Background According to the definition of the German Federal Statistical Office, about every fourth person living in Germany has a so-called migration background (MB), i.e., the person or at least one of their parents was born without German citizenship. However, MB has been defined differently in many studies. Also, the MB summarises people in different living situations, making differentiated analysis in health science more difficult. This article formulates recommendations for the collection and analysis of migration-related, as well as social and structural, determinants of health. Indicators for capturing relevant determinants of health As part of the Improving Health Monitoring in Migrant Populations project (IMIRA), the previous approaches to operationalise and measure migration-related determinants were revised based on literature research and exchange formats, such as workshops, meetings, congress contributions, etc. Instead of MB, the country of birth of the respondents and their parents, duration of residence, citizenship(s), residence status, and German language proficiency should be recorded as minimum indicators and analysed as individual variables. Further social and structural determinants, such as socioeconomic position, working and housing conditions, or self-reported discrimination, should be included. Conclusions In order to describe health inequalities and to specifically identify the needs of people with a history of migration, a mutual and differentiated consideration of migration-related and social determinants of health is essential.
Background After forced migration, pregnant women and new mothers face specific challenges in the host country. Little research focuses on the impact these challenges have on forced migrant (FM) women’s mental health (MH). The study’s aim shed light on FM women’s mental wellbeing in the perinatal period. Methods For this mixed-method study 15 individual problem-centered interviews were carried out in Arabic with FM mothers living in Germany within the postnatal period to one year postpartum. The transcripts were analysed using the Framework Analysis. In addition, structured quantitative interviews with 3070 new mothers were conducted on 3 obstetric wards in Berlin over a period of 23 months using an adapted version of the MFMCQ and the PHQ4. FM women (n = 187) were compared with immigrant (n = 1192) and non-immigrant women (n = 1673). A Kruskal-Wallis-Test was performed to compare the three groups. Results In the qualitative interviews mothers stated having depression and varied emotions (e.g. unavoidable sadness, relief). Most FM mothers indicated contextual factors (e.g. bad housing conditions) and structural barriers in perinatal healthcare as negatively impacting their MH. The preliminary quantitative analysis of the interviews conducted in birth clinics directly after birth showed no significant differences in the mean scores of the PHQ-4 within the compared groups (mFMW= 2.83; mimmi=2.61; mnonimmi= 2.5; p=.72). Conclusions While the quantitative study part indicates that PHQ-4 scores are independent of FM experience, the qualitative part shows that FM new mothers face particular burdens in their living conditions that make them vulnerable to MH issues. Inconsistent results could be attributed to the different timing in which the structured questionnaires and qualitative interviews were conducted. Key messages • To promote Mental health of new mothers, we advocate for a diversity oriented, responsive healthcare system. • Effective approaches must be provided to include FM mothers in existing Early Childhood Intervention programs.
Background Communication and information are part of the Sexual and Reproductive Health and Rights (SRHR). Various studies show that successful communication between birthing person and health care professionals (HCP) has a positive impact on birth and lowers risk of traumatic birth experience for women. Since information and communication is a major challenge for both forced migrant women (FMW) and health workers during birth, we investigated experiences of both sides in qualitative study. Methods Qualitative interviews were conducted with 7 maternal HCPs (midwifes, physicians, social workers) and with 7 FMW 1-9 months after the birth of their child in 3 regions in Germany. The refugee sample included new mothers from 6 countries of origins, 14 languages, and an average of three years living in Germany. The interviews were analyzed via framework analysis. Results The majority of the interviewed FMW had no or little knowledge about SRHR. Good communication is one of the main factors allowing a safe and trustful environment with the birthing women. If verbal communication is not possible nonverbal communication helps to create and maintain a care relationship with the women is given. However, due to lack of staff, time and interpreters FMW with little German language proficiencies receive hardly any relevant information and had a poorer accompaniment during birth. Conclusions To provide for equity and SRHRs in maternal health and care there is an urgent need for reliable professional interpretation and easily accessible information in relevant languages material about giving birth, medical possibilities, procedures and interventions. Additionally, further training on heterogeneous needs and life contexts is necessary, to improve professional care during birth in maternity wards. HCPs 1:1 support is strongly recommended. Key messages • Information on SRHR and communication are a fundamental part of birth work and should be made possible for all women including FMW to prevent discrimination and traumatic birth experiences. • If given, 1:1 support by HCPs during birth can comensate missing communication.
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