Including undocumented migrants in universal health coverage: a maternal health case study from the Thailand-Myanmar border

Tschirhart, Naomi; Jiraporncharoen, Wichuda; Thongkhamcharoen, Rojanasak; Yoonut, Kulyapa; Ottersen, Trygve; Angkurawaranon, Chaisiri

doi:10.1186/s12913-021-07325-z

Cited by 10 publications

(15 citation statements)

References 18 publications

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“…It has been argued for operationalizing structural vulnerability in clinical practice and that clinicians, health systems and policy makers should counteract presumptions of deservingness in order to improve the situation for undocumented migrants [ 62 , 63 ]. Initiatives elsewhere in including pregnant undocumented women in health insurance schemes, and increasing access have increased health coverage and prenatal visits, and reduced infant mortality [ 6 , 64 ]. The COVID 19 pandemic has shown us the need to address structural conditions to achieve health for all [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…5 Faculty of Medicine, University of Bergen, Bergen, Norway. 6 Division of Gynaecology and Obstetrics, Akershus University Hospital, Oslo, Norway. 7 Department of Obstetrics and Gynaecology, Haukeland University Hospital, and Department of clinical medicine, University of Bergen, Bergen, Norway.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…A variety of Non-Governmental Organizations (NGOs) run health clinics for undocumented migrants to fill the gaps of limited access to primary care services in Europe [1]. While primary care is a cornerstone in securing universal health coverage and is one of the top priorities of the World Health Organization, undocumented migrants are often excluded [2][3][4][5][6]. To further facilitate universal health coverage for undocumented migrants, there is a need to investigate how NGO clinics contribute to primary care and interact with public services.…”

Section: Introductionmentioning

confidence: 99%

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

Eick

Vallersnes

Fjeld

et al. 2022

BMC Pregnancy Childbirth

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Background In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. Methods In this historic cohort study we included pregnant women aged 18–49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. Results We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1–3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.

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Section: Discussionmentioning

confidence: 99%

Section: Supplementary Informationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Eick

Vallersnes

Fjeld

et al. 2022

BMC Pregnancy Childbirth

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“…Secondly, beginning in September 2017, a social enterprise launched a low-cost, non-profit health access fund for migrants along the Myanmar-Thailand border to support health-related costs. This program allowed pregnant women attending SMRU ANC clinics easier access to tertiary hospital care in the case of obstetric complications including those related to preterm labor (45)(46)(47). Therefore, to control for these externalities affecting the migrant and refugee communities relating to SCBU service provision, medical charts completed prior to the end of 2017 were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

Hashmi

Darakamon

Aung

et al. 2023

Front. Public Health

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BackgroundPreterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC).Materials and methodsThis sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care.ResultsFrom 2008–2017, mortality was reduced by 68% and 53% in very (EGA 28–32 weeks) and moderate (EGA 33–36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting.DiscussionThis study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs.

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“…It has been argued for operationalizing structural vulnerability in clinical practice and that clinicians, health systems and policy makers should counteract presumptions of deservingness in order to improve the situation for undocumented migrants [62,63]. Initiatives elsewhere in including pregnant undocumented women in health insurance schemes, and increasing access have increased health coverage and prenatal visits, and reduced infant mortality [6,64]. The COVID 19 pandemic has shown us the need to address structural conditions to achieve health for all [65].…”

Section: Underlying Reasons For Underutilization and Adverse Outcomesmentioning

confidence: 99%

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

Eick

Vallersnes

Fjeld

et al. 2022

Preprint

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Background: In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics.Methods: In this historic cohort study we included pregnant women aged 18-49 attending urban NGO clinics from 2009-2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes.Results: We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1-3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion: Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.

show abstract

Including undocumented migrants in universal health coverage: a maternal health case study from the Thailand-Myanmar border

Cited by 10 publications

References 18 publications

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

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

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

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

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