Maternal and perinatal outcomes of asylum seekers and undocumented migrants in Europe: a systematic review

Abstract

Background Asylum seekers (AS) and undocumented migrants (UM) are at risk of adverse pregnancy outcomes due to adverse health determinants and compromised maternal healthcare access and service quality. Considering recent migratory patterns and the absence of a robust overview, a systematic review was conducted on maternal and perinatal outcomes in AS and UM in Europe. Methods Systematic literature searches were performed in MEDLINE and EMBASE (until 1 May 2017), complemented by a grey literature search (until 1 June 2017). Primary research articles reporting on any maternal or perinatal outcome, published between 2007 and 2017 in English/Dutch were eligible for inclusion. Review protocols were registered on Prospero: CRD42017062375 and CRD42017062477. Due to heterogeneity in study populations and outcomes, results were synthesized narratively. Results Of 4652 peer-reviewed articles and 145 grey literature sources screened, 11 were included from 4 European countries. Several studies reported adverse outcomes including higher maternal mortality (AS), severe acute maternal morbidity (AS), preterm birth (UM) and low birthweight (UM). Risk of bias was generally acceptable, although the limited number and quality of some studies preclude definite conclusions. Conclusion Limited evidence is available on pregnancy outcomes in AS and UM in Europe. The adverse outcomes reported imply that removing barriers to high-quality maternal care should be a priority. More research focussing on migrant subpopulations, considering potential risk factors such as ethnicity and legal status, is needed to guide policy and optimize care.

Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study

“…Many WIMs have been victims of violence, that come with physical, sexual and mental trauma [21]. Corresponding with other studies, a high morbidity rate, low birth weight and premature labor are common among WIMs [35], so our study highlights the need for gynaecological assessments, pregnancy tests and looking for signs of sexual abuse. Some studies [36] show that a high percentage of WIMs and girls have been victims of genital mutilation or they are at risk of it, and healthcare professionals can intervene to prevent and detect these risks during first emergency care.…”

Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis

“…However, research on pregnancy outcomes on asylum seekers (i.e. those refugees whose request for sanctuary has not been processed yet) specifically is limited [25,26]. In the Netherlands asylum-seeking women show a 10-fold increase in maternal mortality, twice as much perinatal mortality and an increased risk of maternal morbidity, including a higher prevalence of uterine rupture, eclampsia, major obstetric haemorrhage and intensive care unit admission during pregnancy [27][28][29][30].…”

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

“…Pregnant undocumented immigrants in Europe underutilize maternity care services compared to documented immigrants. They have delayed maternity care during pregnancy care, if any care at all, along with lower screening rates for Hepatitis B, HIV, and syphilis during pregnancy [ 12 , 15 , 16 ]. Studies conducted in the Nordic countries describe that undocumented immigrant women face barriers to maternity care during pregnancy ranging from lack of legal entitlements to care, feelings of insecurity encountering public health care facilities, poor language skills, and financial difficulties [ 17 , 18 ].…”