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LONERGAN GWYNETH. Pregnant racialised migrants and the ubiquitous border: The hostile environment as a technology of stratified reproduction. CRITICAL SOCIAL POLICY 2024; 44:222-241. [PMID: 38510263 PMCID: PMC10948320 DOI: 10.1177/02610183231223951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This article explores the impact of the 'hostile environment' on racialised migrant women's experiences of pregnancy and childbirth in England, arguing that the 'hostile environment' functions as a technology of 'stratified reproduction.' First coined by Shellee Colen, the concept of stratified reproduction describes the dynamic by which some individuals and groups may be supported in their reproductive activities, while others are disempowered and discouraged. This paper locates the stratified reproduction produced by the 'hostile environment' as intertwined with wider gendered and racialised discourses around British citizenship which have been 'designed to fail' racialised residents of the UK. Drawing on interviews with racialised migrant mothers in the north of England, this paper analyses how the proliferation and intensification of immigration controls interacts with gender, race, class, and other social regimes to differentially allocate the resources necessary for a safe and healthy pregnancy and childbirth, and how this is experienced materially by pregnant migrants.
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Osuide JO, Parsa AD, Mahmud I, Kabir R. The effect of limited access to antenatal care on pregnancy experiences and outcomes among undocumented migrant women in Europe: a systematic review. Front Glob Womens Health 2024; 5:1289784. [PMID: 38379839 PMCID: PMC10876992 DOI: 10.3389/fgwh.2024.1289784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Women who are undocumented migrants in Europe encounter a variety of challenges while trying to access health services, including restricted access to antenatal care (ANC) despite the importance of ANC to the well-being of mothers and their infants. This study's aim was to examine the effect that limited access to antenatal care has on the pregnancy experiences and outcomes of undocumented migrant (UM) women in Europe. Systematic searches were done on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, and BioMed Central. From the search results, only primary research articles that reported on the pregnancy outcomes and experiences of undocumented migrants were selected. A meta-analysis was not possible because this review included information from both qualitative and quantitative studies. The data that was taken from the included publications was organised, analysed, using the Microsoft Excel programme, and then meta-synthesised. Twelve papers from seven different European nations-Belgium, France, Sweden, Denmark, Norway, Finland, and England-were included in this systematic review. Eight of the studies aimed to explore the access to and utilization of ANC by undocumented migrant women and the related pregnancy outcomes. Two of the included studies examined the pregnancy experiences of UMs and two examined the perinatal risks associated with living as a migrant with no legal status. Although heterogeneous in their specific findings most of the studies showed undocumented immigrants are more likely to experience unfavourable pregnancy outcomes and experience greater anxiety and worries due to a variety of factors than documented migrants and registered citizens. This review's conclusions demonstrate the pressing need for policy modifications and healthcare reforms in Europe to address the problems associated with undocumented migrants' restricted access to antenatal care. It also highlights the urgent need for structural changes that will give this vulnerable population's health and well-being a higher priority. It is not just an issue of health equality but also a humanitarian obligation to address the many obstacles and difficulties undocumented migrant women endure during pregnancy.
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Affiliation(s)
- Jennifer Okhianosen Osuide
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ali Davod Parsa
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Health, University of New England, Armidale, NSW, Australia
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
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Obionu IM, Onyedinma CA, Mielewczyk F, Boyle E. UK maternity care experiences of ethnic minority and migrant women: Systematic review. Public Health Nurs 2023; 40:846-856. [PMID: 37548036 DOI: 10.1111/phn.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The increasing population of immigrant and migrant women in the United Kingdom has implications to the provision of healthcare and for healthcare experiences. Eliciting women's experiences and perceptions of maternity care received is an important way of monitoring and evaluating the quality of maternity services. This study was designed to explore the maternity care experiences of ethnic minority and migrant women in the United Kingdom. METHODS A literature search for relevant studies was carried across seven databases. We included nine studies carried out between 2015 and February 2022 that met the inclusion criteria. Data were analyzed using a thematic analysis approach. RESULTS Findings showed that ethnic minority women and migrant women have had mixed experiences while utilizing maternity services in the United Kingdom. However, most of the experiences were negative and included issues related to communication, discrimination, culture, access to care, physical comfort, and continuity of care. Only one of the studies reported that the respondents had a wholly positive communication experience, one found that a few women felt the staff were respectful and one reported that the midwives gave the women treatment options that would respect their cultural and religious beliefs. CONCLUSION This study has highlighted some important gaps in the maternity care experiences specific to ethnic minority and migrant women in the United Kingdom which provides useful insights to future policy and clinical practice.
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Affiliation(s)
- Ifeoma Maureen Obionu
- College of Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Chioma Amarachi Onyedinma
- Department of Community Medicine University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Frances Mielewczyk
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Sawadogo PM, Sia D, Onadja Y, Beogo I, Sangli G, Sawadogo N, Gnambani A, Bassinga G, Robins S, Tchouaket Nguemeleu E. Barriers and facilitators of access to sexual and reproductive health services among migrant, internally displaced, asylum seeking and refugee women: A scoping review. PLoS One 2023; 18:e0291486. [PMID: 37708137 PMCID: PMC10501608 DOI: 10.1371/journal.pone.0291486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Migrant, internally displaced, asylum seeking and refugee women experience ongoing risks of having their reproductive healthcare rights violated. This ever-increasing population also has limited access to sexual and reproductive health services. We conducted a scoping review to identify the barriers and facilitating factors when accessing sexual and reproductive health services for this specific population. METHODS We searched the grey literature and queried eight bibliographic databases (Embase, Medline, Cinahl, Scopus, Science Direct, Web of Science, Hinari, and Cochrane Library) to extract articles published between January, 2000, and October, 2021. The extracted data were organized in a framework adapted from Peters et al. and then categorized as facilitators or barriers. We followed the Arksey and O'Malley framework and wrote the report according to the PRISMA-Scr recommendations. RESULTS The search identified 4,722 records of which forty-two (42) met eligibility criteria and were retained for analysis. Ten (10) groups of factors facilitating and/or limiting access to sexual and reproductive health care emerged from the synthesis of the retained articles. The main barriers were lack of knowledge about services, cultural unacceptability of services, financial inaccessibility, and language barriers between patients and healthcare providers. Facilitators included mobile applications for translation and telehealth consultations, patients having a wide availability of information sources, the availability health promotion representatives, and healthcare providers being trained in cultural sensitivity, communication and person-centered care. CONCLUSION Ensuring the sexual and reproductive rights of migrant, internally displaced, asylum-seeking and refugee women requires that policymakers and health authorities develop intervention strategies based on barriers and facilitators identified in this scoping review. Therefore, considering their mental health in future studies would enable a better understanding of the barriers and facilitators of access to sexual and reproductive health services.
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Affiliation(s)
- Pengdewendé Maurice Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Drissa Sia
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Yentéma Onadja
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Idrissa Beogo
- École des Sciences Infirmières, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Sangli
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Assé Gnambani
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Gaëtan Bassinga
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo, (ISSP/UJKZ), Ouagadougou, Burkina Faso
| | - Stephanie Robins
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
| | - Eric Tchouaket Nguemeleu
- Département Sciences Infirmières, Université du Québec en Outaouais, Saint-Jerôme, Québec, Canada
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Sharma E, Tseng PC, Harden A, Li L, Puthussery S. Ethnic minority women's experiences of accessing antenatal care in high income European countries: a systematic review. BMC Health Serv Res 2023; 23:612. [PMID: 37301860 PMCID: PMC10256965 DOI: 10.1186/s12913-023-09536-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: 01/10/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Women from ethnic minority backgrounds are at greater risk of adverse maternal outcomes. Antenatal care plays a crucial role in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise the recent qualitative evidence on ethnic minority women's experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual framework for access based on women's perspectives. METHODS We conducted a comprehensive search of seven electronic databases in addition to manual searches to identify all qualitative studies published between January 2010 and May 2021. Identified articles were screened in two stages against the inclusion criteria with titles and abstracts screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist and extracted data were synthesised using a 'best fit' framework, based on an existing theoretical model of health care access. RESULTS A total of 30 studies were included in this review. Women's experiences covered two overarching themes: 'provision of antenatal care' and 'women's uptake of antenatal care'. The 'provision of antenatal care' theme included five sub-themes: promotion of antenatal care importance, making contact and getting to antenatal care, costs of antenatal care, interactions with antenatal care providers and models of antenatal care provision. The 'women's uptake of antenatal care' theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, help from others in accessing antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate, and immigration status. A novel conceptual model was developed from these themes. CONCLUSION The findings demonstrated the multifaceted and cyclical nature of initial and ongoing access to antenatal care for ethnic minority women. Structural and organisational factors played a significant role in women's ability to access antenatal care. Participants in majority of the included studies were women newly arrived in the host country, highlighting the need for research to be conducted across different generations of ethnic minority women taking into account the duration of stay in the host country where they accessed antenatal care. PROTOCOL AND REGISTRATION The review protocol was registered on PROSPERO (reference number CRD42021238115).
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Affiliation(s)
- Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square London, EC1V 0HB UK
| | - Leah Li
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
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Rassa N, McCarthy M, Casalotti S, Zhang C, Wurie F, Brown C, Campos-Matos I. The impact of NHS charging regulations on healthcare access and utilisation among migrants in England: a systematic review. BMC Public Health 2023; 23:403. [PMID: 36855082 PMCID: PMC9971664 DOI: 10.1186/s12889-023-15230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The NHS Charges to Overseas Visitors Regulations 2015 outline when healthcare costs should be recuperated from overseas visitors in England. National and global stakeholders have expressed concerns that charging may exacerbate health inequalities and undermine public health efforts especially among vulnerable migrant groups. This review aims to systematically describe the evidence regarding the impact of NHS charging regulations on healthcare access and utilisation and health outcomes for migrants in England. METHODS A systematic search of scientific databases and grey literature sources was performed. Quantitative and qualitative studies, case studies and grey literature published between 1 January 2014 and 1 April 2021 were included. Screening, data extraction and quality appraisal were carried out in accordance with PRISMA guidelines. RESULTS From the 1,459 identified studies, 10 were selected for inclusion. 6 were qualitative, 3 were mixed methods and 1 was quantitative. The evidence is lacking but suggests that fears of charging and data sharing can deter some migrants from accessing healthcare. There is also evidence to suggest a lack of knowledge of the charging regulations among patients and healthcare professionals is contributing to this deterrence. CONCLUSIONS Further independent research supported by strengthening of data collection is required to better understand the effects of charging on healthcare and health outcomes among vulnerable migrants. Our findings support improved training and communication about NHS Charging Regulations for patients and professionals.
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Affiliation(s)
- Nazanin Rassa
- NR. Foundation Year 2 Doctor, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Margaret McCarthy
- Board On Health Sciences Policy, The National Academies of Sciences, Engineering, and Medicine, 500 5Th St NW, Washington, D.C., 20001, USA
| | - Seb Casalotti
- SC. Foundation Year 1 Doctor, Queen's Hospital, Barking Havering and Redbridge University Trust, Romford, UK
| | - Claire Zhang
- CZ. Programme Manager - Population Health Metrics (Inclusion Health), Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Fatima Wurie
- FW. National Migrant Health Lead & Inclusion Health Officer, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK
| | - Colin Brown
- CB. Director of Clinical and Emerging Infections (Interim) & Deputy Director of Clinical & Public Health Group - HCAI, Fungal, AMR, AMU, & Sepsis Division (Interim) Director of WHO Collaborating Centre for Reference & Research On Antimicrobial Resistance and Healthcare Associated Infections, UK Health Security Agency, London, UK
| | - Ines Campos-Matos
- IC. Deputy Director for Inclusion Health, Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, National COVID-19 Epidemiology Team, 39 Victoria Street, London, SW1H 0EU, UK
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Bosó Pérez R, Reid D, Maxwell KJ, Gibbs J, Dema E, Bonell C, Mercer CH, Sonnenberg P, Field N, Mitchell KR. Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:12-20. [PMID: 35444001 PMCID: PMC9062459 DOI: 10.1136/bmjsrh-2021-201413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/05/2022] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Access to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic. METHODS In October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey, a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic quotas. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery. RESULTS Twenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and 'socially-distanced' services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However, some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care. CONCLUSION The COVID-19 pandemic impacted access and quality of SRH services. Participants' accounts revealed self-censorship of need, difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services.
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Affiliation(s)
- Raquel Bosó Pérez
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - David Reid
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections in partnership with Public Health England, University College London, London, UK
| | - Karen J Maxwell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Emily Dema
- Institute for Global Health, University College London, London, UK
| | - Christopher Bonell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Kirstin R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Poppleton A, Howells K, Adeyemi I, Chew‐Graham C, Dikomitis L, Sanders C. The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review. Health Expect 2022; 25:2107-2123. [DOI: 10.1111/hex.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aaron Poppleton
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- School of Medicine Keele University Keele UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| | - Kelly Howells
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | - Isabel Adeyemi
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | | | - Lisa Dikomitis
- Kent and Medway Medical School University of Kent and Canterbury Christ Church University Canterbury UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
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Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: A qualitative study. Women Birth 2021; 35:152-159. [PMID: 34074625 DOI: 10.1016/j.wombi.2021.05.005] [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: 02/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM Childbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall. BACKGROUND Childbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported. AIM The aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers. METHODS A qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data. FINDINGS A total of 20 midwives participated. They self-identified as White British (n=7), Black African (n=7), Black Caribbean (n=3) and Asian (n=3). Most (n=12) had more than 10 years' experience practising as a registered midwife (range 2 - 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented. DISCUSSION Co-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences. CONCLUSION Along with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.
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Deal A, Hayward SE, Huda M, Knights F, Crawshaw AF, Carter J, Hassan OB, Farah Y, Ciftci Y, Rowland-Pomp M, Rustage K, Goldsmith L, Hartmann M, Mounier-Jack S, Burns R, Miller A, Wurie F, Campos-Matos I, Majeed A, Hargreaves S. Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees. J Migr Health 2021; 4:100050. [PMID: 34075367 PMCID: PMC8154190 DOI: 10.1016/j.jmh.2021.100050] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Early evidence confirms lower COVID-19 vaccine uptake in established ethnic minority populations, yet there has been little focus on understanding vaccine hesitancy and barriers to vaccination in migrants. Growing populations of precarious migrants (including undocumented migrants, asylum seekers and refugees) in the UK and Europe are considered to be under-immunised groups and may be excluded from health systems, yet little is known about their views on COVID-19 vaccines specifically, which are essential to identify key solutions and action points to strengthen vaccine roll-out. METHODS We did an in-depth semi-structured qualitative interview study of recently arrived migrants (foreign-born, >18 years old; <10 years in the UK) to the UK with precarious immigration status between September 2020 and March 2021, seeking their input into strategies to strengthen COVID-19 vaccine delivery and uptake. We used the 'Three Cs' model (confidence, complacency and convenience) to explore COVID-19 vaccine hesitancy, barriers and access. Data were analysed using a thematic framework approach. Data collection continued until data saturation was reached, and no novel concepts were arising. The study was approved by the University of London ethics committee (REC 2020.00630). RESULTS We approached 20 migrant support groups nationwide, recruiting 32 migrants (mean age 37.1 years; 21 [66%] female; mean time in the UK 5.6 years [SD 3.7 years]), including refugees (n = 3), asylum seekers (n = 19), undocumented migrants (n = 8) and migrants with limited leave to remain (n = 2) from 15 different countries (5 WHO regions). 23 (72%) of 32 migrants reported being hesitant about accepting a COVID-19 vaccine and two (6%) would definitely not accept a vaccine. Participants communicated concerns over vaccine content, side-effects, lack of accessible information in an appropriate language, lack of trust in the health system and low perceived need. A range of barriers to accessing the COVID-19 vaccine were reported and concerns expressed that their communities would be excluded from or de-prioritised in the roll-out. Undocumented migrants described fears over being charged and facing immigration checks if they present for a vaccine. Participants (n = 10) interviewed after recent government announcements that COVID-19 vaccines can be accessed without facing immigration checks remained unaware of this. Participants stated that convenience of access would be a key factor in their decision around whether to accept a vaccine and proposed alternative access points to primary care services (for example, walk-in centres in trusted places such as foodbanks, community centres and charities), alongside promoting registration with primary care for all, and working closely with communities to produce accessible information on COVID-19 vaccination. CONCLUSIONS Precarious migrants may be hesitant about accepting a COVID-19 vaccine and face multiple and unique barriers to access, requiring simple but innovative solutions to ensure equitable access and uptake. Vaccine hesitancy and low awareness around entitlement and relevant access points could be easily addressed with clear, accessible, and tailored information campaigns, co-produced and delivered by trusted sources within marginalised migrant communities. These findings have immediate relevance to the COVID-19 vaccination initiatives in the UK and in other European and high-income countries with diverse migrant populations. FUNDING NIHR.
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Affiliation(s)
- Anna Deal
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sally E Hayward
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mashal Huda
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Felicity Knights
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Alison F Crawshaw
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Jessica Carter
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Osama B Hassan
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Yasmin Farah
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Yusuf Ciftci
- Doctors of the World UK (Médecins du Monde), London, UK
| | - May Rowland-Pomp
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Kieran Rustage
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - Lucy Goldsmith
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | | | - Sandra Mounier-Jack
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel Burns
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, UK
| | - Anna Miller
- Doctors of the World UK (Médecins du Monde), London, UK
| | - Fatima Wurie
- Health Improvement Directorate, Public Health England, London, UK
| | | | - Azeem Majeed
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Sally Hargreaves
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
| | - on behalf of the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
- The Migrant Health Research Group, Institute for Infection and Immunity, St George's, University of London, UK
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Doctors of the World UK (Médecins du Monde), London, UK
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, UK
- Health Improvement Directorate, Public Health England, London, UK
- Department of Primary Care & Public Health, Imperial College London, London, UK
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