Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study

Abstract

ObjectivesImmigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes.DesignThis is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data.Setting and participantsRefugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.Primary outcomesNumerous adverse maternal and perinatal health outcomes.ResultsRefugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers.ConclusionsRefugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.

Offspring birthweight and placental weight in immigrant women from conflict‐zone countries; does length of residence in the host country matter? A population study in Norway

“…In agreement with our results, several previous studies report that immigrant women from developing countries give birth to infants with lower birthweight than European women . In particular, women from conflict‐zone countries seem to give birth to low birthweight infants …”

“…Changes in offspring birthweight after emigration could possibly depend on the level of change in living conditions . Particularly, women who live in an armed conflict region may have been exposed to deprived living conditions and thus be at high risk of giving birth to a low‐birthweight infant …”

Reproductive patterns, pregnancy outcomes and parental leave practices of women physicians in Ontario, Canada: the Dr Mom Cohort Study protocol

“…We will retrospectively evaluate adverse pregnancy outcomes among Ontario women physicians and nonphysicians of reproductive age who have experienced at least one childbirth >20 weeks GA. All outcomes of interest were chosen for their clinical relevance and established methodology for ascertainment from ICES databases such as MOMBABY, DAD and OHIP, using standard diagnostic and procedural codes [46][47][48][49][50][51][52][53][54] (see online supplemental table 3).…”

“…and/or Ontario-specific algorithms to ensure accuracy [46][47][48][49][50][51][52][53][54] ; and have used databases that are validated 55 56 or periodically reabstracted. 57 Aim 1: compare reproductive patterns in women physicians and non-physicians Rationale and overview Numerous survey-based studies suggest that women physicians frequently delay childbearing and subsequently experience a higher rate of infertility compared with the general population.…”

Healthcare access challenges facing six African refugee mothers in South Korea: a qualitative multiple-case study

“…Refugees typically experience malnutrition, difficulty obtaining clean water, trauma, and exposure to infectious diseases in their home countries and during the migration process due to limited or nonexistent healthcare; additionally, they often experience modification of family roles and the separation of family members. After migration, refugees may face barriers to healthcare access and often hold a low socioeconomic position in their new countries 5 6 7 8 9) . Refugees experience more physical and mental health problems than the native population due to these pre- and postmigration social determinants 10 11) .…”