Maternal health care utilization and the obstetric outcomes of undocumented women in Finland – a retrospective register-based study

Abstract

Background Undocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of prenatal care is delayed, and women have an increased risk for infectious diseases. The aim of this study was to describe the use of maternal health care services and the obstetric outcomes of undocumented women in Helsinki, capital city of Finland, in addition to comparing the results with all pregnant women in Finland. Methods The study was a retrospective register-based study consisting of data collected between 2014 to 2018 from the electronic medical records of the public maternity clinic and maternity hospital in Helsinki, Finland. The study population consists of 62 individual pregnancies of undocumented women. The results of the study were compared with national data on parturients and deliveries (N = 47,274 women) and with prenatal screening tests for infectious diseases (N = 51,447 [HIV, HBV], N = 51,446 [syphilis]). Results The majority (91%) of the undocumented women attended public prenatal care. However, four women received no prenatal care and three women were denied access to care. Undocumented women entered prenatal care later and had fewer visits compared with all pregnant women. The majority (71%) of the undocumented women received inadequate prenatal care as the number of visits was less than eight. Of the study population, 5% (3/59) tested positive for HIV, 3% (2/59) for HBV, and 2% (1/57) for syphilis. The prevalence of HIV (p-value < 0.001) and HBV (p-value = 0.007) was significantly higher amongst undocumented women compared with all pregnant women. Conclusions Undocumented women entered prenatal care later than recommended. Most women received inadequate prenatal care and some of them did not receive prenatal care at all. The prevalence of infectious diseases was significantly higher and the coverage of prenatal screenings deficient amongst undocumented pregnant women.

Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

“…In the current study, a total of 46.5% of the women came late for their first antenatal visit (i.e. after the first trimester), fewer than in Denmark (52.6%) and Finland (61%) [ 34 , 35 ]. Late presentation was particularly the case for women from countries outside the Africa and Middle East regions, who also had short stays in Norway.…”

“…Our findings of the provision of substandard care should be seen in relation to the challenges of providing care to a marginalized group affected by structural vulnerabilities, on the one hand, and the NGO clinics’ limited and voluntary resources, on the other [ 18 ]. Studies from other Nordic countries show that women only attending NGO clinics, as well as those being referred to public primary care, had a low number of antenatal visits [ 34 , 35 ]. A study from Sweden, found that fear, along with practical and psychosocial factors were barriers to accessing health care for undocumented migrants even when being entitled to public primary care [ 48 ].…”

HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis

“…However, it is important to note that three out of five studies that recruited pregnant migrant women included refugees or undocumented migrants, which are also factors that increase the risk for HIV. 38 , 39 , 40 Two of these three studies reported high HIV prevalence ratios by a large margin (OR of 95·52 and 62·28), likely due to the types of migrants they included, i.e. refugees and undocumented migrants.…”

Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study

“…As not all women use this option, for instance because they are unaware of the right to shelter or fear deportation, the 319 women in our study probably represent an underestimation of the number of undocumented women giving birth in The Netherlands. Compared to different European populations, poor perinatal health outcomes have been reported in undocumented migrants [ 37 , 38 , 39 ]. Although few studies have compared perinatal outcomes between documented and undocumented migrants, the intersection of a precarious legal status, jeopardized access to healthcare and systemic and social exclusion likely renders undocumented migrants a particularly vulnerable group of pregnant women in ASCs [ 3 , 38 , 39 , 40 , 41 ].…”

“…Compared to different European populations, poor perinatal health outcomes have been reported in undocumented migrants [ 37 , 38 , 39 ]. Although few studies have compared perinatal outcomes between documented and undocumented migrants, the intersection of a precarious legal status, jeopardized access to healthcare and systemic and social exclusion likely renders undocumented migrants a particularly vulnerable group of pregnant women in ASCs [ 3 , 38 , 39 , 40 , 41 ].…”