1
|
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.
Collapse
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
| |
Collapse
|
2
|
Ternström E, Akselsson A, Small R, Andersson J, Lindgren H. Obstetric outcomes and uptake of care among 149 non-Swedish speaking migrant women attending a birth preparation visit during pregnancy - An observational study from Sweden. J Migr Health 2024; 9:100226. [PMID: 38596616 PMCID: PMC11002845 DOI: 10.1016/j.jmh.2024.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction In Sweden almost one third of the population is born in another country and a large number of the women who do not speak Swedish are of reproductive age. Women migrating from low-income countries have higher risks for poor obstetric outcomes than receiving country-born citizens. INFOR (a Swedish word for "before" or "ahead of") is an intervention offering language-assisted, individual birth preparation for non-Swedish speaking pregnant women unfamiliar with the maternity care system. The aim of this study was to describe the uptake of care and obstetric outcomes among non-Swedish speaking migrant women attending INFOR. Methods A descriptive study of the obstetric outcomes and uptake of care was conducted of the 149 non-Swedish speaking pregnant women who participated in INFOR between 2016 and 2020. The data were accessed retrospectively from the medical record system Obstetrix and the population-based Swedish Pregnancy Registry and analysed descriptively. Results Women participating in INFOR originated from 44 countries and spoke 35 different languages. During late pregnancy, 20 percent of the women sought care for decreased fetal movements and 80 percent of the women attended the postpartum visit. While the majority of the participants were offered professional language support during pregnancy, almost none had a professional interpreter present during labour and birth. After birth, 80 percent of the primiparous women were asked to rate their birth experience, but only half of the multiparous women were asked. Further, only half of the primiparous women attending the postpartum visit were asked about their self-rated health. Conclusion INFOR may increase uptake of some important aspects of care during pregnancy, birth and postpartum among migrants of diverse backgrounds. The findings raise concerns however about communication support for migrant women, especially during labour and birth. The offer of professional interpreting as part of standard maternity care for women who need it is essential and must be improved in order to provide equitable care for all.
Collapse
Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Akselsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | | | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| |
Collapse
|
3
|
Nagesh N, Ip CHL, Li J, Fan HSL, Chai HS, Fan Y, Wong JY, Fong DY, Lok KYW. Exploring South Asian women's perspectives and experiences of maternity care services: A qualitative evidence synthesis. Women Birth 2024; 37:259-277. [PMID: 38123436 DOI: 10.1016/j.wombi.2023.12.002] [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: 04/03/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The United Nations Women and other sources have highlighted the poor maternal and neonatal care experienced by South Asian women, emphasizing the need to understand the cultural factors and specific experiences that influence their health-seeking behavior. This understanding is crucial for achieving health equity and improving health outcomes for women and infants. OBJECTIVES This study aims to examine and synthesize qualitative evidence on the perspectives and experiences of South Asian women regarding maternity care services in destination countries. METHODS A systematic review was conducted using the Joanna Briggs Institute's approach. Eight databases were searched for studies capturing the qualitative views and experiences of South Asian women - Medline, EMBASE, CINAHL Plus, Global Health, Scopus, PsycInfo, British Nursing Index and the Applied Social Science Index and Abstracts. Qualitative and mixed method studies written in English are included. The methodological quality of the included studies was assessed using the JBI's QARI checklist for qualitative studies and the MMAT checklist for mixed-methods studies. RESULTS Fourteen studies, including twelve qualitative and two mixed-methods studies, were identified and found to be of high methodological quality. The overarching theme that emerged was "navigating cross-cultural maternity care experiences." This theme encapsulates the challenges and complexities faced by South Asian women in destination countries, including ethnocultural and religious differences, communication and language barriers, understanding different medical systems, and the impact of migration on their maternity care experiences. CONCLUSIONS South Asian migrant women often have expectations that differ from the services provided in destination countries, leading to challenges in their social relationships. Communication and language barriers pose additional obstacles that can be addressed through strategies promoting better communication and culturally sensitive care. To enhance the utilization of maternity healthcare services, it is important to address these factors and provide personalized, culturally sensitive care for South Asian migrant women.
Collapse
Affiliation(s)
- Nitya Nagesh
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Caroline Hoi Lam Ip
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Junyan Li
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Heidi Sze Lok Fan
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Hung Sze Chai
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Yingwei Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Janet Yh Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong
| | - Daniel Yt Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Kris Yuet-Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
| |
Collapse
|
4
|
Oommen H, Esse L, Sajer S, Lukasse M. Somali women's perceptions and experiences of pain and pain relief during childbirth in Norway: A qualitative study. Eur J Midwifery 2024; 8:EJM-8-05. [PMID: 38323166 PMCID: PMC10845056 DOI: 10.18332/ejm/176034] [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: 10/25/2023] [Revised: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Research shows that Somali women are less likely to receive epidural analgesia for labor pain compared to non-immigrant women in Norway. It is unclear why. This study aimed to explore the perceptions and experiences of Somali women regarding pain relief during childbirth. METHODS In January 2023, semi-structured interviews were conducted with 10 Somali women who had lived in Norway for at least ten years and given birth within the past 12 months. Data were analyzed using thematic content analysis as described by Graneheim and Lundman. RESULTS Three themes emerged from the data: a cultural understanding of epidural analgesia, religious and cultural coping strategies, and the midwife's role during labor. The participants expressed that there is a prevalent understanding in the Somali community that epidural analgesia in childbirth subsequently causes physical problems. Participants felt the influence of friends and family, expressed the need for culturally adapted information prior to labor, and concluded that, ultimately, what they decided upon was their own choice. They emphasized the belief that women were designed by God for childbirth. Prayer and placing oneself in God's hands were mentioned as pain management strategies. Nevertheless, the Somali women highlighted the importance of having a culturally competent midwife who is present when needed, creates trust, and provides information and access to different methods of pain relief, including epidural analgesia. CONCLUSIONS Understanding Somali women's cultural and religious background while listening to individual needs for information and pain relief is essential to ensure a positive birth experience for women from a Somali background.
Collapse
Affiliation(s)
- Hanna Oommen
- Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway
- Center for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Leila Esse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Sanabel Sajer
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Center for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
5
|
Ternström E, Small R, Lindgren H. Migrant women's experiences of an individual language-assisted information and support visit to the labor ward before giving birth - A qualitative study from Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 38:100915. [PMID: 37717410 DOI: 10.1016/j.srhc.2023.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 08/10/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Migrant women are less likely to receive an individualized maternal care where they feel safe, informed and supported but few measures have been undertaken to meet their needs. In Södertälje municipality in Sweden, community-based antenatal care midwives identify migrant women and offer them and their partners language-assisted information and support through an individual two-hour-visit to the labor ward. The aim of the present study was to explore migrant women's experiences of antenatal care including receiving language-assisted information and support during pregnancy through a two-hour INFOR-visit to the labor ward. METHODS Semi-structured interviews were conducted with 10 non-Swedish speaking migrant women, using an interpreter. Interview analysis was conducted using reflexive thematic analysis. RESULTS The individualized support, including thorough information given with language support available, sufficient time for questions and discussion, and a caring approach - did appear to inform and reassure the women. Overall, they felt that they were seen and treated as individuals during both pregnancy and birth and that their specific needs were listened to and met by the health care providers. Having professional interpreters was seen as essential for receiving the right information, something achieved at the individual visit. CONCLUSIONS The findings from this study provide evidence that a two-hour-visit to the labor ward during pregnancy has potential to empower migrant women during pregnancy and birth and to improve their experiences of maternity care. The two-hour-visit is a relatively simple intervention with the potential of not only improving migrant women's experiences of pregnancy and birth, but also their medical outcomes.
Collapse
Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helena Lindgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Sophiahemmet University, Stockholm, Sweden.
| |
Collapse
|
6
|
Essén B, Eriksson L. Paradoxes in the cultural doula concept for migrant women: Implications for gender-inclusive care versus migrant-friendly maternity care. Midwifery 2023; 126:103805. [PMID: 37714043 DOI: 10.1016/j.midw.2023.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Swedish healthcare policies promote gender equality, shared parenting and cultural diversity. In response to the risk of adverse outcomes for migrant women, cultural doulas were introduced as support for migrant women during pregnancy and/or labour. The aim is to investigate potential tensions in the cultural doula concept in relation to policies of gender equality and diversity. DESIGN An interview study was designed to analyse perceptions of the cultural doula concept among healthcare providers in Swedish sexual and reproductive healthcare. Through the framework of Bacchi's approach 'What Is the Problem Represented to Be?' and Hochschild's concept of 'global care chains', we analyzed whether the introduction of the cultural doula concept is in line with the policies of gender equality and culturally sensitive care by exploring paradoxes, unintended consequences and what was not reflected upon. SETTING AND PARTICIPANTS Semi-structured interviews (n = 18) with midwives and obstetricians at hospitals in two Swedish counties during 2022. MEASUREMENTS AND FINDINGS The interviews were analyzed through thematic analysis. Cultural doulas were perceived as multi-tasking resources for facilitating integration and providing healthcare information and psychosocial support. Respondents did not identify doula support as a cultural practice in migrants' origin countries. Despite awareness of cultural differences in gender norms, many respondents stated that doula support included male partners. KEY CONCLUSIONS The cultural doula concept includes paradoxes in relation to gender equality and diversity. Rather than empowering migrant women, the cultural doula concept is related to gendered patterns of low-educated, underpaid care work. Labour support interventions including migrant women's social network and intensified partner involvement would be more in line with Swedish policies of gender equality, shared parenting and cultural sensitivity when needed. However, doulas may be an imperfect solution for women lacking partners or social networks, for example, newly arrived migrant women, if no support is to be found within the perinatal care system. IMPLICATIONS FOR PRACTICE Midwives and obstetricians need reflexivity about what the problem is represented to be when it comes to gender equality and cultural sensitivity in their collaboration with cultural doulas, boundaries between roles, how they handle confidentiality, and why cultural doulas are needed in relation to migrant women's integration.
Collapse
Affiliation(s)
- Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala SE-751 85, Sweden
| | - Lise Eriksson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala SE-751 85, Sweden; Faculty of Social Sciences, Business and Economics, Åbo Akademi University, Vänrikinkatu 3 B, Turku FI-20500, Finland.
| |
Collapse
|
7
|
Awuah WA, Adebusoye FT, Ferreira T, Azeem S, Bharadwaj HR, Akpan AA, Wellington J, Zia MR, Kumar H, Khalid A, Abdul-Rahman T, Isik A. The unmet surgical needs of global refugee populations: A perspective review. SAGE Open Med 2023; 11:20503121231204492. [PMID: 37829288 PMCID: PMC10566266 DOI: 10.1177/20503121231204492] [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: 05/28/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
The global refugee community, including those forced to flee due to persecution, conflict, or violence, faces significant challenges in accessing healthcare, resulting in a higher prevalence of surgical disease. These challenges have a profound impact on morbidity and mortality rates, particularly in low- and middle-income countries where many immigrants seek refuge. Limited availability of medical facilities, an inadequate surgical workforce, financial constraints and linguistic and cultural barriers all contribute to reduced access to healthcare. Limited access to competent healthcare leads to poor health outcomes, increased morbidity and mortality rates and suboptimal surgical results for refugees. To address these challenges, a multifaceted approach is necessary. This includes increased funding for healthcare initiatives, workforce recruitment and training and improved coordination between aid organisations and local healthcare systems. Strategies for managing surgical conditions in the global refugee community encompass the development of targeted public health programmes, removing legal barriers, establishing healthcare facilities to enhance surgical access and prioritising disease prevention among refugees.
Collapse
Affiliation(s)
| | | | - Tomas Ferreira
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Saleha Azeem
- King Edward Medical University, Lahore, Pakistan
| | | | | | | | | | | | - Amna Khalid
- King Edward Medical University, Lahore, Pakistan
| | | | - Arda Isik
- Department of General Surgery, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
8
|
Merry L, Kim YN, Urquia ML, Goulet J, Villadsen SF, Gagnon A. Transnational prenatal care among migrant women from low-and-middle-income countries who gave birth in Montreal, Canada. BMC Pregnancy Childbirth 2023; 23:292. [PMID: 37101137 PMCID: PMC10131434 DOI: 10.1186/s12884-023-05582-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVES There is little research examining transnational prenatal care (TPC) (i.e., prenatal care in more than one country) among migrant women. Using data from the Migrant-Friendly Maternity Care (MFMC) - Montreal project, we aimed to: (1) Estimate the prevalence of TPC, including TPC-arrived during pregnancy and TPC-arrived pre-pregnancy, among recently-arrived migrant women from low- and middle-income countries (LMICs) who gave birth in Montreal, Canada; (2) Describe and compare the socio-demographic, migration and health profiles and perceptions of care during pregnancy in Canada between these two groups and migrant women who received no TPC (i.e., only received prenatal care in Canada); and (3) Identify predictors of TPC-arrived pre-pregnancy vs. No-TPC. METHODS The MFMC study used a cross-sectional design. Data were gathered from recently-arrived (< 8 years) migrant women from LMICs via medical record review and interview-administration of the MFMC questionnaire postpartum during the period of March 2014-January 2015 in three hospitals, and February-June 2015 in one hospital. We conducted a secondary analysis (n = 2595 women); descriptive analyses (objectives 1 & 2) and multivariable logistic regression (objective 3). RESULTS Ten percent of women received TPC; 6% arrived during pregnancy and 4% were in Canada pre-pregnancy. The women who received TPC and arrived during pregnancy were disadvantaged compared to women in the other two groups (TPC-arrived pre-pregnancy and No-TPC women), in terms of income level, migration status, French and English language abilities, access barriers to care and healthcare coverage. However, they also had a higher proportion of economic migrants and they were generally healthier compared to No-TPC women. Predictors of TPC-arrived pre-pregnancy included: 'Not living with the father of the baby' (AOR = 4.8, 95%CI 2.4, 9.8), 'having negative perceptions of pregnancy care in Canada (general experiences)' (AOR = 1.2, 95%CI 1.1, 1.3) and younger maternal age (AOR = 1.1, 95%CI 1.0, 1.1). CONCLUSION Women with more capacity may self-select to migrate during pregnancy which results in TPC; these women, however, are disadvantaged upon arrival, and may need additional care. Already-migrated women may use TPC due to a need for family and social support and/or because they prefer the healthcare in their home country.
Collapse
Affiliation(s)
- Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Canada.
| | - Ye Na Kim
- Faculty of Nursing, University of Montreal, Montreal, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Goulet
- School of Psychoeducation, University of Montreal, Montreal, Canada
| | | | - Anita Gagnon
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
9
|
Cuadrado C, Libuy M, Moreno-Serra R. What is the impact of forced displacement on health? A scoping review. Health Policy Plan 2023; 38:394-408. [PMID: 36629500 PMCID: PMC10019572 DOI: 10.1093/heapol/czad002] [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: 07/08/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
While there is a broad literature analysing the effects of migration on health, important knowledge gaps persist particularly on the causal effects of forced displacement on health outcomes. We undertake a scoping review of applied epidemiological, statistical and econometric studies examining causal health impacts of forced displacement, which initially identified 1454 studies from the health and social sciences disciplines published up to May 2021. Our study makes two key contributions. First, we offer a comprehensive overview of the evidence generated, methodologies adopted and analytical challenges faced by current research examining the causal relationship between forced displacement and health. Second, we present concrete examples of how key challenges around study design and estimation approaches influence the strength of the evidence-base on the topic, using as a case study the broad domain of reproductive health. We find that, beyond the increased mortality risk that can be attributed to forced displacement, most of the available empirical evidence for a wide range of health outcomes is prone to substantial bias, making it difficult to draw firm conclusions. Our synthesis of credible studies conducted in different settings indicates that current research practice in the field could be strengthened through selection of valid control groups and application of more appropriate causal inference methods. Our findings are useful to promote the generation of further evidence on the topic that can reliably inform the design of policies to protect the health of displaced populations.
Collapse
Affiliation(s)
| | - Matías Libuy
- Escuela de Salud Pública, Universidad de Chile, Av. Independencia 939, Independencia, Santiago, Chile
| | - Rodrigo Moreno-Serra
- *Corresponding author. Centre for Health Economics, University of York, Alcuin A Block, Heslington, York YO10 5DD, UK. E-mail:
| |
Collapse
|
10
|
Ahrne M, Byrskog U, Essén B, Andersson E, Small R, Schytt E. Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project. BMJ Open 2023; 13:e066000. [PMID: 36697050 PMCID: PMC9884917 DOI: 10.1136/bmjopen-2022-066000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Comparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures. DESIGN A quasi-experimental trial with one intervention and one historical control group, nested in an intervention development and feasibility study. SETTING Midwifery-led antenatal care clinic in a mid-sized Swedish town. PARTICIPANTS Pregnant Somali-born women (<25 gestational weeks); 64 women in gANC and 81 in sANC. INTERVENTION Language-supported gANC (2017-2019). Participants were offered seven 60-minute group sessions with other Somali-born women led by one to two midwives, in addition to 15-30 min individual appointments with their designated midwife. OUTCOMES Primary outcomes were women's overall ratings of antenatal care and emotional well-being (Edinburgh Postnatal Depression Scale (EPDS)) in gestational week ≥35 and 2 months post partum. Secondary outcomes were specific care experiences, information received, social support, knowledge of pregnancy danger signs and obstetric outcomes. RESULTS Recruitment and retention of participants were challenging. Of eligible women, 39.3% (n=106) declined to participate. No relevant differences regarding overall ratings of antenatal care between the groups were detected (late pregnancy OR 1.42, 95% CI 0.50 to 4.16 and 6-8 weeks post partum OR 2.71, 95% CI 0.88 to 9.41). The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference -1.89; 95% CI -3.73 to -0.07). Women in gANC were happier with received pregnancy and birth information, for example, caesarean section where 94.9% (n=37) believed the information was sufficient compared with 17.5% (n=7) in standard care (p<0.001) in late pregnancy. CONCLUSIONS This evaluation suggests potential for language-supported gANC to improve knowledge acquisition among pregnant Somali-born women with residence in Sweden ˂10 years. An adequately powered randomised trial is needed to evaluate the effectiveness of the intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03879200).
Collapse
Affiliation(s)
- Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Byrskog
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Birgitta Essén
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Nursing and Midwifery, Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Erica Schytt
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Department of Health and Caring sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
11
|
Agunwamba AA, Finney Rutten LJ, St Sauver JL, Agunwamba AO, Jacobson DJ, McGree ME, Njeru JW. Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota. J Racial Ethn Health Disparities 2022; 9:1765-1774. [PMID: 34309817 PMCID: PMC9550004 DOI: 10.1007/s40615-021-01113-5] [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: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County. METHODS We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women. RESULTS Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63). CONCLUSION The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.
Collapse
Affiliation(s)
- Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
| | | | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
12
|
Ahrne M, Byrskog U, Essén B, Andersson E, Small R, Schytt E. Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation. BMC Pregnancy Childbirth 2022; 22:721. [PMID: 36131237 PMCID: PMC9494829 DOI: 10.1186/s12884-022-05044-9] [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: 07/07/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo (“mother” in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors. Methods A process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8). Results Language-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC. Conclusions The Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided. Trial registration The study was registered in ClinicalTrials.gov (Identifier: NCT03879200).
Collapse
Affiliation(s)
- Malin Ahrne
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Birgitta Essén
- Women's and Children's Health, IMCH, Uppsala University, Uppsala, Sweden
| | - Ewa Andersson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Erica Schytt
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
13
|
Guðmundsdóttir EÝ, Nieuwenhuijze M, Einarsdóttir K, Hálfdánsdóttir B, Gottfreðsdóttir H. Use of pain management in childbirth among migrant women in Iceland: A population-based cohort study. Birth 2022; 49:486-496. [PMID: 35187714 PMCID: PMC9545143 DOI: 10.1111/birt.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Immigration is rapidly increasing in Iceland with 13.6% of the population holding foreign citizenship in 2020. Earlier findings identified inequities in childbirth care for some women in Iceland. To gain insight into the quality of intrapartum midwifery care, migrant women's use of pain management methods during birth in Iceland was explored. METHODS A population-based cohort study including all women with a singleton birth in Iceland between 2007 and 2018, in total 48 173 births. Logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the relationship between migrant backgrounds defined as holding foreign citizenship and the use of pain management during birth. The main outcome measures were use of nonpharmacological and pharmacological pain management methods. RESULTS Data from 6097 migrant women were included. Migrant women had higher adjusted OR (aORs) for no use of pain management (aOR = 1.23 95% CI [1.12, 1.34]), when compared to Icelandic women. Migrant women also had lower aORs for the use of acupuncture (0.73 [0.64, 0.83]), transcutaneous electrical nerve stimulation (TENS) (0.92 [0.01, 0.67]), shower/bath (0.73 [0.66, 0.82]), aromatherapy (0.59 [0.44, 0.78]), and nitrous oxide inhalation (0.89 [0.83, 0.96]). Human Development Index (HDI) scores of countries of citizenship <0.900 were associated with lower aORs for the use of various pain management methods. CONCLUSIONS Our results suggest that being a migrant in Iceland is an important factor that limits the use of nonpharmacological pain management, especially for migrant women with citizenship from countries with HDI score <0.900.
Collapse
Affiliation(s)
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery ScienceAcademie Verloskunde MaastrichtZuydThe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
| | - Kristjana Einarsdóttir
- Faculty of MedicineCentre of Public Health SciencesUniversity of IcelandReykjavíkIceland
| | | | - Helga Gottfreðsdóttir
- Department of MidwiferyFaculty of NursingUniversity of IcelandReykjavíkIceland,Department of Obstetrics and GynecologyWomen's ClinicLandspítali University HospitalReykjavíkIceland
| |
Collapse
|
14
|
Peters P, Harding C, Forde S, Heckendorf N, Seal A. Exploring barriers to domestic violence screening among culturally and linguistically diverse and migrant women in a regional midwifery setting. Midwifery 2022; 114:103454. [PMID: 35995008 DOI: 10.1016/j.midw.2022.103454] [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: 06/01/2020] [Revised: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women are at an increased risk of experiencing domestic violence (DV) from an intimate partner during the antenatal and post-partum period, contributing to poorer health outcomes for mother and baby. The antenatal period presents a critical window of opportunity for screening and intervention. In Australia, screening guidelines vary across state and territory health departments. NSW Health has introduced compulsory antenatal DV screening, however, screening appears to be more commonly deferred for women of CALD and non-English speaking backgrounds suggesting barriers to screening. AIM To identify barriers to undertaking DV screening of culturally and linguistically diverse (CALD) and migrant women in a regional setting METHODS: Qualitative semi-structured interviews were conducted with midwives who undertook antenatal DV assessment at a regional hospital in rural New South Wales serving a high CALD and migrant population. FINDINGS Eleven midwives participated in the interviews. Four emergent themes were apparent as barriers to DV screening: communications challenges, including literacy and use of interpreters, issues with maternity services including lack of flexibility and continuity, a woman's family issues and cultural difficulties. CONCLUSION The antenatal period presents a critical window for screening and intervention for those living with intimate partner violence from CALD and migrant groups. While it is acknowledged that there are complex language, maternity service, family and cultural barriers that impact on the ability to undertake screening in a regional setting, recognising these is the first step in addressing them and being able to intervene to break the DV cycle.
Collapse
Affiliation(s)
- Priscilla Peters
- The University of Notre Dame Australia, School of Medicine Sydney, Rural Clinical School, PO Box 5050, Wagga Wagga NSW 2650 Australia
| | - Catherine Harding
- The University of Notre Dame Australia, School of Medicine Sydney, Rural Clinical School, PO Box 5050, Wagga Wagga NSW 2650 Australia
| | - Sandra Forde
- Murrumbidgee Local Health District, Level 1, Surgical Services Block, Wagga Wagga Base Hospital, Edward St, Wagga Wagga, NSW 2650 Australia
| | - Narelle Heckendorf
- Murrumbidgee Local Health District, Level 1, Surgical Services Block, Wagga Wagga Base Hospital, Edward St, Wagga Wagga, NSW 2650 Australia
| | - Alexa Seal
- The University of Notre Dame Australia, School of Medicine Sydney, Rural Clinical School, PO Box 5050, Wagga Wagga NSW 2650 Australia.
| |
Collapse
|
15
|
Taraldsen S, Vangen S, Øian P, Sørbye IK. Risk of obstetric anal sphincter injury associated with female genital mutilation/cutting and timing of deinfibulation. Acta Obstet Gynecol Scand 2022; 101:1163-1173. [PMID: 35946127 PMCID: PMC9812199 DOI: 10.1111/aogs.14424] [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: 01/16/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION A greater risk of obstetric anal sphincter injury has been reported among African migrants in several host countries compared with the general population. To what degree female genital mutilation/cutting affects this risk is not clear. In infibulated women, deinfibulation prevents anal sphincter injury. Whether the timing of deinfibulation affects the risk, is unknown. This study aimed to investigate the risks of anal sphincter injury associated with female genital mutilation/cutting and timing of deinfibulation in Norway, and to compare the rates of anal sphincter injury in Somali-born women and the general population. MATERIAL AND METHODS In a historical cohort study, nulliparous Somali-born women who had a vaginal birth in the period 1990-2014 were identified by the Medical Birth Registry of Norway and data collected from medical records. Exposures were female genital mutilation/cutting status and deinfibulation before labor, during labor or no deinfibulation. The main outcome was obstetric anal sphincter injuries. RESULTS Rates of obstetric anal sphincter injury did not differ significantly by female genital mutilation/cutting status (type 1-2: 10.2%, type 3: 11.3%, none: 15.2% P = 0.17). The total rate of anal sphincter injury was 10.3% compared to 5.0% among nulliparous women in the general Norwegian population. Women who underwent deinfibulation during labor had a lower risk than women who underwent deinfibulation before labor (odds ratio 0.48, 95% confidence interval 0.27-0.86, P = 0.01). CONCLUSIONS The high rate of anal sphincter injury in Somali nulliparous women was not related to type of female genital mutilation/cutting. Deinfibulation during labor protected against anal sphincter injury, whereas deinfibulation before labor was associated with a doubled risk. Deinfibulation before labor should not be routinely recommended during pregnancy.
Collapse
Affiliation(s)
- Sølvi Taraldsen
- Norwegian Research Center for Women's Health, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloNorway
| | - Siri Vangen
- Norwegian Research Center for Women's Health, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway,Institute of Clinical MedicineUniversity of OsloNorway
| | - Pål Øian
- Department of Obstetrics and GynecologyUniversity Hospital of North NorwayTromsøNorway
| | - Ingvil K. Sørbye
- Norwegian Research Center for Women's Health, Division of Obstetrics and GynecologyOslo University HospitalOsloNorway,Department of Obstetrics and GynecologyOslo University HospitalOsloNorway
| |
Collapse
|
16
|
Vik ES, Hashi RMA, Hamud ME, Aasheim V, Kringeland T, Aasekjær K. Migrant Somali women’s experiences with their first contact with the labor ward prior to admission: A qualitative study. Eur J Midwifery 2022; 6:45. [PMID: 35958805 PMCID: PMC9302448 DOI: 10.18332/ejm/150584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The first contact with the labor ward is a crucial moment in any birth and can be especially challenging when the woman has a migrant background. The aim of the study was to explore migrant Somali women’s experiences with their first contact with the labor ward prior to admission, in Norway. METHODS In this qualitative study, data were collected through semi-structured individual interviews and Systematic Text Condensation was the method used to analyze the data. Ten Somali-born women who had given birth in Norway were included. RESULTS The migrant Somali women’s first contact with the labor ward prior to admission was challenging, due to one-way communication, poor health literacy, and a fear of interventions or adverse outcomes. To improve care, the migrant Somali women highlighted a need for: 1) flexibility, tailored information and practical guidance before birth; and 2) face-to-face assessment in early labor. CONCLUSIONS The findings in this study indicate that the needs of laboring migrant Somali women are not fully met by antenatal or pre-hospital maternity care services. To improve the critical first contact with the labor ward for migrant Somali women, this study suggests that antenatal care services offer practical guidance on whom to contact and what to expect at the hospital in early labor. Face-to-face assessment of maternal and fetal well-being should be the first choice of care for Somali women in early labor who are unfamiliar with the healthcare system after immigration. Interpretation services need strengthening and our findings support a need for increased continuity of care.
Collapse
Affiliation(s)
- Eline S. Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Randa M. A. Hashi
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Maryam E. Hamud
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tone Kringeland
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Katrine Aasekjær
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
17
|
Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Prinds C, Vaismoradi M. Perinatal and Neonatal Outcomes in Immigrants From Conflict-Zone Countries: A Systematic Review and Meta-Analysis of Observational Studies. Front Public Health 2022; 10:766943. [PMID: 35359776 PMCID: PMC8962623 DOI: 10.3389/fpubh.2022.766943] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives There are controversies regarding the risk of adverse pregnancy outcomes among immigrants from conflict-zone countries. This systematic review and meta-analysis aimed to investigate the risk of perinatal and neonatal outcomes among immigrants from conflict-zone countries compared to native-origin women in host countries. Methods A systematic search on the databases of PubMed/MEDLINE, Scopus, and Web of Science was carried out to retrieve studies on perinatal and neonatal outcomes among immigrants from Somalia, Iraq, Afghanistan, Yemen, Syria, Nigeria, Sudan, Ethiopia, Eritrea, Kosovo, Ukraine, and Pakistan. Only peer-reviewed articles published in the English language were included in the data analysis and research synthesis. The odds ratio and forest plots were constructed for assessing the outcomes of interests using the DerSimonian and Laird, and the inverse variance methods. The random-effects model and the Harbord test were used to account for heterogeneity between studies and assess publication bias, respectively. Further sensitivity analysis helped with the verification of the reliability and stability of our review results. Results The search process led to the identification of 40 eligible studies involving 215,718 pregnant women, with an immigration background from the conflict zone, and 12,806,469 women of native origin. The adverse neonatal outcomes of the risk of small for gestational age (Pooled OR = 1.8, 95% CI = 1.6, 2.1), a 5-min Apgar score <7 (Pooled OR = 1.4, 95% CI = 1.0, 2.1), stillbirth (Pooled OR = 1.9, 95% CI = 1.2, 3.0), and perinatal mortality (Pooled OR = 2, 95% CI = 1.6, 2.5) were significantly higher in the immigrant women compared to the women of native-origin. The risk of maternal outcomes, including the cesarean section (C-S) and emergency C-S, instrumental delivery, preeclampsia, and gestational diabetes was similar in both groups. Conclusion Although the risk of some adverse maternal outcomes was comparable in the groups, the immigrant women from conflict-zone countries had a higher risk of neonatal mortality and morbidity, including SGA, a 5-min Apgar score <7, stillbirth, and perinatal mortality compared to the native-origin population. Our review results show the need for the optimization of health care and further investigation of long-term adverse pregnancy outcomes among immigrant women.
Collapse
Affiliation(s)
- Samira Behboudi-Gandevani
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- *Correspondence: Samira Behboudi-Gandevani
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark
- Department of Midwifery Education, University College South Denmark, Esbjerg, Denmark
| | | |
Collapse
|
18
|
Konje JK, Konje JC. Experiences of accessing maternity care in the UK: Perspectives from Somali migrant women in Leicester. Eur J Midwifery 2021; 5:56. [PMID: 34966891 PMCID: PMC8667475 DOI: 10.18332/ejm/143167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Migrant women born in Somalia often have poorer pregnancy outcomes. Access to care around pregnancy is vital to improve outcomes. The views and experiences of Somali migrant women accessing maternity care in the UK have not been extensively explored. This study therefore explores and describes these with regard to accessing maternity care in the UK, with the hope of gaining a better understanding of perceptions and factors that influence their access to care around pregnancy. METHODS A qualitative approach was used to investigate the views and experiences of women born in Somalia who had migrated to Leicester. Data collected were transcribed and analyzed using a constant comparison method. The software package Nvivo 10 was used to organize themes, and verbatim quotes were used to support their interpretation. RESULTS Main finings included: 1) positive attitudes of community midwives and availability lead to positive and meaningful experiences; 2) language difficulties and ineffective communication are barriers to effective access; 3) lack of cultural awareness and preconceived ideas by some hospital caregivers makes them unsupportive and insensitive; 4) need for continuity of care and the provision of resources are needed to build important trusting relationships with care providers; and 5) personal, community and religious factors impact access to care. CONCLUSIONS The results highlight a number of important potential barriers to accessing care around pregnancy for migrant women born in Somalia and how these could be addressed to improve pregnancy outcomes.
Collapse
Affiliation(s)
| | - Justin C Konje
- Obstetrics and Gynaecology, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| |
Collapse
|
19
|
Contag S, Nardos R, Buhimschi IA, Almanza J. Population based cohort study of fetal deaths, and neonatal and perinatal mortality at term within a Somali diaspora. BMC Pregnancy Childbirth 2021; 21:740. [PMID: 34719388 PMCID: PMC8559350 DOI: 10.1186/s12884-021-04163-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Somali women deliver at greater gestational age with limited information on the associated perinatal mortality. Our objective is to compare perinatal mortality among Somali women with the population rates. Methods This is a retrospective cohort study from all births that occurred in Minnesota between 2011 and 2017. Information was obtained from certificates of birth, and neonatal and fetal death. Data was abstracted from 470,550 non-anomalous births ≥37 and ≤ 42 weeks of gestation. The study population included U.S. born White, U.S. born Black, women born in Somalia or self-identified as Somali, and women who identified as Hispanic regardless of place of birth (377,426). We excluded births < 37 weeks and > 42 weeks, > 1 fetus, age < 18 or > 45 years, or women of other ethnicities. The exposure was documented ethnicity or place of birth, and the outcomes were live birth, fetal death, neonatal death prior to 28 days, and perinatal mortality rates. These were calculated using binomial proportions with 95% confidence intervals and compared using odds ratios adjusted (aOR) for diabetes, hypertension and maternal body mass index. Results The aOR [95%CI] for stillbirth rate in the Somali cohort was greater than for U.S. born White (2.05 [1.49–2.83]) and Hispanic women (1.90 [1.30–2.79]), but similar to U.S. born Black women (0.88 [0.57–1.34]). Neonatal death rates were greater than for U.S. born White (1.84 [1.36–2.48], U.S. born Black women (1.47 [1.04–2.06]) and Hispanic women (1.47 [1.05–2.06]). This did not change after analysis was restricted to those with spontaneous onset of labor. When analyzed by week, at 42 weeks Somali aOR for neonatal death was the same as for U.S. born White women, but compared against U.S. born Black and Hispanic women, was significantly lower. Conclusions The later mean gestational age at delivery among women of Somali ethnicity is associated with greater overall risk for stillbirth and neonatal death rates at term, except compared against U.S. born Black women with whom stillbirth rates were not different. At 42 weeks, Somali neonatal mortality decreased and was comparable to that of the U.S. born White population and was lower than that of the other minorities. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04163-z.
Collapse
Affiliation(s)
- Stephen Contag
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Rahel Nardos
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Global Women's Health, Center for Global Health and Social Responsibility, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Irina A Buhimschi
- Department of Obstetrics & Gynecology, University of Illinois at Chicago College of Medicine, Chicago, IL, 60612, USA
| | - Jennifer Almanza
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota School of Medicine, Medical School MMC 395, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| |
Collapse
|
20
|
Bains S, Skråning S, Sundby J, Vangen S, Sørbye IK, Lindskog BV. Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway. BMC Pregnancy Childbirth 2021; 21:686. [PMID: 34620114 PMCID: PMC8495671 DOI: 10.1186/s12884-021-04131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrant women are at increased risk for complications related to pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services. METHODS In the mixed-method MiPreg-study, we included recently migrated (≤ five years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our findings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers. RESULTS Four main themes of challenges and barriers faced by the migrant women were identified: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identified a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conflicting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the first trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health. CONCLUSION A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psychosocial support and strengthening diversity- and intercultural competence training among healthcare personnel.
Collapse
Affiliation(s)
- Sukhjeet Bains
- Department of Obstetrics and Gynecology, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet; PO box 4950 Nydalen, 0424, Oslo, Norway. .,Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Susanne Skråning
- Department of labour, Welfare and Local Communites, Stovner District, City of Oslo, Oslo, Norway
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Siri Vangen
- Department of Obstetrics and Gynecology, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet; PO box 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvil K Sørbye
- Department of Obstetrics and Gynecology, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet; PO box 4950 Nydalen, 0424, Oslo, Norway
| | - Benedikte V Lindskog
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
21
|
Flanagan J, Mann S. Beginning to Optimize Peripartum Care for Somalia-Born Women by Evaluating Labor, Postpartum and Neonatal Outcomes in the Somali Population Delivering at a Tertiary Care Center in Vermont. J Immigr Minor Health 2021; 22:1017-1022. [PMID: 32279156 DOI: 10.1007/s10903-020-01008-3] [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: 11/28/2022]
Abstract
Vermont has a large population of Somali immigrants and previous research has shown outcome disparities in this population. Labor curves, pregnancy and delivery outcomes information is required and critical to optimize current labor management in an institution that provides obstetrical care for this population. Data were collected for both Somalia-born and non Somalia-born parturients in pre-pregnancy, pregnancy, delivery, neonatal and cervical change categories and were compared to non Somalia-born parturients to observe differences in demographic factors and outcomes as well as labor progress. Overall labor length trended differently between the two groups, the rate of preterm birth in the vaginal delivery group in the Somali population was much lower than the unmatched control group and overall more lacerations were noted. Findings are consistent with prior studies related to reduced preterm birth rate in Somalia-born women. Observation regarding refusal of care demonstrates need for targeted research related to concerns of Somali immigrants.
Collapse
Affiliation(s)
- Jenna Flanagan
- Department of Obstetrics and Gynecology, University of Vermont Medical Center, Burlington, VT, USA.
| | - Stephanie Mann
- Department of Maternal Fetal Medicine, University of Vermont Medical Center, Burlington, VT, USA
| |
Collapse
|
22
|
Implementation, Mechanisms and Context of the MAMAACT Intervention to Reduce Ethnic and Social Disparity in Stillbirth and Infant Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168583. [PMID: 34444335 PMCID: PMC8391863 DOI: 10.3390/ijerph18168583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022]
Abstract
The MAMAACT intervention aimed to address ethnic and social disparity in stillbirth and infant health by improving management of pregnancy complications. This process evaluation of the intervention was guided by the British Medical Research Council’s framework. We examined implementation through dose, reach, and fidelity, important mechanisms and the influence of contextual factors. The intervention included a six-hour training session for antenatal care (ANC) midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials (leaflet and app) on warning signs of severe pregnancy complications and how to respond for pregnant women. A mixed-methods approach was applied. Cross-sectional survey data and administrative data were used to assess intervention reach and dose. Qualitative data (records from dialogue meetings with midwives, participant observations and field notes from ANC visits, focus group interviews with midwives, and individual interviews with non-Western immigrant women) evaluated intervention fidelity, mechanisms, and contextual barriers. More than 80% of women received the MAMAACT leaflet and many found the content useful. The app was used more selectively. Midwives described being more aware and reflective in their communication with women from various cultural backgrounds. Organizational factors in ANC (time pressure, lack of flexibility in visits, poor interpreter services), barriers in women’s everyday life (lack of social network, previous negative experiences/lack of trust and domestic responsibilities), and habitual interaction patterns among midwives served as contextual barriers. The reach of the intervention was high and it was evaluated positively by both pregnant women and midwives. Organizational factors hindered changes towards more needs-based communication in ANC potentially hindering the intended mechanisms of the intervention. When interpreting the intervention effects, attention should be drawn to both organizational and interpersonal factors in the clinic as well as the pregnant women’s life situations.
Collapse
|
23
|
Garnica-Rosas L, Granich-Armenta A, Guerra Y Guerra G, Sánchez-Dominguez M, Lamadrid-Figueroa H. Perinatal Outcomes Among Venezuelan Immigrants in Colombia: A Cross-Sectional Study. J Immigr Minor Health 2021; 23:976-985. [PMID: 34363575 PMCID: PMC8346779 DOI: 10.1007/s10903-021-01248-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration. One of the most vulnerable migrants´ groups is pregnant women. We analyzed the perinatal outcomes of Venezuelan migrants in Colombia and identified if migration was associated with perinatal outcomes. Birth data were obtained from the 2017 Colombian national birth registry (1085 births in migrants and 654,829 in Colombians). Logistic and linear regression models were used to identify the association between the demographic, obstetric and neonatal characteristics with premature birth (PB), low birth weight (LBW), 1-min, and 5-min Apgar score. Venezuelan were more likely to have newborns with LBW, lower Apgar scores at 1-min and 5-min in comparison to Colombians. Furthermore, a difference was observed in the low health insurance coverage and antenatal care visits among Venezuelan in comparison to natives. Access to health care services for the migrants is desirable for the improvement of perinatal health conditions.
Collapse
Affiliation(s)
- Lina Garnica-Rosas
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | - Adriana Granich-Armenta
- Department of Perinatal Health, National Institute of Public Health, Mexico Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, CP 62100, Cuernavaca, Morelos, Mexico
| | - German Guerra Y Guerra
- Department of Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mario Sánchez-Dominguez
- Department of Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Hector Lamadrid-Figueroa
- Department of Perinatal Health, National Institute of Public Health, Mexico Av. Universidad 655 Col. Santa María Ahuacatitlán Cuernavaca, CP 62100, Cuernavaca, Morelos, Mexico.
| |
Collapse
|
24
|
Poncet L, Panjo H, Andro A, Ringa V. Caesarean delivery in a migration context: the role of prior delivery in the host country. Sex Reprod Health Matters 2021; 28:1763576. [PMID: 32544031 PMCID: PMC7888083 DOI: 10.1080/26410397.2020.1763576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Migrant women in industrialised countries experience high caesarean section (CS) rates but little is known about the effect of a previous delivery in the host country. This study set out to investigate this effect among migrant women in France, using data from the DSAFHIR study on healthcare access of migrant women living in emergency housing hotels, collected in the Paris Metropolitan area in 2017. Respondents reported life-long history of deliveries. We focused on deliveries occurring in France in 2000–2017: 370 deliveries reported by 242 respondents. We conducted chi-square tests and multivariate logistic regressions, adjusting for the clustering of deliveries among respondents by computing standard errors allowing for intragroup correlation. Mode of delivery was associated with duration of residence among multiparous women with no prior CS, with a higher CS rate with shorter duration of residence (16% vs. 7%, p = 0.04). In this group, a previous delivery in France was associated with a lower CS rate (5% vs. 16%, p = 0.008). In multivariate analysis, compared with women with previous birth in France, women giving birth in France for the first time had a higher risk of CS, regardless of duration of residence (aOR = 4.0, 95% CI = 1.3–12.1 for respondents with short duration of residence, aOR = 4.7, 95% CI = 1.2–18.0 for respondents with longer duration of residence). Efforts directed at decreasing the CS rate among migrant women should target women giving birth in the host country for the first time.
Collapse
Affiliation(s)
- Lorraine Poncet
- PhD Candidate in Public Health, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France; French Collaborative Institute on Migration, Paris, France
| | - Henri Panjo
- Research Engineer, Université Paris-Saclay (INSERM), UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
| | - Armelle Andro
- Professor, Institute of Demography, Université Paris I Pantheon-Sorbonne, Paris, France; French Collaborative Institute on Migration, Paris, France
| | - Virginie Ringa
- Researcher (INSERM), Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Primary Care and Prevention Team, CESP Villejuif, France
| |
Collapse
|
25
|
Törn AE, Lampa E, Wikström AK, Jonsson M. Hypoxic ischemic encephalopathy in offspring of immigrant women in Sweden: A population-based cohort study. Acta Obstet Gynecol Scand 2021; 100:2285-2293. [PMID: 34289078 DOI: 10.1111/aogs.14234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/23/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION One in four women giving birth in Sweden is foreign-born. Immigrant status has been suggested as a risk factor for adverse perinatal outcomes. It is not known if infants to foreign-born women have an increased risk of severe birth asphyxia, or which factors might mediate such association. MATERIAL AND METHODS A population-based cohort study of 726 730 live births at 36 weeks of gestation or more in Sweden in 2009-2015. The exposure was maternal country of birth, grouped according to the World Bank country classification: low-, lower-middle, upper-middle, and high-income economies. The main outcome was neonatal hypoxic ischemic encephalopathy (HIE). The outcome was estimated by severity and classified as non-hypothermia-treated HIE, representing mainly mild cases, and hypothermia-treated HIE, representing moderate to severe cases. A secondary outcome was low Apgar score at 5 minutes, defined as <7 or <4. Odds ratios with 95% CI were calculated, using Swedish-born women as the reference. Structural equation modeling was used to investigate potential mediation of known antepartum risk factors. RESULTS A total of 854 infants were diagnosed with HIE and 398 received therapeutic hypothermia. Offspring of mothers born in low-income countries had the highest incidences of HIE and low Apgar score, with an incidence of therapeutic hypothermia of 1.1 per 1000. Compared with offspring of Swedish-born mothers, these neonates had an almost two-fold increased risk of HIE, with or without hypothermia treatment (odds ratio 1.7; 95% CI 1.2-2.7 and odds ratio 1.7; 95% CI 1.2-2.6, respectively), and a 2- to 3-fold increased risk of low Apgar score. The structural equation model analysis indicated an exclusive direct effect of country of birth on HIE. Factors reflecting socio-economic status mediated a small proportion of the risk of Apgar score <7 at 5 minutes. CONCLUSIONS Offspring of women born in low-income countries had associations with severe birth asphyxia, with increased risk of both HIE and low Apgar score at 5 minutes. The associations seemed only to be marginally mediated by other antepartum factors. The associations are complex and further studies are needed to find explanatory and potentially preventable factors.
Collapse
Affiliation(s)
- Anna E Törn
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- Department of Medical Science, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
26
|
Katcher T, Thimmesch R, Spitz A, Kulkarni L, Panth N, Weiner A, Woodford Martin M. Sexual and reproductive health information and referrals for resettled refugee women: A survey of resettlement agencies in the United States. PLoS Med 2021; 18:e1003579. [PMID: 33939705 PMCID: PMC8092785 DOI: 10.1371/journal.pmed.1003579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Refugee resettlement offices are the first point of contact for newly arrived refugees and play a significant role in helping refugees acclimate and settle into life in the United States. Available literature suggests that refugee women are vulnerable to poor sexual and reproductive health (SRH) outcomes, including sexually transmitted infections and HIV infections as well as adverse pregnancy outcomes, but little is known about the role that refugee resettlement offices play in supporting refugee women's SRH. This study examines the capacity and interest of resettlement offices in providing SRH information and referrals to newly arrived refugees. METHODS AND FINDINGS The research team conducted an online survey of staff members at refugee resettlement offices throughout the US in 2018 to determine (1) available SRH resources and workshops; (2) referrals to and assistance with making appointments for SRH and primary care appointments; (3) barriers to addressing SRH needs of clients; and (4) interest in building the capacity of office staff to address SRH issues. The survey was created for this study and had not been previously used or validated. Survey data underwent descriptive analysis. A total of 236 resettlement offices were contacted, with responses from 100 offices, for a total response rate of 42%. Fifteen percent (N = 15) of refugee resettlement agencies (RRAs) who responded to the survey provide materials about SRH to clients, and 49% (N = 49) incorporate sexual health into the classes they provide to newly arrived refugee clients. Moreover, 12% (N = 12) of responding RRAs screen clients for pregnancy intention, and 20% (N = 20) directly refer to contraceptive care and services. This study is limited by the response rate of the survey; no conclusions can be drawn about those offices that did not respond. In addition, the survey instrument was not validated against any other sources of information about the practices of refugee resettlement offices. CONCLUSIONS In this study, we observed that many resettlement offices do not routinely provide information or referrals for SRH needs. Responding offices cite lack of time and competing priorities as major barriers to providing SRH education and referrals to clients.
Collapse
Affiliation(s)
- Tonya Katcher
- Advocates for Youth, Washington, District of Columbia, United States of America
- * E-mail:
| | - Rebecca Thimmesch
- Advocates for Youth, Washington, District of Columbia, United States of America
| | - Alison Spitz
- International Rescue Committee, Atlanta Office, Atlanta, Georgia, United States of America
| | - Leena Kulkarni
- Harvard TH Chan School of Public Health, Boston, Massachussetts, United States of America
| | - Neelima Panth
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Arlen Weiner
- Harvard TH Chan School of Public Health, Boston, Massachussetts, United States of America
| | | |
Collapse
|
27
|
Social and ethnic disparities in stillbirth and infant death in Denmark, 2005-2016. Sci Rep 2021; 11:8001. [PMID: 33846451 PMCID: PMC8041838 DOI: 10.1038/s41598-021-87084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Ethnic disparity in stillbirth and infant death has been demonstrated in Europe. As the relation between migration and health change over time, this population based register study investigated the recent figures and explored if potential differences could be explained by the well-known educational and income inequalities in stillbirth and infant death using a novel approach. Stillbirth and infant mortality varied considerably according to country of origin, with only immigrants from China, Norway, and Poland having an overall lower risk than Danish women. Women of Pakistani, Turkish, and Somali origin had a particularly high risk of both outcomes. Women from recent high conflict areas displayed a pattern with increased stillbirth risk. An observed excess risks across generations was found, which is disturbing and rule out factors related to language barriers or newness. Differences in educational level and household income explained only part of the observed inequalities. Strengthening of the maternity care system to better understand and meet the needs of immigrant women seems needed to mitigate the disparities.
Collapse
|
28
|
Schytt E, Wahlberg A, Small R, Eltayb A, Lindgren H. The community-based bilingual doula - A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100614. [PMID: 33813256 DOI: 10.1016/j.srhc.2021.100614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore midwives' and obstetricians' views about community-based bilingual doula (CBD) support during migrant women's labour and birth and their experiences of collaborating with CBDs. STUDY DESIGN A qualitative study with semi-structured individual interviews with 7 midwives and 4 obstetricians holding clinical positions in labour care in Stockholm, Sweden, who all had experiences of working with a CBD. Data analysis followed the framework of thematic analysis. RESULTS The overarching theme was A new actor filling gaps in labour care - With appropriate boundary setting, CBDs can help improve care for migrant women. One year after the introduction of CBDs, the midwives and obstetricians had mainly positive experiences of CBDs who were considered to fill important gaps in maternity care for migrant women, being with the woman and simultaneously being part of the care team and this made providing high quality care easier. The CBDs' main contribution was to help migrant women navigate the maternity care system, to bridge language and cultural divides, and guarantee continuous labour and birth support. However, midwives and obstetricians sometimes experienced CBDs interfering with their professional assessments and decisions and the role of the CBD was somewhat unclear to them. CONCLUSIONS Community-based bilingual doula support was viewed as improving migrant women's well-being during labour and birth and as increasing the possibilities for midwives and obstetricians to provide good and safe care, however, some ambivalence remained about the CBD's role and boundaries.
Collapse
Affiliation(s)
- Erica Schytt
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Dalarna - Uppsala University, Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Anna Wahlberg
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Amani Eltayb
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
29
|
Akselsson A, Lindgren H, Georgsson S, Pettersson K, Skokic V, Rådestad I. Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area - a population-based study. Glob Health Action 2021; 13:1794107. [PMID: 32744184 PMCID: PMC7480426 DOI: 10.1080/16549716.2020.1794107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup. Objective We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia. Methods In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily self-monitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register. Results An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25–3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88–2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29–2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08–0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group. Conclusions A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.
Collapse
Affiliation(s)
- Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University , Stockholm, Sweden
| | - Helena Lindgren
- Department of Women and Children's Health, Karolinska Institutet , Stockholm, Sweden
| | - Susanne Georgsson
- The Swedish Red Cross University College , Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden
| | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
| | - Ingela Rådestad
- Department of Health Promoting Science, Sophiahemmet University , Stockholm, Sweden
| |
Collapse
|
30
|
Taraldsen S, Vangen S, Øian P, Sørbye IK. Female genital mutilation/cutting, timing of deinfibulation, and risk of cesarean section. Acta Obstet Gynecol Scand 2021; 100:587-595. [PMID: 33719034 DOI: 10.1111/aogs.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The impact of female genital mutilation/cutting on obstetric outcomes in high-income countries is not clear. In general, women with female genital mutilation/cutting type 3 (infibulation) seem to be most at risk of adverse outcomes such as cesarean section. Deinfibulation is recommended to prevent obstetric complications. Whether the timing of this procedure affects the complication risk is not known. The aims of this study were, first, to examine the association between female genital mutilation/cutting and the risk of cesarean section in Norway, and, second, whether the timing of deinfibulation affected the cesarean section risk. MATERIAL AND METHODS This was a historical cohort study of nulliparous Somali-born women who gave birth in Norway between 1990 and 2014. The Medical Birth Registry of Norway identified the women. Data were collected from medical records at 11 participating birth units. The exposures were female genital mutilation/cutting status and deinfibulation before pregnancy, during pregnancy, or no deinfibulation before labor onset. The main outcome was odds ratio (OR) of cesarean section. Type of cesarean section, primary indications, and neonatal outcomes were secondary outcomes. RESULTS Women with female genital mutilation/cutting type 3 had lower risk of cesarean section compared with women with no female genital mutilation/cutting (OR 0.54, 95% CI 0.33-0.89 P = .02). Among the 1504 included women, the cesarean section rate was 28.0% and the proportion of emergency operations was 92.9%. Fetal distress was the primary indication in approximately 50% of cases, across the groups with different female genital mutilation/cutting status. Women who had no deinfibulation before labor onset had lower risk of cesarean section compared with those who underwent deinfibulation before or during pregnancy (OR 0.64, 95% CI 0.46-0.88 P = .01). CONCLUSIONS High risk of cesarean section in Somali nulliparous women was not related to the type of female genital mutilation/cutting in the present study. Deinfibulation before labor did not protect against cesarean section. Our findings indicate that nulliparous Somali women are at high risk of intrapartum complications. Future research should focus on measures to reduce maternal morbidity and on how timing of deinfibulation affects the outcomes of vaginal births.
Collapse
Affiliation(s)
- Sølvi Taraldsen
- Norwegian National Advisory Unit on Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Ingvil K Sørbye
- Norwegian National Advisory Unit on Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.,Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
31
|
Malebranche M, Norrie E, Hao S, Brown G, Talavlikar R, Hull A, De Vetten G, Nerenberg KA, Metcalfe A, Fabreau G. Antenatal Care Utilization and Obstetric and Newborn Outcomes Among Pregnant Refugees Attending a Specialized Refugee Clinic. J Immigr Minor Health 2021; 22:467-475. [PMID: 31853807 DOI: 10.1007/s10903-019-00961-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of the study is to characterize the antenatal care utilization and obstetric and newborn outcomes among refugee women at a specialized refugee clinic and determine whether these outcomes varied between refugees (government-assisted or privately-sponsored) and asylum seekers. This retrospective cohort study included women receiving antenatal care at a specialized refugee clinic between 2011 and 2016. Time from arrival to first clinic visit, Adequacy of Prenatal Care Utilization Index, and obstetric and newborn outcomes were examined, stratified by refugee category. Amongst 179 women, median time from arrival to first clinic visit was longer for asylum seekers (2.8 months, IQR 12.9) compared to government-assisted and privately-sponsored refugees (0.4 months, IQR 0.7, and 1.6 months, IQR 3.2, respectively; p < 0.01). A larger proportion of asylum seeking women received inadequate antenatal care. No difference was found in obstetric and newborn outcomes. Differences in antenatal care utilization between refugee categories suggest that barriers may remain for asylum seekers; however, obstetric and newborn outcomes were comparable amongst refugee categories.
Collapse
Affiliation(s)
| | - Eric Norrie
- Mosaic Refugee Health Clinic, Calgary, Canada
| | | | | | | | - Andrea Hull
- Mosaic Refugee Health Clinic, Calgary, Canada
| | | | - Kara A Nerenberg
- Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Gabriel Fabreau
- Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| |
Collapse
|
32
|
Tingleff T, Räisänen S, Vikanes Å, Sandvik L, Laine K. Association between maternal country of birth and preterm birth: A population-based register study of 910,752 deliveries. Scand J Public Health 2021; 49:904-913. [PMID: 33588641 PMCID: PMC8573627 DOI: 10.1177/1403494821992894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Aims: The aim of this study was to analyse associations between maternal country of birth and preterm birth among women giving birth in Norway. Methods: A population-based register study was conducted employing official national databases in Norway. All singleton births, with neonates without major anomalies, between 1999 and 2014 were included (N=910,752). We estimated odds ratios (ORs) for extremely preterm birth (<28 weeks gestation), very preterm birth (28–33 weeks gestation) and late preterm birth (34–36 weeks gestation) by maternal country of birth. We conducted multivariable regression analyses, adjusting for maternal, obstetric and socio-economic confounders. Results: For extremely preterm births (0.4% of the study population), women with an unknown country of birth (adjusted OR (aOR)=3.09; 95% confidence interval (CI) 2.26–4.22) and women born in sub-Saharan Africa (aOR=1.66; CI 1.40–1.96) had the highest ORs compared to Norwegian-born women. For very preterm births (1.2% of the study population), women with an unknown country of birth (aOR=1.72; CI 1.36–2.18) and women born in South Asia (aOR=1.48; CI 1.31–1.66) had the highest ORs. For late preterm births (3.8% of the study population), women born in East Asia Pacific/Oceania (aOR=1.33; CI 1.25–1.41) and South Asia (aOR=1.30; CI 1.21–1.39) had the highest ORs. Conclusions: After adjusting for maternal, obstetric and socio-economic risk factors, maternal country of birth remained significantly associated with preterm birth. Women with an unknown country of birth and women born in sub-Saharan Africa were found to be at increased risk of extremely preterm birth.
Collapse
Affiliation(s)
- Tiril Tingleff
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Tiril Tingleff, Faculty of Medicine, University of Oslo, Pb 4965, Nydalen, 0424 Oslo, Norway. E-mail:
| | | | | | - Leiv Sandvik
- Department of Obstetrics, Oslo University Hospital, Norway
| | - Katariina Laine
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Obstetrics, Oslo University Hospital, Norway
| |
Collapse
|
33
|
Vural T, Gölbaşı C, Bayraktar B, Gölbaşı H, Yıldırım AGŞ. Are Syrian refugees at high risk for adverse pregnancy outcomes? A comparison study in a tertiary center in Turkey. J Obstet Gynaecol Res 2021; 47:1353-1361. [PMID: 33496047 DOI: 10.1111/jog.14673] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/01/2020] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this study, we aim to compare obstetric and perinatal outcomes between Turkish citizens and Syrian refugees who applied to a tertiary center in Izmir. MATERIALS AND METHODS Demographic characteristics, obstetric and neonatal outcomes of 8103 Syrian refugee pregnant women and 47 151 Turkish citizen pregnant women between January 2013 and December 2018 were retrospectively compared. Our primary aim was to compare the cesarean rates and obstetrical results between two groups and to decide antenatal care secondarily. RESULTS Syrian refugee pregnant women are statistically younger (p < 0.001), mean pregnancy duration and mean birth weight is statistically lower (p < 0.001 and p < 0.001, respectively). Adolescent pregnancy rates, preterm birth rates and anemia are statistically higher in refugee group (p < 0.001, p < 0.001, and p < 0.001, respectively). Primary cesarean section rates, combined and triple screening tests application rates, gestational diabetes screening rates are meaningfully lower in refugee group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION Syrian refugees are at risk for inadequate antenatal care, adolescent pregnancy, and adverse pregnancy outcomes. Therefore, care should be given to these risks during pregnancy and childbirth to Syrian refugees.
Collapse
Affiliation(s)
- Tayfun Vural
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ceren Gölbaşı
- Department of Obstetrics and Gynecology, İzmir Tınaztepe University Faculty of Medicine, Izmir, Turkey
| | - Burak Bayraktar
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hakan Gölbaşı
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkım G Ş Yıldırım
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
34
|
Harakow HI, Hvidman L, Wejse C, Eiset AH. Pregnancy complications among refugee women: A systematic review. Acta Obstet Gynecol Scand 2021; 100:649-657. [PMID: 33372265 DOI: 10.1111/aogs.14070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Pregnancy is a time of increased vulnerability for women. Women of refugee background may be further challenged in pregnancy due to a complex series of physical, psychological and social factors. Previous studies show ambiguous results, with some showing increased the risk of prenatal complications in refugees compared with their native counterparts, whereas other studies report the opposite. With the current steep rise in the number of refugees and displaced persons worldwide, research is important to understand whether pregnancy disparities between this population and their native counterparts exist, and the causes. This systematic literature review aims to find out whether refugee women have a higher prevalence of adverse pregnancy outcomes and prenatal infections compared with native women. MATERIAL AND METHODS We conducted a literature search in the databases PubMed and Embase, supplemented with screening of reference lists and citations for relevant literature. We included studies published in English reporting risk of preeclampsia, spontaneous abortion and stillbirths, preterm birth, preterm prelabor rupture of membranes (PPROM) and adverse prenatal infectious diseases in women of refugee status. PROSPERO registration CRD42020205628. RESULTS We identified 19 articles eligible for inclusion: 12 were cross-sectional, six were cohort studies and one was a case-control study. The most frequently reported outcome in the literature was preterm birth (reported in 16 of the studies) and preeclampsia (reported in 11 of the studies). Refugees had increased risk of stillbirth (reported relative risk ranging from 1.20 to 2.24) and spontaneous abortion (reported relative risk ranging from 1.56 to 1.58), when compared with native women and a decreased risk of preeclampsia (reported relative risk ranging from 0.65 to 0.81). CONCLUSIONS The small number of articles eligible for inclusion in the review highlights the lack of research and knowledge on refugee health during pregnancy. Further research is required to understand and reduce disparities in pregnancy outcomes between refugee and non-refugee women.
Collapse
Affiliation(s)
| | - Lone Hvidman
- Department of Obstetrics and Gynecology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian Wejse
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Andreas H Eiset
- Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
35
|
Fontanelli Sulekova L, Spaziante M, Vita S, Zuccalà P, Mazzocato V, Spagnolello O, Lopalco M, Pacifici LE, Bello L, Borrazzo C, Angeletti S, Ciccozzi M, Ceccarelli G. The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health. J Immigr Minor Health 2020; 23:232-239. [PMID: 33278011 PMCID: PMC7914189 DOI: 10.1007/s10903-020-01126-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Background Migration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women. Methods Data about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors. Results Out of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion. Conclusion This study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.
Collapse
Affiliation(s)
- Lucia Fontanelli Sulekova
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy. .,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy. .,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.
| | - Martina Spaziante
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Serena Vita
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Paola Zuccalà
- Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.,Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy
| | - Valentina Mazzocato
- Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy
| | - Ornella Spagnolello
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Emergency NGO, Milan, Italy.,Emergency Department, Policlinico Umberto I Hospital, University of Rome Sapienza, Rome, Italy
| | - Maurizio Lopalco
- Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Laura Elena Pacifici
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Luca Bello
- Unit of Gynecology, Department of Obstetrics and Gynecology, University of Turin, Maria Vittoria Hospital, Turin, Italy
| | - Cristian Borrazzo
- Statistical Unit, Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.,Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy.,Italian Red Cross, Metropolitan Area of Rome Committee, Sanitary Direction of Reception Centers for Migrants, Rome, Italy
| |
Collapse
|
36
|
Byrskog U, Small R, Schytt E. Community-based bilingual doulas for migrant women in labour and birth - findings from a Swedish register-based cohort study. BMC Pregnancy Childbirth 2020; 20:721. [PMID: 33228571 PMCID: PMC7684977 DOI: 10.1186/s12884-020-03412-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background Community-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals. Methods Register study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education. Results Migrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64). Conclusions CBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed.
Collapse
Affiliation(s)
- Ulrika Byrskog
- School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, 3086, Melbourne, Victoria, Australia.,Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
| | - Erica Schytt
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.,Centre for Clinical Research Dalarna, Uppsala University, Nissers väg 3, 791 82, Falun, Sweden.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Møllendalsveien 6, Postboks 7030, 5020, Bergen, Norway
| |
Collapse
|
37
|
Araneta MRG, Baer RJ, Muglia LJ, Ryckman KK, Ryu J, Sidelinger DE, Jeliffe-Powlowski LL, Chambers CD. Health Advantages and Disparities in Preterm Birth Among Immigrants Despite Disparate Sociodemographic, Behavioral, and Maternal Risk Factors in San Diego, California. Matern Child Health J 2020; 24:153-164. [PMID: 31838667 DOI: 10.1007/s10995-019-02836-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Reproductive health advantages have been reported among selected immigrants, but few studies have included new immigrants and refugees, nor simultaneously adjusted for socioeconomic, behavioral, and medical disparities. METHODS We examined the risk of preterm birth (PTB, < 37 weeks' gestation) among singleton live births in San Diego County from 2007 to 2012. Multivariable regression was used to compare PTB (1) by nativity within racial/ethnic groups and (2) among immigrants compared to United States (US) born Whites, while adjusting for sociodemographic, behavioral, reproductive and medical variables. RESULTS Among 230,878 singleton live births, overall PTB prevalence was highest among parturient women who were US-born Blacks (10.9%), Philippine (10.8%) and US-born Filipinas (10.7%), and US-born Asians (8.6%) despite differences in socioeconomic and maternal risk factors, and lowest among Somali (5.5%) migrants. Blacks born in Somalia or outside of the US, had significantly lower overall PTB prevalence compared to US-born Blacks (5.5% vs 7.6% vs 10.9%). Compared to US-born Whites, spontaneous PTB risk was significantly lower among Somali migrants (4.8% vs 3.7%, adjusted relative risk, aRR 0.7 [95% Confidence Intervals 0.5-0.9]), but higher among Philippine migrants (4.8% vs 7.7%, aRR 1.4 [1.3-1.6]). The strongest risk factor for overall PTB among nulliparous US-born Blacks was preexisting diabetes (aRR 3.81 [2.05-7.08]), and preexisting hypertension among Filipinas (aRR: 3.27 [2.36-4.54] and US-born Asians (aRR: 3.64 [1.61-8.24]). CONCLUSION Black migrants had lower PTB prevalence compared to US-born Blacks, but this immigrant advantage was not observed in other racial/ethnic groups. Compared to US-born Whites, Somali migrants had significantly lower risk of spontaneous PTB while Filipinas had elevated risk.
Collapse
Affiliation(s)
- Maria Rosario G Araneta
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive MC-0606, La Jolla, CA, 92093-0606, USA.
| | - Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
| | - Louis J Muglia
- Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Julie Ryu
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Dean E Sidelinger
- County of San Diego Health and Human Services Agency, Medical Care Services Division, San Diego, CA, USA
| | - Laura L Jeliffe-Powlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christina D Chambers
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive MC-0606, La Jolla, CA, 92093-0606, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
38
|
Aasheim V, Nilsen RM, Vik ES, Small R, Schytt E. Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration related factors. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100553. [PMID: 32919243 DOI: 10.1016/j.srhc.2020.100553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/28/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate associations between maternal country of birth and other migration related factors (length of residence, reason for migration, paternal origin) and epidural analgesia for labour pain in nulliparous women in Norway. DESIGN Population-based register study including nulliparous migrant women (n = 75,922) and non-migrant women (n = 444,496) with spontaneous or induced labour. Data were retrieved from the Medical Birth Registry and Statistics Norway, 1990-2013. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression, and adjusted for maternal age, marital status, maternal education, gross income, birth year, hospital size and health region. MAIN OUTCOME Epidural analgesia for labour pain. RESULTS Epidural analgesia was administered to 38% of migrant women and 31% of non-migrant women. Compared with non-migrants, the odds of having epidural analgesia were lowest in women from Vietnam (adjOR 0.54; CI 0.50-0.59) and Somalia (adjOR 0.63; CI 0.58-0.68) and highest in women from Iran (adjOR 1.32; CI 1.19-1.46) and India (adjOR 1.19; CI 1.06-1.33). Refugees (adjOR 0.83; CI 0.79-0.87) and newly arrived migrants (adjOR 0.92; CI 0.89-0.94) had lower odds of epidural analgesia. Migrant women with a non-migrant partner (adjOR 1.14; CI 1.11-1.17) and those with length of residence ≥10 years (adjOR 1.06; CI 1.02-1.10) had higher odds. CONCLUSION The use of epidural analgesia varied by maternal country of birth, reason for migration, paternal origin and length of residence. Midwives and obstetricians should pay extra attention to the provision of adequate information about pain relief options for refugees and newly arrived migrants, who had the lowest use.
Collapse
Affiliation(s)
- Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Erica Schytt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway; Centre for Clinical Research Dalarna - University of Uppsala, Falun, Sweden
| |
Collapse
|
39
|
Joarder T, Sutradhar I, Hasan MI, Bulbul MMI. A Record Review on the Health Status of Rohingya Refugees in Bangladesh. Cureus 2020; 12:e9753. [PMID: 32944468 PMCID: PMC7489778 DOI: 10.7759/cureus.9753] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The Rohingya refugee crisis is neither new nor a sudden problem for Bangladesh. However, the recent violence in August 2017 instigated the migration of 6,93,000 additional Rohingyas into Bangladesh and as of June 2018, around one million Rohingya refugees were residing in Bangladesh. Against this backdrop, it is important to know their current health status because, without this information, equal and equitable health service provision is not possible. So, we conducted this review to understand the current health status of the Rohingya refugees in Bangladesh. For this purpose, a systematic literature search was conducted in July 2018 using transparent selection criteria and the keywords "Rohingya", "Health", Bangladesh". After screening the title and abstract and removing duplication, 12 articles and 21 organizational reports were found eligible for final review. Major health problems prevailing among Rohingya refugees are unexplained fever, acute respiratory infection, and diarrhea. Non-communicable diseases like hypertension, diabetes, and their risk factors are also highly prevalent among these people. More than half of the Rohingya refugees are women and many of them experience sexual abuse or exploitation. More than 50,000 Rohingya refugee women were pregnant, however, a significant portion of pregnant women did not have access to quality antenatal care. Mental health problems like post-traumatic stress disorder (PTSD), depression, and suicidal thoughts were also commonly prevailing in the Rohingya community.
Collapse
Affiliation(s)
| | - Ipsita Sutradhar
- Epidemiology and Public Health, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BGD
| | - Md Imran Hasan
- National Consultant, Institute of Public Health Nutrition, Dhaka, BGD
| | - Md Mafizul I Bulbul
- Ministry of Health and Family Welfare, National Nutrition Services, Dhaka, BGD
| |
Collapse
|
40
|
Yelland J, Mensah F, Riggs E, McDonald E, Szwarc J, Dawson W, Vanpraag D, Casey S, East C, Biro MA, Teale G, Willey S, Brown SJ. Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: An interrupted time series design. PLoS Med 2020; 17:e1003089. [PMID: 32649668 PMCID: PMC7351141 DOI: 10.1371/journal.pmed.1003089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this 'whole-of-system' approach was to improve access to antenatal care. The objective of this paper is to report refugee women's access to hospital-based antenatal care over the period of health system reforms. METHODS AND FINDINGS The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks' gestation compared over time and to Australian-born women using logistic regression analyses. In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks' gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting. CONCLUSIONS Accurate ascertainment of 'harder-to-reach' populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.
Collapse
Affiliation(s)
- Jane Yelland
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Mensah
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ellie McDonald
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Wendy Dawson
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Dannielle Vanpraag
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Christine East
- School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Mercy Health and La Trobe University, Bundoora, Victoria, Australia
| | - Mary Anne Biro
- School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Glyn Teale
- Women’s and Children’s, Western Health, Sunshine, Victoria, Australia
| | - Sue Willey
- School Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Stephanie J. Brown
- Intergenerational Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
41
|
Wallmo S, Allgurin K, Berterö C. The lived experience among Somali women of giving birth in Sweden: an interpretive phenomenological study. BMC Pregnancy Childbirth 2020; 20:262. [PMID: 32357845 PMCID: PMC7193409 DOI: 10.1186/s12884-020-02933-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background The health care-seeking behaviour among Somali women is different from Swedish women’s behaviour, and this may have consequences for birth giving. The aim of the study was to identify and describe Somali women’s lived experience of birth giving in Sweden. Methods Qualitative individual interviews were conducted in Swedish with seven Somali women. The sample was purposeful, and the snowball sampling method was used. The interviews were digitally recorded and transcribed verbatim. Data were analysed using interpretative phenomenological analysis. Results Four themes emerged during the analysis which revealed the Somali women’s lived experiences of giving birth in Sweden. a) Being recognised and confirmed as a woman. Somali women consider it important to be confirmed as a woman by the surrounding and professionals during pregnancy and birth giving. b) Communication is important for the women’s independence. There is a need to provide a structure for how this information is given and adaptation regarding content and format .c) Something naturally becomes unknown and complicated. Somali women come from a different culture, which affects their lived experiences of pregnancy and birth giving. There is a need for improved and clearer information for these Somali women regarding pregnancy and birth giving in another culture- the Swedish context d) Professional and competent taking care of. The women appreciate if they are treated with competency and professionalism; they do not want to be discriminated. The women feel confidence in health care when they meet competent and professional health care professionals. Conclusions The findings in the study indicate that reproductive health care for Somali women should be improved with regard to cultural differences and lived experiences, as this affects their experience of pregnancy and childbirth in Sweden. There is a need for both knowledge and understanding in order to provide good quality care for these Somali women, especially those who have been genitally mutilated.
Collapse
Affiliation(s)
- Susanne Wallmo
- Women's Health Care, Gynaecological Clinic Ryhov Region County Hospital, SE- 551 85, Jönköping, Sweden
| | - Karin Allgurin
- Maternity Ward, Gynaecological Clinic Ryhov County Region Hospital, SE- 551 85, Jönköping, Sweden
| | - Carina Berterö
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, SE- 581 83, Linköping, Sweden.
| |
Collapse
|
42
|
Profile of severely growth-restricted births undelivered at 40 weeks in Western Australia. Arch Gynecol Obstet 2020; 301:1383-1396. [PMID: 32318796 DOI: 10.1007/s00404-020-05537-y] [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: 10/29/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the proportion of severely growth-restricted singleton births < 3rd percentile (proxy for severe fetal growth restriction; FGR) undelivered at 40 weeks (FGR_40), and compare maternal characteristics and outcomes of FGR_40 births and FGR births at 37-39 weeks' (FGR_37-39) to those not born small-for-gestational-age at term (Not SGA_37+). METHODS The annual rates of singleton FGR_40 births from 2006 to 2015 were calculated using data from linked Western Australian population health datasets. Using 2013-2015 data, maternal factors associated with FGR births were investigated using multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI) while relative risks (RR) of birth outcomes between each group were calculated using Poisson regression. Neonatal adverse outcomes were identified using a published composite indicator (diagnoses, procedures and other factors). RESULTS The rate of singleton FGR_40 births decreased by 23.0% between 2006 and 2015. Factors strongly associated with FGR_40 and FGR_37-39 births compared to Not SGA_37+ births included the mother being primiparous (ORs 3.13: 95% CI 2.59-3.79; 1.69, 95% CI 1.47, 1.94, respectively) and ante-natal smoking (ORs 2.55, 95% CI 1.97, 3.32; 4.48, 95% CI 3.74, 5.36, respectively). FGR_40 and FGR_37-39 infants were more likely to have a neonatal adverse outcome (RRs 1.70, 95% CI 1.41, 2.06 and 2.46 95% CI 2.18, 2.46, respectively) compared to Not SGA 37+ infants. CONCLUSIONS Higher levels of poor perinatal outcomes among FGR births highlight the importance of appropriate management including fetal growth monitoring. Regular population-level monitoring of FGR_40 rates may lead to reduced numbers of poor outcomes.
Collapse
|
43
|
Yelland J, Riggs E, Dawson W, Vanpraag D, Szwarc J, Brown S. 'It requires something drastic': Interviews with health care leaders about organisational responses to social disadvantage. Women Birth 2020; 34:296-302. [PMID: 32205076 DOI: 10.1016/j.wombi.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PROBLEM Persisting disparities in maternal and child health outcomes in high income countries require new insights for health service response. BACKGROUND Significant social hardship, including factors related to migration, are associated with perinatal morbidity and mortality. The universality of maternity and child health care offers opportunities to reduce health disparities. Process evaluation of health service initiatives to address refugee health inequalities in Melbourne, Australia, is the setting for the study. AIM To explore the views of health service leaders about health system and service capacity to tailor care to address social adversity and reduce disparities in maternal and child health outcomes. METHODS In-depth interviews with leaders of maternity and maternal and child health services with questions guided by a diagram to promote discussion. Thematic analysis of transcribed interviews. FINDINGS Health care leaders recognised the level of social complexity and diversity of their clientele. The analysis revealed three key themes: grappling with the complexity of social disadvantage; 'clinical risk' versus 'social risk'; and taking steps for system change. DISCUSSION Priority given to clinical requirements and routine practices together with the rising demand for services is limiting service response to families experiencing social hardship and hampering individualised care. System change was considered possible only if health service decision makers engaged with consumer and community perspectives and that of front-line staff. CONCLUSION Achieving equity in maternal and child health outcomes requires engagement of all key stakeholders (communities, clinicians, managers) to facilitate effective system re-design.
Collapse
Affiliation(s)
- Jane Yelland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| | - Wendy Dawson
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Dannielle Vanpraag
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia.
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia.
| |
Collapse
|
44
|
Turkay Ü, Aydın Ü, Salıcı M, Çalışkan E, Terzi H, Astepe BS, Varlıklı O. Comparison of pregnant Turkish women and Syrian refugees: Does living as a refugee have an unfavorable effect on pregnancy outcomes? Int J Gynaecol Obstet 2020; 149:160-165. [DOI: 10.1002/ijgo.13117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/14/2019] [Accepted: 02/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Ünal Turkay
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Ümit Aydın
- Department of Obstetrics and Gynecology Medikal Park Hospital İzmit Kocaeli Turkey
| | - Mehmet Salıcı
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Ebru Çalışkan
- Kocaeli Provincial Health Directorate, quality coordinator and productivity İzmit Kocaeli Turkey
| | - Hasan Terzi
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Bahar S. Astepe
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Onursal Varlıklı
- Department of Pediatric Surgery University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| |
Collapse
|
45
|
Mozooni M, Pennell CE, Preen DB. Healthcare factors associated with the risk of antepartum and intrapartum stillbirth in migrants in Western Australia (2005-2013): A retrospective cohort study. PLoS Med 2020; 17:e1003061. [PMID: 32182239 PMCID: PMC7077810 DOI: 10.1371/journal.pmed.1003061] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Māori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Māori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Māori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.
Collapse
Affiliation(s)
- Maryam Mozooni
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Craig E. Pennell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David B. Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
46
|
Factors Associated with Access to Maternal and Reproductive Health Care among Somali Refugee Women Resettled in Ohio, United States: A Cross-Sectional Survey. J Immigr Minor Health 2020; 21:946-953. [PMID: 30206769 DOI: 10.1007/s10903-018-0824-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined maternal and reproductive health (MRH) access of Somali refugees in the U.S. across four access dimensions (willingness to seek care, gaining entry to the health system, seeing a primary provider and seeing a specialist). We conducted a cross-sectional survey of 427 Somali refugee reproductive-age women in Franklin County, Ohio. Following descriptive statistics of demographics, we conducted multivariate analyses to test associations between demographics and the four access dimensions. Most Somali refugee women were married (68%), attained primary education (92%), employed (64%) and were circumcised (82%). Young (OR 2.61, 95% CI 1.25-5.60), single (OR 1.78, 95% CI 1.15-2.78), and minors upon arrival (OR 2.36, 95% CI 1.44-3.90) were more willing to seek care. Lack of insurance, limited language fluency and being circumcised limited access to care across all dimensions. Barriers to access need to be systematically addressed. Deconstructing beliefs regarding health systems may improve access, especially among older Somali women.
Collapse
|
47
|
Royer PA, Olson LM, Jackson B, Weber LS, Gawron L, Sanders JN, Turok DK. "In Africa, There Was No Family Planning. Every Year You Just Give Birth": Family Planning Knowledge, Attitudes, and Practices Among Somali and Congolese Refugee Women After Resettlement to the United States. QUALITATIVE HEALTH RESEARCH 2020; 30:391-408. [PMID: 31347453 PMCID: PMC7219277 DOI: 10.1177/1049732319861381] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
It is crucial for refugee service providers to understand the family planning knowledge, attitudes, and practices of refugee women following third country resettlement. Using an ethnographic approach rooted in Reproductive Justice, we conducted six focus groups that included 66 resettled Somali and Congolese women in a western United States (US) metropolitan area. We analyzed data using modified grounded theory. Three themes emerged within the family planning domain: (a) concepts of family, (b) fertility management, and (c) unintended pregnancy. We contextualized these themes within existing frameworks for refugee cultural transition under the analytic paradigms of "pronatalism and stable versus evolving family structure" and "active versus passive engagement with family planning." Provision of just and equitable family planning care to resettled refugee women requires understanding cultural relativism, social determinants of health, and how lived experiences influence family planning conceptualization. We suggest a counseling approach and provider practice recommendations based on our study findings.
Collapse
Affiliation(s)
| | | | | | | | - Lori Gawron
- University of Utah, Salt Lake City, Utah, USA
| | | | | |
Collapse
|
48
|
Utne R, Antrobus-Johannessen CL, Aasheim V, Aasekjær K, Vik ES. Somali women's experiences of antenatal care: A qualitative interview study. Midwifery 2020; 83:102656. [PMID: 32035344 DOI: 10.1016/j.midw.2020.102656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore Somali women's experiences of antenatal care in Norway. DESIGN A qualitative study based on individual semi-structured interviews conducted either face-to-face or over the phone. SETTING Norway. PARTICIPANTS Eight Somali-born women living in Norway. KEY FINDINGS Four themes were generated from the analysis. From their experiences of antenatal care in Norway, the Somali women described: 1) when care was provided in a way that gained their trust, they made better use of the available health services, 2) the importance of continuity of care and of sharing commonalities with the caregiver, 3) a need for accessible information, specifically tailored to the needs of Somali women and 4) how culturally insensitive caregivers had a negative impact on the quality of care. CONCLUSION AND IMPLICATIONS FOR PRACTICE The Somali women in this study were grateful for the care provided, although the quality of antenatal care did not always meet their needs. This study should serve as a reminder of the importance of establishing trust between the pregnant woman and the caregiver, strengthening interpretation services and assuring tailored information is available to Somali women at an early stage. The findings further suggest that antenatal care for Somali women may be improved by offering continuity of care and improving clinical and cultural skills in clinicians. Suggestions for practice, and future research, include initiating group antenatal care especially tailored to Somali women.
Collapse
Affiliation(s)
- Renate Utne
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway
| | | | - Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway.
| | - Katrine Aasekjær
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway.
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, PO.box 7030, N-5020 Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, PO.box 7804, N-5020 Bergen, Norway.
| |
Collapse
|
49
|
Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Humanitarian migrant women's experiences of maternity care in Nordic countries: A systematic integrative review of qualitative research. Midwifery 2019; 80:102572. [PMID: 31739182 DOI: 10.1016/j.midw.2019.102572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maternal morbidity and sub-optimal maternity care are more common in humanitarian migrants in comparison to country-born population in the Nordic countries. Statistical reviews on the issue are plenty, whereas little synthesis on humanitarian migrants' lived experiences exists. AIM This systematic integrative literature review investigated humanitarian migrant women's experiences on maternity care in Nordic countries, aiming to address possible hindrances for optimal care. METHODS Electronic search in PubMed, CINAHL, SocIndex, Scopus, PsycINFO and Web of Science yielded 474 papers. PICoS inclusion and exclusion criteria were used. Critical appraisal was conducted utilising 32-item COREQ tool. The findings of the review articles were synthesised through thematic analysis. FINDINGS Ten qualitative studies were included in the review. Altogether 198 women in Sweden, Norway and Finland had participated interviews or focus group discussions. Analysis of the women's reported experiences of care emerged three themes: Diminished negotiation power on care, Sense of insecurity, and Experienced care-related discrimination. KEY CONCLUSION Humanitarian migrant women's maternal morbidity and sub-optimal care has multiple potential explanations, and their experiences of care reflect those earlier reported. IMPLICATIONS FOR PRACTICE Recommendations for tackling the addressed hindrances are: (1) enabling humanitarian migrant women's negotiation power by acknowledging their vulnerability but also competency, (2) increasing the sense of security, and (3) improving care providers' cultural competence.
Collapse
Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland; Kuopio University Hospital, Finland
| |
Collapse
|
50
|
Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183396. [PMID: 31540218 PMCID: PMC6765944 DOI: 10.3390/ijerph16183396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/13/2023]
Abstract
Inequity in immigrants’ health during pregnancy and childbirth has been shown. We studied the Danish regional organization of public midwifery-based antenatal care (ANC) for immigrant women to assess the strengths and weaknesses of organizing ANC as either universal or immigrant-targeted. A telephone survey in 2012 to all the Danish maternity wards (n = 20) was conducted. Semi-structured interviews with midwives providing targeted care (n = 6) were undertaken and characteristics of care were qualitatively analyzed, having the immigrant density of the facilities, the Danish ANC policy, and theories of cultural competence as the frame of reference. Six maternity wards were providing immigrant-targeted ANC. Targeted care implied longer consultations and increased attention to the individual needs of immigrant women. At these facilities, navigation in the health care system, body awareness, and use of interpreter services were key topics. The selection of women for targeted care was based on criteria (including names) that risk stigmatizing immigrant women. The arguments for not providing targeted care included that immigrant-targeted care was considered stigmatizing. Current universal care may overlook the needs of immigrant women and contribute to inequities. A strategy could be to improve dynamic cultural competencies of midwives, interpreter services, and flexibility of the care provision of the universal ANC system.
Collapse
|