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Grossetti É, Tessier V, Gomes E. [Maternal mortality among socially vulnerable women in France 2016-2018]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:273-279. [PMID: 38373495 DOI: 10.1016/j.gofs.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
Social vulnerability is a known factor in perinatal medical risk, both for the foetus and the mother. As part of the French confidential enquiry into maternal deaths, the introduction in 2015 of specific items relating to social status has made it possible to recreate this composite variable. Over the period 2016-2018, one woman in three who died was in a situation of social vulnerability. Of these 79 deaths, 32 (41%) were related to direct obstetric causes, 26 (33%) to indirect obstetric causes, 12 (15%) to suicides and 8 (10%) of unknown cause. Care was considered sub-optimal in 73% of cases, compared with 64% in the group of maternal deaths with no identified social vulnerability. 43 deaths were judged to be probably (n=12) or possibly (n=31) avoidable, 25 were not avoidable, and 11 were not sufficiently documented for this assessment; i.e. a proportion of 63% of probable or possible avoidability, a higher proportion compared with the 56% of avoidability among women with no identified social vulnerability. In 1/3 of maternal deaths, a lack of interaction between the woman and the healthcare system was involved in the chain of events leading to death, i.e. 2 times more than in the case of socially non-vulnerable women. Improving the interaction of women in socially vulnerable situations with the hospital system and the institutional and voluntary networks providing care, support and assistance is a priority. A specific, responsive medical and social organisation could contribute to this.
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Affiliation(s)
- Élizabeth Grossetti
- Gynécologue-obstétricien, Pôle femme mère enfant, maison des femmes du Havre, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France.
| | - Véronique Tessier
- Sage-femme, Direction de la recherche clinique et de l'innovation, AP-HP, France.
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Darebo TD, Spigt M, Teklewold B, Badacho AS, Mayer N, Teklewold M. The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis). BMC Public Health 2024; 24:520. [PMID: 38373954 PMCID: PMC10877851 DOI: 10.1186/s12889-024-17916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. METHODS We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles' quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. RESULTS We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants' homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. CONCLUSION To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements.
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Affiliation(s)
- Tadele Dana Darebo
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Mark Spigt
- Research Institute CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromso, Norway
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Osuide JO, Parsa AD, Mahmud I, Kabir R. The effect of limited access to antenatal care on pregnancy experiences and outcomes among undocumented migrant women in Europe: a systematic review. Front Glob Womens Health 2024; 5:1289784. [PMID: 38379839 PMCID: PMC10876992 DOI: 10.3389/fgwh.2024.1289784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Women who are undocumented migrants in Europe encounter a variety of challenges while trying to access health services, including restricted access to antenatal care (ANC) despite the importance of ANC to the well-being of mothers and their infants. This study's aim was to examine the effect that limited access to antenatal care has on the pregnancy experiences and outcomes of undocumented migrant (UM) women in Europe. Systematic searches were done on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, and BioMed Central. From the search results, only primary research articles that reported on the pregnancy outcomes and experiences of undocumented migrants were selected. A meta-analysis was not possible because this review included information from both qualitative and quantitative studies. The data that was taken from the included publications was organised, analysed, using the Microsoft Excel programme, and then meta-synthesised. Twelve papers from seven different European nations-Belgium, France, Sweden, Denmark, Norway, Finland, and England-were included in this systematic review. Eight of the studies aimed to explore the access to and utilization of ANC by undocumented migrant women and the related pregnancy outcomes. Two of the included studies examined the pregnancy experiences of UMs and two examined the perinatal risks associated with living as a migrant with no legal status. Although heterogeneous in their specific findings most of the studies showed undocumented immigrants are more likely to experience unfavourable pregnancy outcomes and experience greater anxiety and worries due to a variety of factors than documented migrants and registered citizens. This review's conclusions demonstrate the pressing need for policy modifications and healthcare reforms in Europe to address the problems associated with undocumented migrants' restricted access to antenatal care. It also highlights the urgent need for structural changes that will give this vulnerable population's health and well-being a higher priority. It is not just an issue of health equality but also a humanitarian obligation to address the many obstacles and difficulties undocumented migrant women endure during pregnancy.
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Affiliation(s)
- Jennifer Okhianosen Osuide
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ali Davod Parsa
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- School of Health, University of New England, Armidale, NSW, Australia
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Essex, Chelmsford, United Kingdom
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Eick F, Vallersnes OM, Fjeld HE, Sørbye IK, Ruud SE, Dahl C. Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway. Scand J Prim Health Care 2023; 41:317-325. [PMID: 37485974 PMCID: PMC10478594 DOI: 10.1080/02813432.2023.2237074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway. DESIGN A cross-sectional study of consultations at several time points. SETTING The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway. SUBJECTS Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women's residency status as 'probably documented migrant', 'uncertain migrant status', or 'probably undocumented migrant'. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions. MAIN OUTCOME MEASURES Manchester Triage System urgency level at presentation, and hospitalization. RESULTS Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14-3.04) and being hospitalized (RR 1.68, 95% CI 1.21-2.34), compared to pregnant residents. CONCLUSION Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.
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Affiliation(s)
- Frode Eick
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway
| | - Heidi E. Fjeld
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingvil Krarup Sørbye
- Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Sven Eirik Ruud
- Oslo Accident and Emergency Outpatient Clinic, Department of Emergency General Practice, City of Oslo Health Agency, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Radjack R, Hemmerter S, Azria E, Moro MR. [Relevance of the transcultural approach to improve the care relationship in the perinatal period]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:342-347. [PMID: 37080294 DOI: 10.1016/j.gofs.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
The international literature review highlights higher neonatal morbimortality in migrant patients and their babies. The explanatory hypotheses include late pregnancy follow-up with difficulty accessing care, language barriers, and different cultural representation in pregnancy support. On the one hand, we propose to explain the cultural factors that can impact the caring relationship during the perinatal period. On the other hand, we set out tools for anthropological and psychological understanding to enhance the sharing of cultural representations around pregnancy follow-up, the needs of a baby, and obstetrical or postnatal complications. The request for a specialised transcultural opinion needs to be more systematic; the transcultural posture is adaptable to each care professional. This requires the professional to address explicitly the impact of culture in care and consider their own cultural distance. Specialised advice is recommended in certain situations of cumulative vulnerability (complex trauma, perinatal depression with cultural coding of symptoms), blockage or refusal of care for cultural reasons and to avoid cultural misunderstandings. We detail two modalities: mediation and a discussion group around cultural issues set up in the maternity ward. The institutional work we propose within the multidisciplinary team in the maternity ward also allows the acquisition of transcultural competencies.
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Affiliation(s)
- Rahmeth Radjack
- AP-HP, Maison de Solenn, Maison des adolescents de l'Hôpital Cochin, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, CESP, Team DevPsy, Inserm, 94807 Villejuif, France.
| | - Stéphane Hemmerter
- Unit Director Hall ward, Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Elie Azria
- Maternité du Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France; UMR 1153, Équipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé); Université de Paris Cité, Paris, France
| | - Marie Rose Moro
- AP-HP, Maison de Solenn, Maison des adolescents de l'Hôpital Cochin, 75014 Paris, France; Université de Paris, PCPP, 92100 Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, CESP, Team DevPsy, Inserm, 94807 Villejuif, France
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Richard E, Vuillermoz C, Lioret S, Berrocal RR, Guyavarch E, Lambert Y, Azria E, Leffondre K, Vandentorren S. Social determinants of inadequate prenatal care utilization in sheltered homeless mothers in the Greater Paris area in France. Front Public Health 2023; 11:1080594. [PMID: 37026140 PMCID: PMC10071020 DOI: 10.3389/fpubh.2023.1080594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/01/2023] [Indexed: 04/08/2023] Open
Abstract
Background Sheltered homeless families suffer from deleterious living conditions such as housing instability (i.e., moving from one shelter to another) that could be an additional barrier to healthcare utilization. Few studies have specifically examined perinatal health in homeless mothers and their utilization of prenatal healthcare. This study aimed to identify social determinants such as living conditions (i.e., housing instability) associated with inadequate prenatal care utilization (PCU) in sheltered homeless mothers in the Greater Paris area in France. Methods The homeless children and families cross-sectional survey [ENFAMS: (Enfants et familles sans logement)] was performed on a random representative sample of homeless families living in shelters in the greater Paris area in 2013. Following French guidelines, PCU was deemed inadequate if one or more of the following criteria was met: attending fewer than 50% of recommended prenatal visits, PCU initiation after the first trimester of pregnancy, and fewer than three ultrasounds during the entire pregnancy. Families were interviewed in 17 languages by trained peer interviewers in face-to-face interviews. Structural equation modeling was used to identify factors associated with inadequate PCU and to estimate correlations between them. Results This study analyzed data on 121 homeless sheltered mothers who had at least one child less than one year old. They were socially disadvantaged and most were born outside France. One in five (19.3%) had inadequate PCU. Associated factors were socio-demographic characteristics (young age, primiparous), health status (dissatisfaction with self-perceived general health), and living conditions (housing instability in the second and third trimesters). Conclusion It is essential to reduce housing instability to help sheltered mothers to benefit from social, territorial and medical support and healthcare utilization. Housing stability for pregnant sheltered homeless mothers should be a priority to ensure better PCU and guarantee the newborn's health as much as possible.
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Affiliation(s)
- Elodie Richard
- Santé Publique France, University of Bordeaux, Bordeaux Population Health Laboratory, INSERM U1219, Bordeaux, France
- *Correspondence: Elodie Richard
| | - Cécile Vuillermoz
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | | | - Raquel Rico Berrocal
- École des Hautes Études en Sciences Sociales (EHESS), Center d'étude des Mouvements Sociaux (CEMS), EHESS/CNRS UMR 8044/INSERM U1276, Paris, France
| | | | | | - Elie Azria
- Maternity Unit, Paris Saint Joseph Hospital, Université de Paris, U1153 CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Karen Leffondre
- University of Bordeaux, Bordeaux Population Health Laboratory, INSERM U1219, Bordeaux, France
| | - Stéphanie Vandentorren
- Santé Publique France, University of Bordeaux, Bordeaux Population Health Laboratory, INSERM U1219, Bordeaux, France
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Adverse Pregnancy Outcomes and International Immigration Status: A Systematic Review and Meta-analysis. Ann Glob Health 2022; 88:44. [PMID: 35854922 PMCID: PMC9248985 DOI: 10.5334/aogh.3591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Disparities in health outcomes between immigrant and native-origin populations, particularly pregnant women, pose significant challenges to healthcare systems. The aim of this systematic-review and meta-analysis was to investigate the risk of adverse pregnancy outcomes among immigrant-women compared to native-origin women in the host country. Methods: PubMed (including MEDLINE), Scopus, and Web of Science were searched to retrieve studies published in English language up to September 2020. All observational studies examining the prevalence of at least one of the short-term single pregnancy outcomes for immigrants who crossed international borders compared to native-origin pregnant population were included. The meta-prop method was used for the pooled-estimation of adverse pregnancy-outcomes’ prevalence. For pool-effect estimates, the association between the immigration-status and outcomes of interest, the random-effects model was applied using the model described by DerSimonian and Laird. I2 statistic was used to assess heterogeneity. The publication bias was assessed using the Harbord-test. Meta-regression was performed to explore the effect of geographical region as the heterogeneity source. Findings: This review involved 11 320 674 pregnant women with an immigration-background and 56 102 698 pregnant women as the native-origin population. The risk of emergency cesarean section (Pooled-OR = 1.1, 95%CI = 1.0–1.2), shoulder dystocia (Pooled-OR = 1.1, 95%CI = 1.0–1.3), gestational diabetes mellites (Pooled-OR = 1.4, 95%CI = 1.2–1.6), small for gestational age (Pooled-OR=1.3, 95%CI = 1.1–0.4), 5-min Apgar less than 7 (Pooled-OR = 1.2, 95%CI = 1.0–1.3) and oligohydramnios (Pooled-OR = 1.8, 95%CI = 1.0–3.3) in the immigrant women were significantly higher than those with the native origin background. The immigrant women had a lower risk of labor induction (Pooled-OR = 0.8, 95%CI = 0.7–0.8), pregnancy induced hypertension (Pooled-OR = 0.6, 95%CI = 0.5–0.7) preeclampsia (Pooled-OR = 0.7, 95%CI = 0.6–0.8), macrosomia (Pooled-OR = 0.8, 95%CI = 0.7–0.9) and large for gestational age (Pooled-OR = 0.8, 95%CI = 0.7–0.8). Also, the risk of total and primary cesarean section, instrumental-delivery, preterm-birth, and birth-trauma were similar in both groups. According to meta-regression analyses, the reported ORs were not influenced by the country of origin. Conclusion: The relationship between the immigration status and adverse perinatal outcomes indicated a heterogenous pattern, but the immigrant women were at an increased risk of some important adverse pregnancy outcomes. Population-based studies with a focus on the various aspects of this phenomena are required to explain the source of these heterogenicities.
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Trinh NT, de Visme S, Cohen JF, Bruckner T, Lelong N, Adnot P, Rozé JC, Blondel B, Goffinet F, Rey G, Ancel PY, Zeitlin J, Chalumeau M. Recent historic increase of infant mortality in France: A time-series analysis, 2001 to 2019. Lancet Reg Health Eur 2022; 16:100339. [PMID: 35252944 PMCID: PMC8891691 DOI: 10.1016/j.lanepe.2022.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The infant mortality rate (IMR) serves as a key indicator of population health. Methods We used data from the French National Institute of Statistics and Economic Studies on births and deaths during the first year of life from 2001 to 2019 to calculate IMR aggregated by month. We ran joinpoint regressions to identify inflection points and assess the linear trend of each segment. Exploratory analyses were performed for overall IMR, as well as by age at death subgroups (early neonatal [D0-D6], late neonatal [D7-27], and post-neonatal [D28-364]), and by sex. We performed sensitivity analyses by excluding deaths at D0 and using other time-series modeling strategies. Results Over the 19-year study period, 53,077 infant deaths occurred, for an average IMR of 3·63/1000 (4·00 in male, 3·25 in female); 24·4% of these deaths occurred during the first day of life and 47·8% during the early neonatal period. Joinpoint analysis identified two inflection points in 2005 and 2012. The IMR decreased sharply from 2001 to 2005 (slope: -0·0167 deaths/1000 live births/month; 95%CI: -0·0219 to -0·0116) and then decreased slowly between 2005 and 2012 (slope: -0·0041; 95%CI: -0·0065 to -0·0016). From 2012 onwards, a significant increase in IMR was observed (slope: 0·0033; 95%CI: 0·0011 to 0·0056). Subgroup analyses indicated that these trends were driven notably by an increase in the early neonatal period. Sensitivity analyses provided consistent results. Interpretation The recent historic increase in IMR since 2012 in France should prompt urgent in-depth investigation to understand the causes and prepare corrective actions. Funding No financial relationships with any organizations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.
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Schönborn C, Castetbon K, De Spiegelaere M. Country of birth as a potential determinant of inadequate antenatal care use among women giving birth in Brussels. A cross-sectional study. PLoS One 2022; 17:e0267098. [PMID: 35427390 PMCID: PMC9012396 DOI: 10.1371/journal.pone.0267098] [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] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background One of the mechanisms explaining perinatal health inequalities could be inadequate antenatal care among some immigrant groups. Few European studies compared antenatal care use between different groups of immigrants taking into account individual characteristics. This research investigates the associations of three birth regions with the use of antenatal care, by also considering socioeconomic and migration-related determinants. Methods We included 879 mothers born in Belgium, North Africa, and Sub-Saharan Africa, and interviewed them in four Brussels hospitals after they gave birth, using an adapted version of the Migrant-Friendly Maternity Care Questionnaire. We additionally collected clinical data from hospital records. We carried out descriptive analyses and ran univariate and multivariable logistic regression models to estimate the associations of socioeconomic and migration characteristics with a) late start of antenatal care and b) less than minimum recommended number of consultations. Results The vast majority of women in this study had adequate care in terms of timing (93.9%), frequency of consultations (82.2%), and self-reported access (95.9%). Region of birth was an independent risk factor for late initiation of care, but not for infrequent consultations. Women born in Sub-Saharan Africa were more prone to accessing care late (OR 3.3, 95%CI 1.5–7.7), but were not more at risk of infrequent consultations. Women born in North Africa, had similar adequacy of care compared to the Belgium-born population. The three groups also differed in terms of socioeconomic profiles and socioeconomic predictors of antenatal care use. Housing type, professional activity, and health insurance status were important predictors of both outcomes. Conclusions This study showed that the region of birth was partly associated with adequacy of care, in terms of initiation, but not number of consultations. Further dimensions of adequacy of care (content, quality) should be studied in the future. Socioeconomic factors are also key determinants of antenatal care use.
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Affiliation(s)
- Claudia Schönborn
- Research Centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
- Research Centre in Health Systems and Policies, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
- * E-mail:
| | - Katia Castetbon
- Research Centre in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam De Spiegelaere
- Research Centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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Azria E, Sauvegrain P, Anselem O, Bonnet MP, Deneux-Tharaux C, Rousseau A, Richetin J. Implicit biases and differential perinatal care for migrant women: methodological framework and study protocol of the BiP study part 3. J Gynecol Obstet Hum Reprod 2022; 51:102340. [PMID: 35181544 DOI: 10.1016/j.jogoh.2022.102340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The mechanisms of disparities in maternal and perinatal health between migrant and native women are multiple and remain poorly understood. Access to and quality of care are likely to participate in these mechanisms, and one hypothesis is the existence of implicit biases among caregivers through which ethno-racial belonging can influence medical decisions and consequently engender healthcare disparities. Their existence and their role in the generation of non-medically justified differential care have been documented in the United States apart from perinatal care, but remain largely unexplored in Europe. In this article, we present the study protocol and theoretical framework of a study that aims to test and quantify the existence of implicit bias toward African Sub-Saharan migrant women among caregivers working in the perinatal field, and to explore the association between implicit bias and differential care. MATERIAL AND METHODS This study is based on an online survey to which French obstetricians, midwives, and anesthetists were invited to take part. The potential existence of implicit biases toward African Sub-Saharan migrant will be quantified through a validated tool, the Implicit Association Test. Then we will assess how implicit biases are likely to influence clinical decisions and lead to differential care using clinical vignettes designed by an experts group. DISCUSSION Implicit bias and differential care are concept that are tricky to capture and interpret. This research program opens up in France a field of research on certain forms of health discriminations and sheds new light on the issue of social inequalities in perinatal health. STUDY REGISTRATION Registration in the Open Science Framework portal: https://osf.io/djva7/?view_only=c6012ace3fe94165a65b05c2dc6aff9e.
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Affiliation(s)
- Elie Azria
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU Prema, Paris, France.
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, Maternity Unit, Groupe Hospitalier Pitié-Salpêtrière, DMU Origyne, AP-HP, Paris, France
| | - Olivia Anselem
- Port-Royal Maternity Unit, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique Hôpitaux de Paris, Université Paris, FHU Prema, Paris, France
| | - Marie-Pierre Bonnet
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, Department of Anesthesia and Intensive Care, Armand Trousseau Hospital, DMU DREAM, GRC 29, AP-HP, Paris, France; SFAR Research Network
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Anne Rousseau
- Université Paris-Saclay, UVSQ, UFR S. Veil-Santé, CESP équipe Epidémiologie Clinique, Inserm U1018, 78180 Montigny le Bretonneux; Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, F-78300 Poissy, France
| | - Juliette Richetin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.; Bicocca center for Applied Psychology, University of Milano Bicocca, Milan, Italy
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Eslier M, Deneux-Tharaux C, Sauvegrain P, Schmitz T, Luton D, Mandelbrot L, Estellat C, Azria E. Severe maternal morbidity among undocumented migrant women in the PreCARE prospective cohort study. BJOG 2022; 129:1762-1771. [PMID: 35157345 DOI: 10.1111/1471-0528.17124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the risk of severe maternal outcomes among migrant women, considering both their legal status and birthplace; in Europe, migrant women, especially from sub-Saharan Africa, have higher risks of adverse maternal outcomes compared with non-migrants and legal status, a component of migrant condition, may be an important, and potentially actionable, risk factor. DESIGN Prospective cohort study. SETTING Four maternity units around Paris in 2010-12. SAMPLE A total of 9599 women with singleton pregnancies. METHODS Legal status was categorised in four groups: reference group of non-migrant native Frenchwomen, legal migrants with French or European citizenship, other legal migrants with non-European citizenship, and undocumented migrants. The risk of severe maternal morbidity was assessed with multivariable logistic regression models according to women's legal status and birthplace. MAIN OUTCOME MEASURE Binary composite criterion of severe maternal morbidity. RESULTS Undocumented migrants had resided for less time in France, experienced social isolation, linguistic barriers and poor housing conditions more frequently and had a pre-pregnancy medical history at lower risk than other migrants. The multivariable analysis showed that they had a higher risk of severe maternal morbidity than non-migrants (33/715 [4.6%] versus 129/4523 [2.9%]; adjusted odds ratio [aOR] 1.68, 95% CI 1.12-2.53). This increased risk was significant for undocumented women from sub-Saharan Africa (18/308 [5.8%] versus 129/4523 [2.9%]; aOR 2.26, 95% CI 1.30-3.91), and not for those born elsewhere (15/407 [3.7%] versus 129/4523 [2.9%]; aOR 1.44, 95% CI 0.82-2.53). CONCLUSION Undocumented migrants are the migrant subgroup at highest risk of severe maternal morbidity, whereas the prevalence of risk factors does not appear to be higher in this subgroup. This finding suggests that their interaction with maternity care services may be sub-optimal.
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Affiliation(s)
- Maxime Eslier
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Obstetrics and Gynaecology, Caen Hospital, Caen, France
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Priscille Sauvegrain
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Thomas Schmitz
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Department of Obstetrics and Gynaecology, Robert Debré Hospital, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynaecology, Beaujon-Bichat Hospital, FHU PREMA, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, FHU PREMA, Colombes, France
| | - Candice Estellat
- Department of Biostatistics, Public Health and Medical Information, Clinical Research Unit, Pharmacoepidemiology Center (Céphépi), Sorbonne University, INSERM UMR-S 1136 - Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Elie Azria
- Université de Paris, CRESS, Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.,Maternity Unit, Paris Saint Joseph Hospital, FHU PREMA, Paris, France
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Newly Arrived Migrant Women's Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147523. [PMID: 34299974 PMCID: PMC8307311 DOI: 10.3390/ijerph18147523] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/23/2023]
Abstract
Limited understanding of health information may contribute to an increased risk of adverse maternal outcomes among migrant women. We explored factors associated with migrant women's understanding of the information provided by maternity staff, and determined which maternal health topics the women had received insufficient coverage of. We included 401 newly migrated women (≤5 years) who gave birth in Oslo, excluding migrants born in high-income countries. Using a modified version of the Migrant Friendly Maternity Care Questionnaire, we face-to-face interviewed the women postnatally. The risk of poor understanding of the information provided by maternity staff was assessed in logistic regression models, presented as adjusted odds ratios (aORs), with 95% confidence intervals (CI). The majority of the 401 women were born in European and Central Asian regions, followed by South Asia and North Africa/the Middle East. One-third (33.4%) reported a poor understanding of the information given to them. Low Norwegian language proficiency, refugee status, no completed education, unemployment, and reported interpreter need were associated with poor understanding. Refugee status (aOR 2.23, 95% CI 1.01-4.91), as well as a reported interpreter need, were independently associated with poor understanding. Women who needed but did not get a professional interpreter were at the highest risk (aOR 2.83, 95% CI 1.59-5.02). Family planning, infant formula feeding, and postpartum mood changes were reported as the most frequent insufficiently covered topics. To achieve optimal understanding, increased awareness of the needs of a growing, linguistically diverse population, and the benefits of interpretation services in health service policies and among healthcare workers, are needed.
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