Migration and young women's access to maternal healthcare in sub-Saharan Africa

Child fostering and maternal migration in sub-Saharan Africa

Rising feminization of migration has resulted in substantial flows of women migrating in Africa, increasing the importance of migration in women's lives. Although child fostering is an enduring feature of family life throughout Africa, few studies have examined the role that maternal migration may play in these arrangements. I use Demographic and Health Survey data from 24 African countries to explore associations between maternal migration experience and fostering out of children aged 0-17, focusing on maternal migrant status, migrant stream, motivation, and timing of migration relative to births of children, to explore potential disruption introduced by migration. Results suggest that maternal migration disrupts mother-child co-residence, with greater fostering among children of migrant mothers, particularly rural-urban migrants. Children born before migration display the highest probability of fostering, consistently across migrant streams. These results suggest a need for greater attention to the impacts of maternal migration for children's living arrangements, particularly as migration flows become increasingly feminized.

Perinatal health outcomes of offspring of internal migrant women according to human development index: a registry-based cohort study of over 10 million live births from Brazil

Background

Migration, driven by factors like poverty, violence, and natural disasters, is a key social determinant of health. While international migrants often have worse perinatal outcomes, research on perinatal health differences between internal migrants and non-migrants remains limited. We aimed to determine whether the offspring of women who migrate within Brazil experience poorer perinatal outcomes than those of non-migrants, according to the Human Development Index (HDI) of their municipalities of origin and destination.

Methods

We used the CIDACS Birth Cohort, consisting of women applying for social programmes in the Unified Registry for Social Programmes Cadastro Único linked with live births and mortality registries. We included live births conceived from March 2010 to February 2018. Internal migrants were women who changed their state of residence from registration in CadUnico to the birth of the child. We derived risk ratios (RR) of migration's effect according to HDI of residence before and after migration using logistic regression.

Findings

We included 10,184,021 births in the study, with 5.7% of these births from women who were internal migrants. The offspring of women who migrated to municipalities with equal/higher HDI (80% of migrations), exhibited a decreased risk of preterm births (RR: 0.94, 95% CI: 0.93-0.95), low birth weight (RR: 0.94, 95% CI: 0.92-0.95) and small for gestational age (RR: 0.92, 95% CI: 0.91-0.93), but higher risk of congenital abnormalities (RR: 1.14, 95% CI: 1.10-1.18). The offspring of women who migrated to municipalities with lower HDI had delayed access to healthcare and worse outcomes except for a lower risk of low birth weight (RR: 0.94, 95% CI: 0.92-0.96).

Interpretation

Offspring of those migrating to municipalities with equal/higher HDI tend to have better perinatal outcomes, whereas migrants to lower HDIs have a similar pattern to non-migrant women.

Funding

NIHR, Wellcome Trust, Royal Society.

"She held my hand and advised me": Young migrants' experiences of individual peer support to access health and social services in two small towns in southwestern Uganda

We describe how a pilot intervention called "Lending a Hand" was implemented to mitigate some of the risks associated with migration among young recent migrants (14-24 years) in two small towns in south-western Uganda. The design of the intervention was informed by the `protection-risk framework', with key protection components of the intervention (positive role models/ "good" social network, safer environment, health and social support) affording support to young migrants to counter risks in their new environment. As part of the intervention (November 2021-January 2023), peer supporters were recruited and trained to provide practical assistance, emotional support, and guidance to young recent migrants. We conducted qualitative in-depth interviews with 20 young migrants (11 males and 9 females). They were purposively selected to participate in two in-depth interviews each to explore their experiences with peer support. Young migrants were eligible to participate if they were aged between 14 and 24 years and in their first year as a migrant in the town. Data were analysed thematically, and three themes on the role of peer supporters were identified based on the protection-components drawn from the protection-risk framework: facilitating access to health services, offering responsive and person-centred support and fostering a social support system, friendship and mentorship. We found that peer supporters improved young migrants' access to health and social support. They facilitated access to healthcare services, provided information and counselling services and offered responsive and person-centred support. Peer supporters in the Lending a Hand intervention played a valuable role in addressing healthcare challenges faced by young migrants. This experience offers lessons for the integration of formal peer support into interventions targeting young migrants to access health and social support services.

Results of the Sukuma Ndoda ("Stand up, Man") HIV Self-Screening and Assisted Linkage to Care Project in Johannesburg: A Quasi-Experimental Pre-Post Evaluation

BACKGROUND

HIV testing rates among South African men lag behind rates for women and national targets. Community-based HIV self-screening (HIVSS) distribution and follow-up by community health workers (CHWs) is a scalable option to increase testing coverage, diagnosis, and treatment initiation. We provided HIVSS and assisted linkage to care to men not recently tested (within the past 12 months) residing in high-HIV-burden areas of Johannesburg.

METHODS

CHWs distributed HIVSS in 6 clinic catchment areas. Follow-up to encourage confirmatory testing and antiretroviral therapy initiation was conducted through personal support (PS) or an automated short message service (SMS) follow-up and linkage system in 3 clinic areas each. Using a quasi-experimental pre-post design, we compared differences in the proportion of men testing in the clinic catchment areas during the HIVSS campaign (June-August 2019) to the 3 months prior (March-May 2019) and compared treatment initiations by assisted linkage strategy.

RESULTS

Among 4793 participants accepting HIVSS, 62% had never tested. Among 3993 participants with follow-up data, 90.6% reported using their HIVSS kit. Testing coverage among men increased by 156%, from under 4% when only clinic-based HIV testing services were available to 9.5% when HIVSS and HIV testing services were available (z = -11.6; P < 0.01). Reported test use was higher for men followed through PS (99% vs. 68% in SMS); however, significantly more men reported reactive self-test results in the SMS group compared with PS (6.4% vs. 2.0%), resulting in more antiretroviral therapy initiations in the SMS group compared with PS (23 vs. 9; P < 0.01).

CONCLUSIONS

CHW HIVSS distribution significantly increases testing among men. While PS enabled personalized follow-up, reporting differences indicate SMS is more acceptable and better aligned with expectations of privacy associated with HIVSS.

Health service behaviors of migrants: A conceptual framework

Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.

Childhood vaccination timeliness following maternal migration to an informal urban settlement in Kenya

INTRODUCTION

Timely receipt of recommended vaccines is a proven strategy to reduce preventable under-five deaths. Kenya has experienced impressive declines in child mortality from 111 to 43 deaths per 1000 live births between 1980 and 2019. However, considerable inequities in timely vaccination remain, which unnecessarily increases risk for serious illness and death. Maternal migration is a potentially important driver of timeliness inequities, as the social and financial stressors of moving to a new community may require a woman to delay her child's immunizations. This analysis examined how maternal migration to informal urban settlements in Nairobi, Kenya influenced childhood vaccination timeliness.

METHODS

Data came from the Nairobi Urban Health and Demographic Surveillance System, 2002-2018. Migration exposures were migrant status (migrant, non-migrant), migrant origin (rural, urban), and migrant type (first-time, circular [previously resided in settlement]). Age at vaccine receipt (vaccination timeliness) was calculated for all basic vaccinations. Accelerated failure time models were used to investigate relationships between migration exposures and vaccination timeliness. Confounding was addressed using propensity score weighting.

RESULTS

Over one-third of the children of both migrants and non-migrants received at least one dose late or not at all. Unweighted models showed the children of migrants had shorter time to OPV1 and DPT1 vaccine receipt compared to the children of non-migrants. After accounting for confounding only differences in timeliness for DPT1 remained, with the children of migrants receiving DPT1 significantly earlier than the children of non-migrants. Timeliness was comparable among migrants with rural and urban origins and among first-time and circular migrants.

CONCLUSION

Although a substantial proportion of children in Nairobi's informal urban settlements do not receive timely vaccination, this analysis found limited evidence that maternal migration and migration characteristics were associated with delays for most doses. Future research should seek to elucidate potential drivers of low vaccination timeliness in Kenya.

Maternal education level and maternal healthcare utilization in the Democratic Republic of the Congo: an analysis of the multiple indicator cluster survey 2017/18

Background

Understanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the DRC. Maternal education is considered an important associate of maternal health service utilization. This study aims to investigate the association between maternal education and the utilization of maternal health services, as well as present geographical and socio-economic disparities in the utilization.

Methods

The MICS survey was employed as the data source, which is a nationally representative survey conducted from 2017 to 2018 in the DRC. The exposure for this study was the maternal education level, which was categorized into three groups: (1) below primary and none, (2) primary and (3) secondary and above. Prenatal care indicators included: if the mother ever received prenatal care, if the mother had antenatal checks no less than four times, and if a skilled attendant was present at birth. Postnatal care indicators included: if the mother received postnatal care and if the baby was checked after birth. Emergency obstetric interventions were indicted by cesarean sections. Descriptive analyses and logistic regressions were used as analytical methods.

Results

Of all 8,560 participants included, 21.88 % had below primary school or no education, 39.81 % had primary school education, and 38.31 % had secondary education or above. The majority of participants were from rural areas, except for Kinshasa. Overall, a better education was associated with higher utilization of antenatal care. A dose-response effect was also observed. Compared to women with below primary or no education, women with secondary and above education were more likely to receive cesarean sections. Wealth status, as well as rural and urban division, modified the associations.

Conclusions

Mothers’ education level is an important associate for utilizing appropriate maternal healthcare, with wealth and region as modifying factors. Educational levels should be considered when designing public health interventions and women’s empowerment programs in the DRC. For example, relevant programs need to stratify the interventions according to educational attainment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06854-x.

Social Support and Health Services Use in People Aged over 65 Years Migrating within China: A Cross-Sectional Study

Background: Due to the household registration system, Chinese elderly migrants have insufficient access to health services and social support. Thus, this study examined the use of health services, the access to social support, and the interaction among the elderly migrating within China. Methods: Data were obtained from the China Migrant Dynamic Monitoring Survey in 2015, adopting probability proportionate to size as the sampling strategy. Structural equation modeling and mediating effect tests were employed to explore the associations. Results: Approximately 45.9% of elderly migrants did not seek health services when needed. The use of outpatient and inpatient services was more common than free essential public health services. The use of health services was negatively associated with migrating duration and migrating for offspring, while it was positively associated with outer social support. The mediating effects of outer social support were discovered on the relationships between the use of health services and independent variables such as migrating duration and migrating for offspring, respectively. Conclusion: Elderly migrants with a longer migrating duration or migrated for offspring seem to obtain less outer social support, resulting in a decreased use of health services. Outer social support was suggested as a key effort to improve the equalization of health services in Chinese elderly migrants.

Association of Time since Migration from Rural to Urban Slums and Maternal and Child Outcomes: Dhaka (North and South) and Gazipur City Corporations

This study analyzes data from a new Urban Health and Demographic Surveillance (UHDSS) in five slums in Dhaka (North and South) and Gazipur City Corporations to examine the relationship between migration status and maternal and child health service utilization. Migration status was determined by duration in urban slums (<= 9.99 years, 10-19.99 years, 20+ years, and urban-born). Compared to those born in the city, migrants were characterized by significant disadvantages in every maternal, neonatal, and child health (MNCH) indicator under study, including antenatal care, facility-based delivery, doctor-assisted delivery, child immunization, caesarean-section delivery, and use of modern contraceptives. We found that the level of service coverage among migrants gradually converged-but did not fully converge-to that of the urban-born with increasing duration in the city. We observed a strong positive association between wealth and total MNCH coverage, with a more modest association with higher levels of schooling attainment. Women who were engaged in market employment were less likely to receive adequate coverage, suggesting a tradeoff between livelihood attainment and mother-and-child health. After controlling for these socioeconomic and neighborhood variations in coverage, the duration gradient was diminished but still significant. In line with existing studies of healthcare access, this study highlights the persistent and widespread burden of unequal access to maternal and child health care facing migrants to slum areas, even relative to the overall disadvantages experienced in informal settlements.