Recency of migration, region of origin and women's experience of maternity care in England: Evidence from a large cross-sectional survey

Abstract

BackgroundIn the UK, changes to legislation in 2003 regarding the free movement of people in the European Union resulted in an increase in immigration from countries that joined the EU since 2004, the Accession countries.ObjectiveTo describe and compare the maternity experiences of recent migrant mothers to those who had been resident in the UK for longer, and to UK-born women, while taking into account their region of origin.DesignCross-sectional national survey.SettingEngland, 2009.ParticipantsRandom sample of postpartum women.MeasurementsQuestionnaires asked about demographic characteristics, care during pregnancy, labour, birth and postnatally, about country of origin and, if not born in the UK, when they came to the UK. Country of origin was grouped into UK, Accession countries, and rest of the world. Recency of migration was grouped into recent arrivals (0–3 years), and earlier arrivals (4 or more years since arrival). Descriptive statistics and binary logistic regression were used to explore women's experiences of care. Stratified analyses were used to account for the strong correlation between recency of migration and region of origin.FindingsOverall, 5332 women responded to the survey (a usable response rate of 54%). Seventy-nine percent of women were UK-born. Of the 21% born outside the UK, a third were born in Accession countries. All migrants reported a poorer experience of care than UK-born women. In particular, recent migrants from the Accession countries were significantly less likely to feel that they were spoken to so they could understand and treated with kindness and respect.ConclusionsGiven the rising population of non-UK-born women of childbearing age resident in the UK and the relatively high proportion from Accession countries, it is important that staff are able to communicate effectively, through interpreters if necessary.Implications for practiceThe differences in clinical practice between women's home countries and the UK should be discussed so that women's expectations of care are informed about the options available to them.

Variations in neonatal mortality, infant mortality, preterm birth and birth weight in England and Wales according to ethnicity and maternal country or region of birth: an analysis of linked national data from 2006 to 2012

“…Mother’s country of birth may influence birth outcomes of infants through conditions and risk factors which may be common to migrant groups, for example, health behaviour, cultural, environmental, economical, social and lifestyle factors,26 and experiences of migration. The finding of health advantages among migrant populations relative to native populations may be considered an epidemiological paradox,27 in view of the possible socioeconomic disadvantages28 and poorer experience of health care29 of the former. A number of potentially complementary factors may explain this paradox,30 including: health selection among some immigrant groups, including the ‘healthy worker’ effect by which healthier, better educated individuals are more likely to successfully migrate in search of work;31 healthier lifestyles among immigrants from some societies (‘cultural buffering’) including lower prevalence of smoking,32 alcohol consumption33 and obesity and immigration policies at destination which may profile and select immigrants on the basis of their health status 34.…”

Perinatal mental health: a review of progress and challenges

“…Barriers to access for other groups have also been identified across the care pathway – for example, ethnic and socio‐economic differences in initial identification by universal services 185 , and socio‐economic differences in access to inpatient mother and baby units 186 . Qualitative research finds that different professional groups use different languages to communicate risk and have different perspectives of mental illness severity.…”

Involvement in maternal care by migrants and ethnic minorities: a narrative review

“…Five studies approached three dimensions of involvement [57][58][59][60][61], and none addressed all of them. Evidence derives mainly from studies conducted in the UK (n = 8), Australia (n = 3) and Portugal (n = 3) and published between 2001 [62,63] and 2018 [64,65], with an increase of research in recent years. A total of 14 out of the 22 studies reviewed were published between 2013 and 2018.…”

“…Two population-based studies carried out in England found Black and Minority Ethnic women to be less likely to be spoken to in a way that they could understand [59] and to rate communication with maternal care staff worse than native women [61]. Suboptimal communication was also more often reported by migrant women than by non-migrant women in studies undertaken in France, Sweden and England [64,72,73].…”