Migrant women's utilization of prenatal care: a systematic review

Exploring South Asian women's perspectives and experiences of maternity care services: A qualitative evidence synthesis

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.

Temporary childbirth migration and maternal health care in India

BACKGROUND

Women in South Asia often return to their natal home during pregnancy, for childbirth, and stay through the postpartum period-potentially impacting access to health care and health outcomes in this important period. However, this phenomenon is understudied (and not even named) in the demographic or health literature, nor do we know how it impacts health.

OBJECTIVE

The aim of this study is to measure the magnitude, timing, duration, risk factors and impact on care of this phenomenon, which we name Temporary Childbirth Migration.

METHODS

Using data from 9,033 pregnant and postpartum women collected in 2019 in two large states of India (Madhya Pradesh and Bihar) we achieve these aims using descriptive statistics and logistic regression models, combined with qualitative data from community health workers about this practice.

RESULTS

We find that about one third of women return to their natal home at some point in pregnancy or postpartum, mostly clustered close to the time of delivery. Younger, primiparous, and non-Hindu women were more likely to return to their natal home. Women reported that they went to their natal home because they believed that they would receive better care; this was born out by our analysis in Bihar, but not Madhya Pradesh, for prenatal care.

CONCLUSIONS

Temporary childbirth migration is common, and, contrary to expectations, did not lead to disruptions in care, but rather led to more access to care.

CONTRIBUTION

We describe a hitherto un-named, underexplored yet common phenomenon that has implications for health care use and potentially health outcomes.

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

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.

Do maternal obstetric morbidity and its concomitants differ between sedente and migrant groups? The case of the Oraon populations of Eastern India

The state of pregnancy and child birth is a stretch of intense vulnerability and incurs reproductive cost, which is governed within a specific socio-ecological context. We asked in our research whether the obstetric morbidities at three stages: antepartum, intrapartum and postpartum, and their concomitants differed significantly between sedente and migrant populations. 403 Oraon indigenous women [203 sedente and 200 migrants] living in Eastern India were selected. Data on socio-demographic, reproductive, maternal health care services and obstetric morbidities were collected using semi structured schedules. We applied Categorical Principal Component Analysis (CATPCA) on the first three variables; PC1 and PC4 were loaded with "socio-demographic and maternal health care services" and PC2 and PC3 loaded with "socio-demographic and reproductive" variables. We applied Poisson regression to examine the determinants of obstetric morbidities. Bivariate analyses showed significant (p ≤ 0.05) sedente-migrant differences in variables related to socio-demographic, reproductive, maternal health care and obstetric morbidities. Poisson regression showed migrants were more likely (p ≤ 0.001) to experience ante and intrapartum morbidities than the sedentes, after controlling the confounders. PC1, PC2 and PC3 could significantly (p ≤ 0.05) predict ante and intrapartum morbidities. For postpartum morbidities, barring the variables related to availing of maternal health care services at the time of child delivery and post delivery, neither migration status nor any of the PCs was a significant predictor. For example, participants who delivered their child in health institutions and had episiotomy and/or caesarean delivery (p ≤ 0.01); and those who availed first PNC within the 24 hours of delivery, stayed under medical supervision after delivery for more than 48 hours and received higher coverage of PNCs were more and less likely respectively (p ≤ 0.05) to have experienced postpartum morbidities. We conclude that the maternal obstetric morbidities and their concomitants differed between sedente and migrant Oraon populations owing to their living in differential socio-ecological contexts.

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest

BACKGROUND

Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts.

OBJECTIVES

This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community.

METHODS

This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area.

RESULTS

FTPNC was challenged by women's immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education.

CONCLUSIONS FOR PRACTICE

Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.

Exploring Prenatal Care Quality and Access During the COVID-19 Pandemic Among Pregnant Immigrants in Philadelphia Through the Lens of Community-Based Organizations

Background

The peak of the COVID-19 pandemic led to decreased maternal and child health care engagement, especially among marginalized populations. Existing disparities in prenatal care access and quality faced by pregnant immigrant people are likely to be amplified by the pandemic.

Materials and Methods

We conducted a study with direct service providers (DSPs) at community-based organizations (CBOs) serving pregnant immigrant families in the Philadelphia region. Semistructured interviews addressed barriers and facilitators to prenatal health care access and engagement among immigrant families both before and then after the onset of the pandemic in March 2020. Additional questions elicited context about the demographics of service populations, organizational connectedness to health care providers, and pandemic-related operational changes.

Results

Between June and November 2021, 10 interviews were conducted in English and Spanish with DSPs at 5 CBOs. Primary themes included diminished access and quality of care received due to decreased language accessibility, increased restrictions around support persons, shifts to telemedicine, and changes to appointment scheduling. Additional themes included heightened hesitancy engaging with services due to documentation status, confusion around legal rights, financial strain, and health insurance status. Interviewees provided suggestions for improving service access during and postpandemic for immigrant pregnant people, including implementation of culturally responsive group prenatal care, institutional policies to improve understanding of legal rights, and increased financial supports.

Conclusions

Understanding emergent and exacerbated barriers to prenatal care access and quality during the COVID-19 pandemic provides context for how to improve health equity for immigrant pregnant people through public health and health care policies as the pandemic continues, and once it has subsided.

Association between language barrier and inadequate prenatal care utilization among migrant women in the PreCARE prospective cohort study

BACKGROUND

Inadequate prenatal care utilization (PCU) is involved in the higher risk of adverse maternal outcomes among migrant vs. native women. Language barrier may be a risk factor for inadequate PCU. We aimed to assess the association between this barrier and inadequate PCU among migrant women.

METHODS

This analysis took place in the French multicentre prospective PreCARE cohort study, conducted in four university hospital maternity units in the northern Paris area. It included 10 419 women giving birth between 2010 and 2012. Migrants' language barrier to communication in French were categorized into three groups: migrants with no, partial or total language barrier. Inadequate PCU was assessed by the date prenatal care began, the proportion of recommended prenatal visits completed and ultrasound scans performed. The associations between these language barrier categories and inadequate PCU were tested with multivariable logistic regression models.

RESULTS

Among the 4803 migrant women included, the language barrier was partial for 785 (16.3%) and total for 181 (3.8%). Compared to migrants with no language barrier, those with partial [risk ratio (RR) 1.23, 95% confidence interval (CI) 1.13-1.33] and total (RR 1.28, 95% CI 1.10-1.50) language barrier were at higher risk of inadequate PCU. Adjustment for maternal age, parity and region of birth did not modify these associations, which were noted particularly among socially deprived women.

CONCLUSION

Migrant women with language barrier have a higher risk of inadequate PCU than those without. These findings underscore the importance of targeted efforts to bring women with language barrier to prenatal care.

Transnational prenatal care among migrant women from low-and-middle-income countries who gave birth in Montreal, Canada

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.

Sexual and reproductive health and gender-based violence among female migrants in Morocco: a cross sectional survey

BACKGROUND

Over the past decade, Morocco has increasingly become the chosen destination for a growing number of migrants from neighbouring countries and especially from Sub-Saharan Africa. The aim of this study is to describe the sexual and reproductive health (SRH), as well as sexual and gender-based violence (SGBV) among female migrants in Morocco.

METHODS

This is a descriptive cross-sectional study conducted between July and December 2021. Female migrants were recruited from one university maternity hospital and two primary healthcare centres in Rabat. Data were collected using a structured face-to-face questionnaire, which included information about sociodemographic characteristics, SRH, history of SGBV and its impact, as well as the utilization of preventive and supportive SGBV services.

RESULTS

A total of 151 participants were included in this study. The majority of participants (60.9%) were aged 18 to 34 years old and 83.3% were single. Many participants (62.1%) did not use contraceptives. More than half (56%) of the participants who were pregnant at the time of the study were receiving pre-natal care. About 29.9% of interviewed participants reported experiencing female genital mutilation, and a significant majority (87.4%) experienced SGBV at least once during their lifetimes, while 76.2% experienced SGBV during migration. The most commonly reported form of violence was verbal abuse (75.8%). Among the victims of SGBV, a minority have visited a health facility (7%) or filed a complaint (9%) in the aftermath of violence.

CONCLUSION

Overall, our findings showed low contraception coverage, moderate access to prenatal care, high prevalence of SGBV, and low utilization of preventive and supportive SGBV services among migrant women in Morocco. Further studies are needed to understand the contextual barriers to access, and utilization of SRH care and additional efforts should be undertaken to strengthen SGBV prevention and support systems.

Antenatal Care and Health Behavior of Pregnant Women—An Evaluation of the Survey of Neonates in Pomerania

Background. The German maternity guidelines require regular medical checkup (MC) during pregnancy as a measure of prevention. Socioeconomic factors such as education, profession, income and origin, but also age and parity may influence the preventive and health behavior of pregnant women. The aim was to investigate the influence of these factors on the participation rate in MC of pregnant women. Method. The current analysis is based on the prospective population-based birth cohort study Survey of Neonates in Pomerania, which was conducted in Western Pomerania, Germany. The data of 4092 pregnant women from 2004 to 2008 were analyzed regarding the antenatal care and health behavior. Up to 12 MC were regularly offered; participation in 10 MC is defined as standard screening according to maternity guidelines. Results. Women participated in the first preventive MC on average in the 10th (±3.8 SD) week of pregnancy. 1343 (34.2%) women participated in standard screening and 2039 (51.9%) took a screening above standard. 547 (13.92%) women participated in less than the 10 standard MCs. In addition, about one-third of the pregnancies investigated in this study were unplanned. Bivariate analyses showed an association between better antenatal care behavior and higher maternal age, stabile partnerships and mother born in Germany, p < 0.05. On the contrary antenatal care below standard were more often found by women with unplanned pregnancies, less educational women and women with lower equivalent income, p < 0.001. Health behaviors also influenced antenatal care. Whereas the risk of antenatal care below standard increased by smoking during pregnancy (RRR 1.64; 95% CI 1.25, 2.14) and alcohol consumption (RRR 1.31; 95% CI 1.01, 1.69), supplementation intake was associated with decreased risk (iodine—RRR 0.66; 95% CI 0.53, 0.81; folic acid—RRR 0.56; 95% CI 0.44, 0.72). The health behavior of pregnant women also differs according to their social status. Higher maternal income was negatively correlated with smoking during pregnancy (OR 0.2; 95% CI 0.15, 0.24), but positively associated with alcohol consumption during pregnancy (OR 1.3; 95% CI 1.15, 1.48) and lower pre-pregnancy BMI (Coef. = 0.083, p < 0.001). Lower maternal education was positively correlated with smoking during pregnancy (OR 59.0; 95% CI 28.68, 121.23). Conclusions. Prenatal care according to maternity guidelines is well established with a high participation rate in MC during pregnancy of more than 85%. However, targeted preventive measures may address younger age, socioeconomic status and health-damaging behaviors (smoking, drinking) of the pregnant women because these factors were associated with antenatal care below standard.

Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature

INTRODUCTION

This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model.

METHODS

Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria.

RESULTS

The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors.

DISCUSSION

Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.

Women, Infants, and Children enrollment and pregnancy-related behaviors and outcomes among Medicaid recipients in the United States

BACKGROUND

Nearly 40% of pregnant women in 2016 were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prior studies have investigated nutritional behaviors among WIC participants and access to WIC breastfeeding counseling services. However, there are no (few?) nationally representative, large-scale analyses of WIC users and pregnancy behaviors. Thus, the present study aims to examine associations between WIC use and select pregnancy outcomes among Medicaid enrollees.

METHODS

We examined pregnancy-related behaviors and outcomes using 2018 U.S. Birth Certificates for Medicaid patients aged 18-45 years (N = 1 159 263). Outcomes included prenatal care (PNC) adequacy, breastfeeding initiation, cigarette use, and gestational weight gain. Standard binary and multinomial logistic regressions were used to estimate odds ratios (OR) and 95% confidence intervals (CIs).

RESULTS

After adjustment, WIC users had statistically significant increased odds of adequate PNC (adjusted OR [AOR] = 1.31 [95% CI 1.30, 1.32]), cigarette use (quit smoking during pregnancy 1.09 [1.07, 1.11]; smoked throughout pregnancy 1.16 [1.14, 1.18], and exceeding recommendations of weight gain 1.07 [1.06, 1.08]) compared with non-WIC users. WIC enrollees also experienced decreased odds of breastfeeding initiation (0.85 [0.85, 0.86]) compared with non-WIC users.

CONCLUSIONS

The study underscores the value of the WIC program in improving access to PNC. Yet, low-income women remain at risk for smoking during pregnancy and exceeding the recommended amount of weight gain. Breastfeeding initiation is lower than anticipated among WIC participants. Additional studies are needed to investigate WIC program efficacy.

Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project

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).

Social determinants of inadequate prenatal care utilization in sheltered homeless mothers in the Greater Paris area in France

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.

Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation

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).

Host-country language proficiency and migrant-native disparities in prenatal care utilization: A nationwide study in Portugal

BACKGROUND

Migrant-native disparities in perinatal health and care utilization are well-established, yet most evidence comes from countries without universal health coverage. Migrant-specific factors potentially contributing to such disparities are seldom examined. We investigated the association between migration and host-country language proficiency and inadequate utilization of prenatal care (PNC) in Portugal.

METHODS

We used robust Poisson regression to analyze data from 1419 migrant and 2477 native women enrolled in the Portuguese Bambino cohort study who had given birth at a Portuguese public hospital between 2017 and 2019. Migrant women's language proficiency was self-rated for understanding, speaking, reading, and writing skills. PNC utilization inadequacy was assessed using three dimensions: initiation, number of visits, and the modified Adequacy of Prenatal Care Utilization (mAPNCU) Index score.

RESULTS

Migrant women were overall more likely to initiate PNC late and have inadequate/intermediate mAPNCU scores than natives. Migrant-native disparities in the number of PNC visits were only observed among recent migrants (≤5 years in Portugal). Full, intermediate, and limited Portuguese skills were associated with increasingly higher risks of late PNC initiation (aRR 1.34 [95%CI 1.20-1.50]); (aRR 1.52 [95%CI 1.28-1.80]); (aRR 1.91 [95%CI 1.52-2.40]), inadequate number of PNC visits (aRR 1.06 [95%CI 0.93-1.22]); (aRR 1.14 [95%CI 0.97-1.34]); (aRR 1.57 [95%CI 1.19-2.07]), and inadequate/intermediate mAPNCU scores (aRR 1.18 [95%CI 1.07-1.32]); (aRR 1.30 [95%CI 1.11-1.53]); (aRR 1.69 [95%CI 1.38-2.07]) compared with native Portuguese skills, respectively.

CONCLUSIONS

Migrant-native disparities in PNC utilization are present in Portugal, despite universal health coverage. Recent migrants and women with limited language competence are the most vulnerable to inadequate PNC use.

Language-supported labor ward visits for pregnant migrant women: Staff experiences in a Swedish hospital

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

Disparities in Adverse Maternal Outcomes Among Five Race and Ethnicity Groups

Background: Racial/ethnic disparities are evident in adverse maternal health outcomes, but they are shifting due to interventions, initiatives, changing demographics, and the prevalence of preexisting conditions. This study examined the current racial/ethnic disparities in adverse maternal outcomes. Materials and Methods: In a cross-sectional study, the International Classification of Diseases-10 codes for the principal diagnosis and secondary diagnoses were retrieved from the National Inpatient Sample database (2016-2018). A weighted multiple logistic regression model assessed disparities in seven adverse maternal outcomes, including preterm labor, gestational hypertension (GHTN) and diabetes, premature rupture of membranes (PRM), infection of the amniotic cavity (INFAC), placental abruption, and postpartum hemorrhage (PPH). A weighted linear regression model assessed disparities in a composite variable of maternal outcomes. A maternal-specific comorbidity index assessed risk adjustment, and other clinical, sociodemographic, and hospital factors were considered. Results: A total of 2,211,345 pregnancies were included. Preterm labor, GHTN, and placental abruption had the highest raw rate among Black women compared to all races. After adjusting for control variables in the regression analysis, these adverse outcomes also showed the highest odds ratio (OR) among Black women compared to White women (the reference group). Gestational diabetes, PRM, and INFAC had the highest raw rate among Asians/Pacific Islanders (PIs). After adjusting for control variables, these adverse outcomes also showed the highest OR among Asians/PIs compared to White women. The OR for PPH was the highest for Native Americans compared to White women. Furthermore, results of the composite outcome variable indicated that all minority groups experienced the overall poorer maternal outcome than White women. Conclusions: Overall, all four minority women had higher raw rates and also odds of experiencing the studied adverse outcomes than White women. Existing efforts should be strengthened to continue reducing racial/ethnic disparities in adverse maternal outcomes.

Complications and Healthcare Consumption of Pregnant Women with a Migrant Background: Could There be an Association with Psychological Distress?

Objective

Previous studies reported less prenatal healthcare consumption and more perinatal complications in women with a migrant background. Hence, we investigated in a country with free healthcare access whether women with a migrant background differed with respect to pregnancy complications, healthcare consumption and in terms of associations with psychological distress in comparison to native Dutch.

Methods

We included 324 native Dutch and 303 women with a migrant background, who visited two hospitals in Amsterdam for antenatal care between 2014 and 2015. Participants completed the Edinburgh Postnatal Depression Scale, the Hospital Depression and Anxiety Scale, and sociodemographic questions. Complications and healthcare consumption during pregnancy were extracted from medical records. Regression analyses were used with adjustment for covariates.

Results

Except for gestational diabetes [adjusted OR = 3.09; 95% CI = (1.51, 6.32)], no differences were found between groups in perinatal complications [OR = 1.15; 95% CI = (0.80, 1.64)], nor in healthcare consumption [OR = 0.87; 95% CI = (0.63, 1.19)].

Women with a migrant background reported more depressive symptoms [Cohen’s d = 0.25; 95% CI = (0.10, 0.41)], even after adjustment for socio-economic factors. Psychological distress was associated with more hospital admissions during pregnancy. When experiencing depressive symptoms, women with a migrant background had an increased risk to be admitted [OR = 1.11; 95% CI = (1.01, 1.21)].

Conclusions for Practice

This cohort study found no differences in pregnancy-related complications, except for diabetes, nor different healthcare consumption, in women with a migrant background versus native Dutch, in a country with free health care access. However, women with a migrant background experienced more depressive symptoms, and when depressed their risk for hospital admission increased. Additional research is warranted to improve healthcare for this population.

Country of birth as a potential determinant of inadequate antenatal care use among women giving birth in Brussels. A cross-sectional study

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.

Qualitative research on maternal care access among Arabic-speaking refugee women in the USA: study protocol

BACKGROUND

Refugees tend to have greater health needs and pre-existing medical conditions due to poor living conditions, lack of health services, exposure to a variety of risk factors, and a high level of stress and trauma prior to entry to a host country. Notwithstanding distinctive needs and inherent conditions, there is a paucity of literature on refugee maternal health, especially for Arabic-speaking refugee women resettled in the USA.

METHODS AND ANALYSIS

The paper delineates a qualitative study protocol to explore the experiences of Arabic-speaking refugee women in the USA when accessing maternal care. Informed by social cognitive theory, the study will employ two qualitative research methods; in-depth interviews and 'go-along' interviews with Arabic-speaking refugee women. Go-along interview will be used to elicit spatial experiences in situ to explore perceptions of environments among study participants and environmental and structural barriers. 20 refugee women who meet the inclusion criteria will be recruited through snowball sampling with support from community partners. Two researchers will code the transcription and fieldnotes using MAXQDA 2020 (VERBI Software, 2019). The analysis will involve deductive content analysis using a structured categorisation matrix based on the theory while also incorporating inductive codes that may emerge through the process.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Human Subjects Protection Programme at the University of Arizona (IRB 2104716241). The study results will be condensed in a summary report, which will be shared with community partners, including refugee resettlement agencies and relevant staff at the state department. Also, community feedback will be garnered from the dissemination workshops to inform community discussions for actions and an intervention to address the identified needs.

Implicit biases and differential perinatal care for migrant women: methodological framework and study protocol of the BiP study part 3

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.

Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018)

Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.

Inclusive partnership and community mobilization approaches to improve maternal health care access among internal migrants in nine Indian cities

Background

Disparities in healthcare access to internal migrants exist, and the gaps may widen further if appropriate steps are not taken. Innovative approaches are needed to better align the healthcare services with the migrants’ needs.

Aim

The aim was to develop and test a supportive strategy of healthcare, which would achieve the desired level of access and delivery of maternal healthcare services to internal migrants living in nine Indian cities.

Methods

This intervention with the quasi-experimental design was conducted with pre- vs post-intervention comparisons within the interventional groups and with the control group. The intervention was implemented with an inclusive partnership approach. Advocacy and community mobilization were the main intervention components.

Findings

An increased proportion of women sought antenatal care during the intervention. More women initiated seeking antenatal care in the first trimester. Due to intervention, health workers’ prenatal (41.7% in the post- against 14.7% in the pre-interventional phase) and postnatal home visits increased (11.6% to 34.7%) considerably.

Conclusions

Interventions with inclusive partnership would improve healthcare access to vulnerable communities such as migrants. Hence, efforts to strengthen the government healthcare system through novel strategies are crucial to provide better healthcare to migrants.

Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016-2018

Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016-2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.

Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway

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.

[Maternal and child health inequalities among migrants: the case of Haiti and the Dominican RepublicDesigualdades na saúde materno-infantil entre migrantes: o caso do Haiti e da República Dominicana]

Objective

To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans.

Methods

Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition.

Results

Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups.

Conclusion

Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.

Description of a migrant pediatric population visiting the Toulouse Children's Hospital emergency department

BACKGROUND

Today, one in eight migrants and one in two refugees are children. Since this population has been less studied than the adult population, there is little data available on the state of health of this pediatric migrant population and the reasons they seek care.

OBJECTIVE

The objective of this study was to describe the sociodemographic and medical characteristics of a pediatric migrant population visiting an emergency department in order to better understand their specific needs.

MATERIALS AND METHODS

This was a retrospective observational study using data from medical records and social surveys of migrant children who had visited the Toulouse pediatric emergency department between 1 January 2018 and 31 December 2018.

RESULTS

A total of 203 migrant children, i.e., 344 emergency visits, were analyzed. The average age of the children was 3.3 years old. More than half (58.1%) of the children were from Eastern Europe; 71% visited due to infectious pathologies. The severity of the reasons for visiting (90% of the reasons for visiting had a CCMU (Clinical Classification of Emergency Patients) of 1 or 2) and the hospitalization rate (9%) were not higher in the pediatric migrant population than in the general pediatric population. We discovered associated diagnoses (e.g., scabies, anemia, oral and dental disorders) in connection with migration and/or the resulting vulnerability. There was a language barrier in 78% of the visits analyzed with underuse of professional interpreting (7%).

CONCLUSION

Because of the journey they make, migrant children are likely to have specific health needs and require dedicated care.

Does women's place of birth affect their opportunity for an informed choice about Down syndrome screening? A population-based study in France

Background

To examine disparities by maternal place of birth in the opportunity to make an informed choice about Down syndrome screening, in France, where the national guidelines recommend that physicians offer it to all pregnant women.

Methods

We used population-based data from the nationally representative French Perinatal Surveys in 2010 and 2016 (N=24,644 women) to analyze the opportunity for an informed choice for prenatal screening, measured by a composite indicator.

Results

Among the 24 644 women in the study, 20 612 (83.6%) were born in France, 861 (3.5%) elsewhere in Europe, 1550 (6.3%) in North Africa, and 960 (3.9%) in sub-Saharan Africa. The probability of screening was lower for women born outside France. After adjustment for survey year, maternal age, parity, education level, and the maternity unit’s level of perinatal care, women born outside France had the opportunity to make an informed choice less often than women born in France. This association remained essentially the same even after excluding women without adequate prenatal care.

Conclusions

Women born outside France, including those with adequate prenatal care, had less opportunity than women born in France to make an informed choice about prenatal screening for Down syndrome.

"We have a lot of home deliveries" A qualitative study on the impact of COVID-19 on access to and utilization of reproductive, maternal, newborn and child health care among refugee women in urban Eastleigh, Kenya

Background

Little is known about how pregnant refugee women, and the frontline health care workers who serve them, are affected by the COVID-19 pandemic in terms of health, and health service access. Women refugees are classified as a vulnerable group with regard to pregnancy outcomes and access to maternal care, and may be disproportionally at risk for COVID-19 infection as they are likely to face unique barriers to information and access to reproductive health services during the pandemic. Few studies identify gaps that could inform potential interventions to improve service uptake for refugee women, particularly in the context of COVID-19. Yet, understanding how pregnant refugees are impacted in the context of the pandemic is critical to developing and implementing strategies and measures that can help in their care and the delivery of health services.

Aims

This study aimed to improve understanding of the impact of COVID-19 on women refugees' access to and utilisation of antenatal care, delivery and postnatal care in Eastleigh, Kenya.

Methods

The study was conducted in Eastleigh, a semi-urban centre in Nairobi. We conducted 25 in-depth interviews with facility and community health care staff (n = 10) and women attending antenatal (n = 10) and postnatal care services (n = 5) in October 2020. Data was analysed using NVIVO 12 software.

Findings

Our findings suggest that within the first eight months of COVID-19, preferences for home deliveries by refugee women increased and health care workers reported having observed reduced utilisation of services and delayed care. Fear, economic challenges and lack of migrant-inclusive health system policies were key factors influencing home deliveries and delayed and low uptake of facility-based care.

Conclusions

The findings highlight the need to mitigate and lower barriers that prevent refugee women from seeking care at health facilities. One approach includes the development of refugee-inclusive public health policies, particularly during a pandemic, and the need to tailor health care services for refugees at facilities and in the communities.

The differences in perinatal outcomes between refugee and resident mother-infant dyads: A retrospective study in Turkey between 2013 and 2018

In this study, we aimed to examine and compare the perinatal outcomes between refugee and resident mother-infant dyads. Data of refugee women who had given birth in a university hospital (n = 924) and matched resident mother-infant dyads (n = 957) were included. Analysis revealed higher adolescent pregnancy rates and lower rates of antenatal care attendance among refugee mothers compared to residents. No significant differences in neonatal outcomes were found, except for a significantly higher number of preterm births among refugee infants. Interventions should be made to ensure antenatal care for all pregnant women, which can also prevent preterm birth.

Satisfaction with maternity care among recent migrants: an interview questionnaire-based study

OBJECTIVE

To examine factors associated with recently migrated women's satisfaction with maternity care in urban Oslo, Norway.

DESIGN

An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire.

SETTING

Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020.

PARTICIPANTS

International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries.

PRIMARY OUTCOME

Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences.

SECONDARY OUTCOME

Negative healthcare experiences and their association with reason for migration.

RESULTS

A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification.

CONCLUSIONS

Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.

Newly Arrived Migrant Women's Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway

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.

Interventions to Support International Migrant Women's Reproductive Health in Western-Receiving Countries: A Systematic Review and Meta-Analysis

Purpose: The reproductive health outcomes of international migrant women differ in comparison with receiving-country-born women, depending on country of birth and immigrant status. Effective interventions to support the reproductive health of international migrant women are not well known.

Methods: We conducted a systematic review and meta-analysis of studies between 2010 and 2017 evaluating interventions directly or indirectly affecting the reproductive health (as defined by the World Health Organization) of international migrant women in Western-receiving countries.

Results: Sixteen studies representing 5080 migrants were identified. Interventions consisted of linguistically (e.g., translated brochures) or culturally adapted (e.g., cultural narratives) routine care or new interventions. Meta-analysis showed that interventions increased rates of preventive reproductive health activities, including mammography, condom use, and Pap test completion, by almost 18% (95% confidence interval 7.61–28.3) compared with usual care or interventions not adapted to migrant women.

Conclusion: Culturally and linguistically adapted care practices congruent with target populations of international migrant women are effective in improving their reproductive health outcomes, particularly their participation in preventative reproductive health activities.

Midwives' experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project

BACKGROUND

The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The "Operational Refugee and Migrant Maternal Approach" (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives' experiences of the training and providing care within the ORAMMA project.

METHODS

Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives' experiences of the training and of caring for migrant women within the ORAMMA project.

RESULTS

A significant improvement of the median score pre to post-test was observed for midwives' knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives' experiences of the training revealed themes of "appropriate and applicable", "made a difference" and "training gaps" and data from ORAMMA project experiences identified three further themes; "supportive care", "working alongside peer supporters" and "challenges faced".

CONCLUSIONS

The training improved midwives' knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters' roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Association between migration status and caesarean section delivery based on a modified Robson classification in China

Background

China has one of the highest caesarean section (C-Section) rates in the world. In recent years, China has been experiencing a massive flow of migration due to rapid urbanization. In this study, we aimed to differentiate the rates of C-Section between migrants and residents, and explore any possible factors which may moderate the association between migrant status and C-Section rates.

Methods

We conducted a retrospective cohort study in Shanghai, China. All deliveries were classified using the modified Robson Classification. The association between women’s migrant status and C-Section rates was assessed using the Poisson regression of sandwich estimation, after adjusting for possible factors.

Results

Of the 40,621 women included in the study, 66.9% were residents and 33.1% were internal migrants. The rate of C-Section in migrants was lower than that of residents in all subjects (39.9 and 47.7%) and in group 1 subjects (based on the Robson Classification) using a modified Robson Classification. There was an association between migrant status and caesarean delivery on maternal request that was statistically significant (RR = 0.664, p < 0.001), but the association was weakened after adjusting for such factors as maternal age at delivery (aRR = 0.774, p = 0.02), ethnicity (aRR = 0.753, p < 0.001), health insurance (aRR = 0.755, p < 0.001), and occupation (aRR = 0.747, p = 0.004), but had no significant changes when adjusting for health conditions (aRR = 0.668, p = 0.001) and all considering variables (aRR = 0.697, p = 0.002). In group 1 subjects, the effect of migrant status on maternal requested intrapartum C-Section was also statistically significant (RR = 0.742, p = 0.004).

Conclusion

C-Section rates are lower among migrant women than residents, especially on maternal request. The medical practitioners should further reinforce the management of elective C-Section in resident women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03708-6.

Maternity care for refugees living in Greek refugee camps: What are the challenges to provision?

BACKGROUND

Over a two-year period between 2015 and 2016, unprecedented numbers of people arrived in Greece fleeing conflict, persecution, and poverty. With new arrivals every day, there is a significant unmet need for health care provision, posing a challenge to the Greek Healthcare System. For pregnant refugees, a known vulnerable group, this has resulted in a complex partnership of shared maternity care between humanitarian organizations, the Greek national health care system, and European multi-state initiatives. Our aim was to understand the challenges to providing maternity care services in Greek refugee camps as perceived by health care providers.

METHODS

A qualitative study comprising observation and semi-structured interviews with health care providers working with pregnant refugees was conducted in five refugee camps in May 2017. Interviews were transcribed and analyzed with thematic coding.

RESULTS

Twenty-one health care providers were interviewed and field notes taken from observational study of services in five refugee camps. Health care providers describe difficult cross-cultural communication to be their biggest challenge to caring for pregnant refugee women. The limited availability of female only safe spaces is also identified as a barrier. Lastly, the overburdened Greek public health system limits their ability to provide care.

CONCLUSIONS

Our research supports other literature describing difficult communication and the overburdened Greek health system as significant health care barriers for pregnant refugees in Greece. There is limited literature examining the role of "safe space," and further research is needed. Stakeholders providing maternity care to refugees should look to tackle these key issues as they seek to provide care to this population.

Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity

Identifying the opportunities and barriers of promoting and fulfilling the sexual health rights of migrants remains a challenge that requires systematic assessment. Such an assessment would include estimating the influence of acculturation processes on sexual and reproductive health, and mapping intersectional inequities that influence migrants’ sexual and reproductive health in comparison with the native population. The aim of this research was to locate, select, and critically assess/summarize scientific evidence regarding the social, cultural, and structural factors influencing migrants’ sexual and reproductive health outcomes in comparison with native population. An umbrella review of systematic reviews and/or meta-analyses, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) standards was undertaken. Medline, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews were searched from their start date until June 2019. The quality of the included articles was determined using the assessment of multiple systematic reviews tool (AMSTAR 2). From the 36 selected studies, only 12 compared migrant with native populations. Overall, the findings indicated that migrants tend to underuse maternal health services and have an increased risk of poor sexual and reproductive health outcomes. Specific intersectional inequities were identified and discussed.

Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies

OBJECTIVE

Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular.

METHODS

Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status.

RESULTS

In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake.

CONCLUSIONS FOR PRACTICE

Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.

"It's a life you're playing with": A qualitative study on experiences of NHS maternity services among undocumented migrant women in England

BACKGROUND

Undocumented migrant women experience complex barriers to maternity services, are less likely to receive the recommended level of maternity care, and have poorer obstetric outcomes than non-migrant women. There are concerns increasing restrictions on entitlement to health services have a detrimental impact on access to services and obstetric outcomes, particularly among undocumented migrant women. The study aimed to investigate the experiences of undocumented migrant women who have been pregnant in England, and factors affecting access to care and health outcomes.

METHODS

We conducted in-depth semi-structured interviews June-December 2017 with a purposive sample of migrant women born outside the UK (aged>18) who had experiences of pregnancy and undocumented status (without permission to reside) in the UK, recruited through Doctors of the World (DOTW) UK. Interpreting services were used on request. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval: Imperial College London Research Ethics Committee (ICREC reference: 17IC3924).

RESULTS

Semi-structured interviews were conducted with 20 participants, 10 of whom had their first antenatal appointment after the national target of 13 weeks, and nine of whom reported complications. Themes defining women's experiences of pregnancy included: restricted agency, intersecting stressors, and an ongoing cycle of precarity, defined by legal status, social isolation, and economic status.

CONCLUSIONS

This study provides new evidence of women's experiences of pregnancy in the UK in the context of increasingly restrictive health policies including charging and data sharing. Six recommendations are made to ensure the UK and other migrant receiving countries work towards reducing inequalities and achieving national and global targets for maternal and child health and universal health coverage.

Autism Spectrum and Other Neurodevelopmental Disorders in Children of Immigrants: A Brief Review of Current Evidence and Implications for Clinical Practice

Children of immigrants may have higher neurodevelopmental risks than those of non-immigrant populations. Yet, some evidence suggests that this group may receive late diagnosis, and therefore miss beneficial early interventions. Clinicians may misattribute symptoms of disorders to other social, behavioral or language problems. Likewise, there might be cultural differences in parents' likelihood of perceiving or reporting first developmental concerns to clinicians. Population-based standardized screening may play an important role in addressing ethnic inequalities in the age at diagnosis, although further research focusing on cross-cultural use is necessary. Once children are diagnosed, clinicians may rely on culturally sensitive procedures (translation services, cultural mediators) to increase the accessibility of interventions and improve adherence among immigrant families. In this brief review, we provide an overview about what is currently known about the epidemiology and risk factors of neurodevelopmental disorders, paying special attention to autism spectrum disorder (ASD), in children of immigrants and suggest the necessity of population-based screening and culturally sensitive care.

Maternity care through the eyes of Southern European immigrant parents in Norway

OBJECTIVE

To explore Southern European immigrant mothers and fathers' experiences of reproductive health services in Norway, and their perceptions of health providers' beliefs and attitudes regarding pregnancy and childbirth.

METHOD

We employed a qualitative research methodology with two focus group discussions and 11 in-depth interviews with 4 fathers and 11 mothers from Italy, Spain, Portugal, and Greece, whose children were born in Norway. Thematic Analysis was conducted to identify and analyze patterns across the data.

RESULTS

We identified three themes as key elements in parents' experiences: experiences with the coverage and organization of the Reproductive Health Services; relational experiences with health providers; and pregnancy and delivery as a culturally-shaped event. The immigrant parents experienced a clash between their expectations and the procedures and health facility environment encountered in Norway regarding check-ups, diagnosis tests, childbirth preparation courses, and health facilities. Informants perceived that the maternity care practices of the host country were underpinned by the health care providers' cultural understandings of labor and pregnancy. Particularly, they experienced a less interventionist approach towards pregnancy and childbirth.

CONCLUSIONS

The experiences of immigrant parents provide relevant information to improve reproductive health services in a cross-cultural context. Inmigration brings new challenges that must be addressed from a perspective of cultural competence. These services should acknowledge diversity in cultural beliefs around childrearing and involve both fathers and mothers in decision-making.

Association Between Chronic Medical Conditions and Acute Perinatal Psychiatric Health-Care Encounters Among Migrants: A Population-Based Cohort Study

OBJECTIVES

To examine the relationship between prepregnancy chronic medical conditions (CMCs) and the risk of acute perinatal psychiatric health-care encounters (i.e., psychiatric emergency department visits, hospitalizations) among refugees, nonrefugee immigrants, and long-term residents in Ontario.

METHODS

We conducted a population-based study of 15- to 49-year-old refugees (N = 29,189), nonrefugee immigrants (N = 187,430), and long-term residents (N = 641,385) with and without CMC in Ontario, Canada, with a singleton live birth in 2005 to 2015 and no treatment for mental illness in the 2 years before pregnancy. Modified Poisson regression was used to estimate the relative risk of a psychiatric emergency department visit or hospitalization from conception until 1 year postpartum among women with versus without CMC, stratified by migrant status. An unstratified model with an interaction term between CMC and migrant status was used to test for multiplicativity of effects.

RESULTS

The association between CMC and risk of a psychiatric emergency department visit or hospitalization was stronger among refugees (adjusted relative risk [aRR] = 1.87; 95% confidence interval [CI], 1.36 to 2.58) compared to long-term residents (aRR = 1.39; 95% CI, 1.30 to 1.48; interaction P = 0.047). The strength of the association was no different in nonrefugee immigrants (aRR = 1.26; 95% CI, 1.05 to 1.51) compared to long-term residents (interaction P = 0.45).

CONCLUSION

Our study identifies refugee women with CMC as a high-risk group for acute psychiatric health care in the perinatal period. Preventive psychosocial interventions may be warranted to enhance supportive resources for all women with CMC and, in particular refugee women, to reduce the risk of acute psychiatric health care in the perinatal period.

Maternal and child health inequalities among migrants: the case of Haiti and the Dominican Republic

Objective.

To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans.

Methods.

Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition.

Results.

Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups.

Conclusion.

Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.

Association between Migrant Women's Legal Status and Prenatal Care Utilization in the PreCARE Cohort

Barriers to access to prenatal care may partially explain the higher risk of adverse pregnancy outcomes among migrants compared with native-born women in Europe. Our aim was to assess the association between women's legal status and inadequate prenatal care utilization (PCU) in France, where access to healthcare is supposed to be universal. The study population was extracted from the PreCARE prospective cohort (N = 10,419). The associations between women's legal status and a composite outcome variable of inadequate PCU were assessed with multivariate logistic regressions. The proportion of women born in sub-Saharan Africa (SSA) was higher among the undocumented than that of other migrants. All groups of migrant women had a higher risk of inadequate PCU (31.6% for legal migrants with European nationalities, 40.3% for other legal migrants, and 52.0% for undocumented migrants) than French-born women (26.4%). The adjusted odds ratio (aOR) for inadequate PCU for undocumented migrants compared with that for French-born women was 2.58 (95% confidence interval 2.16-3.07) overall, and this association was similar for migrant women born in SSA (aOR 2.95, 2.28-3.82) and those born elsewhere (aOR 2.37, 1.89-2.97). Regardless of the maternal place of birth, undocumented migrant status is associated with a higher risk of inadequate PCU.

"No Papers. No Doctor": A Qualitative Study of Access to Maternity Care Services for Undocumented Immigrant Women in Denmark

The purpose of this study is to explore undocumented immigrant women’s experiences of, as well as their access to, maternity care services during pregnancy in Denmark. Recruiting through the two branches of a non-governmental organization (NGO)-driven health clinic in Denmark, we conducted 21 semi-structured interviews with undocumented immigrant women in Denmark from January 2018 to January 2019. The undocumented immigrant women experienced barriers such as fear of deportation, concerns about payment for services, and uncertainties about rules for access. Many of them described depending on NGO-driven initiatives to access maternity care services and found these as providing a safe environment for care. Our findings contribute insights towards understanding the health behavior of undocumented immigrant women and highlight the need for inclusive care to safeguard the health of the women and their children.

Implementation of Obstetric Telehealth During COVID-19 and Beyond

Purpose

The purpose of this article is to illustrate and discuss the impact the 2019 novel Coronavirus (COVID-19) pandemic on the delivery of obstetric care, including a discussion on the preexisting barriers, prenatal framework and need for transition to telehealth.

Description

The COVID-19 was first detected in China in December of 2019 and by March 2020 spread to the United States. As this virus has been associated with severe illness, it poses a threat to vulnerable populations—including pregnant women. The obstetric population already faces multiple barriers to receiving quality healthcare due to personal, environmental and economic barriers, now challenged with the additional risks of COVID-19 exposure and limited care in times much defined by social distancing.

Assessment

The current prenatal care framework requires patients to attend multiple in-office prenatal visits that can exponentially multiply depending on maternal and fetal comorbidities. To decrease the rate of transmission of the COVID-19 and limit exposure to patients, providers in Hillsborough County, Florida (and nationwide) are rapidly transitioning to telehealth. The use of a virtual care model allows providers to reduce in-person visits and incorporate virtual visits into the schedule of prenatal care.

Conclusion

Due to the COVID-19 pandemic, implementation of telehealth and telehealth have become crucial to ensure the safe and effective delivery of obstetric care. This implementation is one that will continue to require attention to planning, procedures and processes, and thoughtful evaluation to ensure the sustainability of telehealth and telehealth post COVID-19 pandemic.

Barriers and associated factors for adequate antenatal care among Afghan women in Iran; findings from a community-based survey

BACKGROUND

Almost a third of Afghan women living in Iran are at childbearing age. Antenatal care (ANC) is an inextricable part of healthy pregnancy and could prevent the adverse birth outcomes. Almost 97% of Iranian expectant women are receiving adequate ANC (4 or more visits). However, the situation for pregnant Afghan women is unclear. Some studies indicated low access to ANC among Afghan women. In the present study, we aimed to explore the sociodemographic factors and potential barriers associated with adequate ANC among Afghan women in Iran.

METHODS

A cross sectional study was conducted between June 2019 and August 2019. Using time location sampling (TLS), we recruited 424 Afghan women aged 18-45 years old at three health centers in south region of Tehran. The data were collected on sociodemographic characteristics and the reported reasons for inadequate ANC using a questionnaire and analyzed applying bivariate, and multivariate analyses. Factor analysis was performed to reduce the number of potential reasons for inadequate ANC in order to improve the precision of regression analysis.

RESULTS

Almost a third of Afghan women in this study had adequate ANC (≥ 8 visits). The women in older age group, those with higher education and family income, women with longer length of stay, those of legal status were more likely to have adequate ANC. In multivariate analysis, the poor knowledge and attitude toward ANC (AOR = 0.06; 95% CI [0.03-0.15]), the poor quality of services (AOR = 0.17 95% CI [0.07-0.41]); and to some extent, the difficulties in access (AOR = 0.33; 95% CI [0.11-1.00]) were the main obstacles toward adequate ANC among the study population.

CONCLUSION

Our study emphasized the important role of the personal knowledge and attitude toward ANC with adequate antenatal care among Afghan women in Iran. This could be addressed by well-oriented interventions and health education for Afghan women. The collaboration between central government with international agencies should be directed toward enhancing the social support, promoting the awareness and knowledge, and expanding the safety net services to improve the access and quality care among Afghan women in Iran.

Norwegian multicultural doulas' experiences of supporting newly-arrived migrant women during pregnancy and childbirth: A qualitative study

OBJECTIVE

This study was part of a project promoted with the caption 'Vulnerable, pregnant and new in Norway - Safe during childbirth with a multicultural doula.' The project aimed to provide multicultural doulas who could strengthen maternity care and give migrant women safe births. The aim of the study was to examine how the multicultural doulas experienced their work with newly arrived migrant women during pregnancy and childbirth.

METHODS

A qualitative approach was used for the data collection and the data was collected from nine in-depth interviews with multicultural doulas. All the participants were educated by Oslo University Hospital, Norway, where they worked as doulas. The method of data analysis was inspired by Granheim and Lundman's qualitative content analysis.

RESULTS

The qualitative content analysis revealed four categories: providing important knowledge, creating continuity of care for migrant women, being aware of migrant women's vulnerability, and building a cultural bridge. One main theme emerged: Feeling like a mother for vulnerable migrant women and a person who builds a cultural bridge between them and maternity care in Norway.

CONCLUSION

The multicultural doulas saw themselves as a resource for both newly-arrived migrant women and midwives during pregnancy and childbirth. The findings suggested that their presence can strengthen maternity care for migrant women by providing information, continuity, and a cultural bridge between migrant women and maternity care in Norway.

Preterm Birth among Infants Exposed to in Utero Ultrafine Particles from Aircraft Emissions

INTRODUCTION

Ambient air pollution is a known risk factor for adverse birth outcomes, but the role of ultrafine particles (UFPs) is not well understood. Aircraft-origin UFPs adversely affect air quality over large residential areas downwind of airports, but their reproductive health burden remains uninvestigated.

OBJECTIVES

This analysis evaluated whether UFPs from jet aircraft emissions are associated with increased rates of preterm birth (PTB) among pregnant mothers living downwind of Los Angeles International Airport (LAX).

METHODS

This population-based study used birth records, provided by the California Department of Public Health, to ascertain birth outcomes and a novel, validated geospatial UFP dispersion model approach to estimate in utero exposures. All mothers who gave birth from 2008 to 2016 while living within 15km of LAX were included in this analysis (N=174,186; including 15,134 PTBs).

RESULTS

In utero exposure to aircraft-origin UFPs was positively associated with PTB. The odds ratio (OR) per interquartile range (IQR) increase [9,200 particles per cubic centimeter (cc)] relative UFP exposure was 1.04 [95% confidence interval (CI): 1.02, 1.06]. When comparing the fourth quartile of UFP exposure to the first quartile, the OR for PTB was 1.14 (95% CI: 1.08, 1.20), adjusting for maternal demographic characteristics, exposure to traffic-related air pollution, and airport-related noise.

CONCLUSION

Our results suggest that emissions from aircraft play an etiologic role in PTBs, independent of noise and traffic-related air pollution exposures. These findings are of public health concern because UFP exposures downwind of airfields are common and may affect large, densely populated residential areas. https://doi.org/10.1289/EHP5732.