale (EPDS). Women were followed until the first mental healthcare received 2 years' postpartum, death or emigration. Using Cox regression models, we estimated the time to mental healthcare by migrant status and explored the role of migration characteristics. RESULTS A total of 29% of women (n = 45,573) had a mental health need identified by the CHV, and 7% (n = 4968) had an EPDS ⩾ 11. Immigrants accounted for 19.5%, and descendants for 4.7% of the sample. Immigrants were at lower risk of using mental healthcare than the majority group (CHV: hazard ratio adjusted (HRa) 0.75 (0.70-0.79), EPDS: HRa 0.67 (0.58-0.78)), as were descendants (CHV: HRa 0.77 (0.70-0.86), EPDS: HRa 0.69 (0.55-0.88)). Among migrants, those not refugees, newly arrived, whose partners were immigrants or descendants, and those originally from Africa showed a lower risk of using postpartum mental healthcare. CONCLUSIONS Our findings emphasize the need to strengthen access to mental healthcare for immigrants and descendants experiencing postpartum mental health concerns and consider migration characteristics as indicators of potential inequalities in access to maternal mental healthcare.
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Affiliation(s)
- Paula SantiÁ
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar-Pompeu Fabra University-Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Christopher Jamil de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
| | - Trine Pagh Pedersen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Marti-Castaner
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
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Biesiada A, Mastalerz-Migas A, Babicki M. Response to provide key health services to Ukrainian refugees: The overview and implementation studies. Soc Sci Med 2023; 334:116221. [PMID: 37689012 DOI: 10.1016/j.socscimed.2023.116221] [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: 05/17/2023] [Revised: 08/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND The outbreak of war in Ukraine has contributed to the largest migration crisis in this part of Europe since the Second World War. In a short period of time, several million refugees of different ages and with different health needs have arrived in Poland. This study aims to assess the health problems of Ukrainian refugees, evaluate the barriers faced by primary care physicians (PCPs), and analyse and evaluate the system solutions available (including the use of modern information technology) to address them. METHODOLOGY For this purpose, an original questionnaire distributed to PCPs in Poland was created and a literature review of implemented system solutions was conducted. The survey was conducted between the 3rd-10th April 2022-45 days after the outbreak of the war. The survey was repeated between 20th January and February 15, 2023. RESULTS The survey was completed by 402 physicians who provided health care to refugees at that time. There were 252 respondents in the first stage of the study while 150 PCPs took part in the repeat survey. The findings of the survey revealed that the most common health problems among refugees were infections, regardless of age. The biggest barrier to providing care to refugees was the lack of available medical records and language difficulties. During the first months of the refugee influx in Poland, many - both systemic and grassroot - solutions were implemented to improve the quality of health care for refugees. CONCLUSIONS According to PCPs, the language barrier and the lack of previous medical records are key constraints when providing medical care to refugees. The health needs of refugees and the difficulties in providing care for them require constant monitoring and implementation of appropriate systemic solutions that can reduce the limitations in the daily work of medical staff.
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Affiliation(s)
- Aleksander Biesiada
- Ad Vitam Przychodnia Zdrowia Sp. z o.o. Sp. k, Poland; Polish Society of Family Medicine, Poland.
| | - Agnieszka Mastalerz-Migas
- Polish Society of Family Medicine, Poland; Department of Family Medicine, Wroclaw Medical University, 51-141, Wroclaw, Poland
| | - Mateusz Babicki
- Polish Society of Family Medicine, Poland; Department of Family Medicine, Wroclaw Medical University, 51-141, Wroclaw, Poland
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Forbes F, Wynter K, Zeleke BM, Fisher J. Engaging culturally diverse fathers in maternal and family healthcare: Experiences and perspectives of healthcare professionals. Health Promot J Austr 2023; 34:691-701. [PMID: 37370198 DOI: 10.1002/hpja.769] [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: 02/20/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
ISSUE ADDRESSED Australian maternal, family and child services increasingly espouse the value of being 'father-inclusive'. However, fathers report feeling excluded or marginalised during healthcare visits with their partners/infants, and experience barriers to engaging in perinatal healthcare at the community, individual and healthcare service level. These barriers may be amplified in men who are members of minority groups, such as those from culturally and linguistically diverse (CALD) backgrounds. METHODS This research investigated healthcare professionals' perceptions and experiences of providing perinatal health services to families from CALD backgrounds. Semi-structured interviews were held with healthcare professionals from multiple disciplinary backgrounds providing services to families in the perinatal period. Interviews were audio recorded, transcribed and analysed thematically to identify key themes and sub-themes. RESULTS Ten healthcare professionals were interviewed. Participants acknowledged that inclusion of fathers in care is important as involvement enables fathers to support their pregnant partners and children, manage their own mental health, and helps to transform harmful gender roles. CONCLUSIONS Overall, healthcare professionals are willing to include culturally diverse fathers. However, the ability of culturally diverse families to engage with healthcare services is impacted by the cultural competency of the services. So what? Healthcare delivered during pregnancy, childbirth and postpartum year may be improved by adopting a whole-family approach, which considers the needs and perspectives of fathers and partners. However, particular attention is needed to ensure healthcare policies and practices are culturally competent to meet the needs of fathers from culturally diverse backgrounds.
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Affiliation(s)
- Faye Forbes
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Wynter
- School of Nursing & Midwifery - Western Health Partnership, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Berihun M Zeleke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ramage K, Stirling-Cameron E, Ramos NE, Martinez SanRoman I, Bojorquez I, Spata A, Baltazar Lujano B, Goldenberg SM. "When you leave your country, this is what you're in for": experiences of structural, legal, and gender-based violence among asylum-seeking women at the Mexico-U.S. border. BMC Public Health 2023; 23:1699. [PMID: 37659997 PMCID: PMC10474729 DOI: 10.1186/s12889-023-16538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/16/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Recent U.S. immigration policy has increasingly focused on asylum deterrence and has been used extensively to rapidly deport and deter asylum-seekers, leaving thousands of would-be asylum-seekers waiting indefinitely in Mexican border cities, a large and growing proportion of whom are pregnant and parenting women. In the border city of Tijuana, Mexico, these women are spending unprecedented durations waiting under unsafe humanitarian conditions to seek safety in the U.S, with rising concerns regarding increases in gender-based violence (GBV) among this population during the COVID-19 pandemic. Given existing gaps in evidence, we aimed to describe the lived experiences of GBV in the context of asylum deterrence policies among pregnant and parenting asylum-seeking women at the Mexico-U.S. border. METHODS Within the community-based Maternal and Infant Health for Refugee & Asylum-Seeking Women (MIHRA) study, we conducted semi-structured qualitative interviews with 30 asylum-seeking women in Tijuana, Mexico between June and December 2022. Eligible women had been pregnant or postpartum since March 2020, were 18-49 years old, and migrated for the purposes of seeking asylum in the U.S. Drawing on conceptualizations of structural and legal violence, we conducted a thematic analysis of participants' experiences of GBV in the context of asylum deterrence policies and COVID-19. RESULTS Pregnant and parenting asylum-seeking women routinely faced multiple forms of GBV perpetuated by asylum deterrence policies at all stages of migration (pre-migration, in transit, and in Tijuana). Indefinite wait times to cross the border and inadequate/unsafe shelter exacerbated further vulnerability to GBV. Repeated exposure to GBV contributed to poor mental health among women who reported feelings of fear, isolation, despair, shame, and anxiety. The lack of supports and legal recourse related to GBV in Tijuana highlighted the impact of asylum deterrence policies on this ongoing humanitarian crisis. CONCLUSION Asylum deterrence policies undermine the health and safety of pregnant and parenting asylum-seeking women at the Mexico-U.S. border. There is an urgent need to end U.S. asylum deterrence policies and to provide respectful, appropriate, and adequately resourced humanitarian supports to pregnant and parenting asylum-seeking women in border cities, to reduce women's risk of GBV and trauma.
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Affiliation(s)
- Kaylee Ramage
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Emma Stirling-Cameron
- Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Isela Martinez SanRoman
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Center for Latin American Studies, San Diego State University, San Diego, CA, USA
| | - Ietza Bojorquez
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Mexico
| | - Arianna Spata
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Center for Latin American Studies, San Diego State University, San Diego, CA, USA
| | | | - Shira M Goldenberg
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, USA.
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Khaw SML, Homer CSE, Dearnley R, O'Rourke K, Akter S, Bohren MA. A qualitative study on community-based doulas' roles in providing culturally-responsive care to migrant women in Australia. Women Birth 2023; 36:e527-e535. [PMID: 37117124 DOI: 10.1016/j.wombi.2023.04.003] [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: 11/20/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND There is limited exploration into how culturally-responsive care may be provided to migrant women through community-based doulas. AIM We aim to explore the roles of community-based doulas in providing culturally-responsive care to migrant women in Australian maternity settings, from the perspectives of maternity care providers and doulas. METHODS We used an interpretive phenomenological qualitative approach with in-depth interviews with 30 maternity care providers and Birth for Humankind doulas, in Victoria, Australia. All interviews were conducted over video-call and inductive thematic analysis was performed using NVivo software. FINDINGS Doulas were seen to support and enhance migrant women's maternity care experiences through numerous ways, strengthening cultural-responsive care provision. There were three domains which described the role of doulas in providing migrant women with culturally-responsive care: 1) enhanced care; 2) respectful care; and 3) supportive relationships with providers. The three domains included seven themes: 1) continuous individualised support; 2) social connectedness; 3) creating safe spaces; 4) cultural facilitator; 5) non-judgemental support; 6) enhancing communication and rapport with providers; and 7) making connections. DISCUSSION Doulas appeared to counter negative factors that impact migrant women's maternity care experiences. Doulas with previous professional birth support qualifications and trauma-informed care training were equipped to create safe spaces and increase emotional safety for migrant women. Doulas may also have more responsibilities expected of them by providers when connecting migrant women with additional services in situations that may be missed through hospital care. CONCLUSION Birth for Humankind doulas in Victoria play an important role in providing culturally-responsive care to migrant women. Employment models may be the next steps in acknowledging their valuable contribution as a complementary service to maternity settings.
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Affiliation(s)
- Sarah Min-Lee Khaw
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053, Australia.
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Red Dearnley
- Birth for Humankind, 552 Victoria Street, North Melbourne, VIC 3051, Australia
| | - Kerryn O'Rourke
- Realist Research, Evaluation and Learning Initiative, Northern Institute, College of Indigenous Futures, Education & the Arts, Charles Darwin University, Building Yellow 1, Level 3 Ellen Gowan Drive, Casuarina, NT 0810, Australia; Judith Lumley Centre, La Trobe University, School of Nursing and Midwifery, Level 3, George Singer Building, Bundoora, VIC 3086
| | - Shahinoor Akter
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3053, Australia
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Evans CR, Nieves CI, Erickson N, Borrell LN. Intersectional inequities in the birthweight gap between twin and singleton births: A random effects MAIHDA analysis of 2012-2018 New York City birth data. Soc Sci Med 2023; 331:116063. [PMID: 37467517 DOI: 10.1016/j.socscimed.2023.116063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
Birthweight is a widely-used biomarker of infant health, with inequities patterned intersectionally by maternal age, race/ethnicity, nativity/immigration status, and socioeconomic status in the United States. However, studies of birthweight inequities almost exclusively focus on singleton births, neglecting high-risk twin births. We address this gap using a large sample (N = 753,180) of birth records, obtained from the 2012-2018 New York City (NYC) Department of Health and Mental Hygiene, Bureau of Vital Statistics, representing 99% of all births registered in NYC, and a novel random coefficients intersectional MAIHDA (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) model. Our results show evidence of intersectional inequities in birthweight outcomes for both twin and singleton births by maternal age, race/ethnicity, education, and nativity status. Twins have considerably lower predicted birthweights than singletons overall (-930 g on average), and this is especially true for babies born to mothers who are younger (11-19 years), older (40+), racial/ethnic minoritized, foreign-born, and have lower education. However, the magnitude of this birthweight 'gap' between twins and singletons varies considerably across social identity strata, ranging between 830.8 g (observed among 40+ year old Black foreign-born mothers with high school degrees) and 1013.7 g (observed among 30-39 year old Hispanic/Latina foreign-born mothers with less than high school degrees). This study underscored the needs of a high-risk population and the need for aggressive social policies to address health inequities and dismantle intersectional systems of marginalization, oppression, and socioeconomic inequality. In addition to our substantive contributions, we add to the growing methods literature on intersectional quantitative analysis by demonstrating how to apply intersectional MAIHDA with random coefficients and random slopes. We conclude with a discussion of the significant potential for this methodological extension in future research on inequities.
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Affiliation(s)
- Clare R Evans
- Department of Sociology, University of Oregon, Eugene, OR, USA.
| | - Christina I Nieves
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | | | - Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
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