Responding to the health needs of women from migrant and refugee backgrounds—Models of maternity and postpartum care in high‐income countries: A systematic scoping review

Rogers, H. Jane; Hogan, Lily; Coates, Dominiek; Homer, Caroline; Henry, Amanda

doi:10.1111/hsc.12950

Cited by 60 publications

(71 citation statements)

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“…In addition to inviting service providers who were users of the CCW Service to participate, the CCWs as providers of the Service were also invited to participate in the interviews. This was done because the authors felt their perceptions were uniquely important in presenting the first-hand experiences of role deliverance and capacity to fulfil the Service aims, and such perspectives have been very limited or non-existent in prior related research [ 41 ]. The aim was to interview 15–20 service providers, pending when data saturation had been reached.…”

Section: Methodsmentioning

confidence: 99%

“…A recent systematic scoping review of pregnancy and postpartum models of care for women from migrant and refugee background living in high income countries (HIC) identified seventeen studies [ 41 ]. A diverse range of potentially effective models were identified, including female paraprofessional bicultural/bilingual workers, [ 42 – 52 ], multidisciplinary group models of antenatal care [ 42 , 53 ], and specialised antenatal clinics [ 54 – 56 ].…”

Section: Introductionmentioning

confidence: 99%

“…A diverse range of potentially effective models were identified, including female paraprofessional bicultural/bilingual workers, [ 42 – 52 ], multidisciplinary group models of antenatal care [ 42 , 53 ], and specialised antenatal clinics [ 54 – 56 ]. All the interventions were acceptable to women; however the review highlighted the need for future research to demonstrate effectiveness, acceptability from the perspective and experiences of women, their partners, family members, and service providers [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

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Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

et al. 2021

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Background Women from migrant and refugee backgrounds who live in high-income countries are at increased risk of adverse perinatal outcomes, including mental health issues, preterm birth and maternal and infant mortality. There is a need to implement and evaluate models of care to meet their specific needs in order to improve health outcomes, their experiences of care, and overcome barriers to access. In Sydney, Australia, a unique model of care was implemented to support women and families from migrant and refugee backgrounds to access health and community-based services through the continuum of pregnancy to the early parenting period. This model of care is known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service). The aim of this study was to explore the perceptions of service providers regarding the CCW Service and identify recommendations for improvement. Methods A mixed-methods study was conducted consisting of surveys and face to face semi-structured interviews. Service providers were recruited from hospital-based maternity and community-based services. Survey data were analysed descriptively. Interviews were analysed using qualitative content analysis. Results Sixty-nine service providers completed surveys and 19 were interviewed. The CCW Service was highly regarded by service providers who perceived it to be critical in improving care for women from migrant and refugee backgrounds. The overarching theme from the interviews was the ability of the CCW Service to act as a ‘bridge to health’ through the provision of culturally responsive care. There were three main categories; supporting access to health and community-based services, improving the healthcare experience, and organisational factors, including part-time hours, capacity, heavy workloads and confusion/lack of clarity regarding the CCW role, which affected CCWs’ capacity to optimally support service providers in providing culturally responsive care. These limitations meant CCWs were not able to meet demand, and fully operationalise the model. Conclusion Service providers perceived the CCW model to be a culturally responsive model of care tailored to the needs of women and families from migrant and refugee backgrounds, that reduces barriers to access, and has the potential to improve perinatal outcomes, and women's experience and satisfaction with care.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

et al. 2021

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“…A recent systematic scoping review of pregnancy and postpartum models of care for women from migrant and refugee background living in high income countries (HIC) identi ed seventeen studies [33]. A diverse range of potentially effective models were identi ed, including female paraprofessional bicultural/bilingual workers, [34][35][36][37][38][39][40][41][42][43][44], multidisciplinary group models of antenatal care [34,45], and specialised antenatal clinics [46][47][48].…”

Section: Introductionmentioning

confidence: 99%

“…A diverse range of potentially effective models were identi ed, including female paraprofessional bicultural/bilingual workers, [34][35][36][37][38][39][40][41][42][43][44], multidisciplinary group models of antenatal care [34,45], and specialised antenatal clinics [46][47][48]. All the interventions were acceptable to women; however the review highlighted the need for future research to demonstrate effectiveness, acceptability from the perspective and experiences of women, their partners, family members, and service providers [33].…”

Section: Introductionmentioning

confidence: 99%

Cross Cultural Workers for Women and Families From Migrant and Refugee Backgrounds: A Mixed-Methods Study of Service Providers Perceptions

Rogers

Hogan

Coates

et al. 2021

Preprint

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BackgroundWomen from migrant and refugee backgrounds who live in high-income countries are at increased risk of adverse perinatal outcomes, including mental health issues, preterm birth and maternal and infant mortality. There is a need to implement and evaluate models of care to meet their specific needs in order to improve health outcomes, their experiences of care, and overcome barriers to access. In Sydney, Australia, a unique model of care was implemented to support women and families from migrant and refugee backgrounds to access health and community-based services through the continuum of pregnancy to the early parenting period. This model of care is known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service). The aim of this study was to explore the perceptions of service providers regarding the CCW Service and identify recommendations for improvement.MethodsA mixed-methods study was conducted consisting of surveys and face to face semi-structured interviews. Service providers were recruited from hospital-based maternity and community-based services. Survey data were analysed descriptively. Interviews were analysed using qualitative content analysis. ResultsSixty-nine service providers completed surveys and 19 were interviewed. The CCW Service was highly regarded by service providers who perceived it to be critical in improving care for women from migrant and refugee backgrounds. The overarching theme from the interviews was the ability of the CCW Service to act as a ‘bridge to health’. There were three main categories; supporting access to health and community-based services, improving the healthcare experience, and organisational factors affecting CCW Service provision. A limitation of the CCW Service was the part-time hours of the CCWs, reducing their ability to meet demand, build service provider capacity to provide culturally responsive care and fully operationalise the model. Conclusion Service providers perceived the CCW model to be a culturally responsive model of care tailored to the needs of women and families from migrant and refugee backgrounds, that reduces barriers to access, has the potential to improve perinatal outcomes, and women's experience and satisfaction with care.

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Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada

et al. 2023

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ImportanceEvidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas.ObjectiveTo compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada.Design, Setting, and ParticipantsThis population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks’ gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022.ExposuresNonrefugee immigrant status vs nonimmigrant status.Main Outcomes and MeasuresThe primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or ≥3 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity.ResultsThe cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of −1.5 per 1000 births (95% CI, −2.3 to −0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19).Conclusions and RelevanceThis study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.

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Responding to the health needs of women from migrant and refugee backgrounds—Models of maternity and postpartum care in high‐income countries: A systematic scoping review

Cited by 60 publications

References 40 publications

Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

Cross Cultural Workers for Women and Families From Migrant and Refugee Backgrounds: A Mixed-Methods Study of Service Providers Perceptions

Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada

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