Severe maternal morbidity among immigrant women in the Netherlands: patients' perspectives

Abstract

This 2006 study investigated ethnicity-related factors contributing to sub-standard maternity care and the effects on severe maternal morbidity among immigrant women in the Netherlands. In-depth interviews were carried out with 40 immigrant and 10 native Dutch women. The immigrant women reported that health care providers often paid insufficient attention to their pregnancy-related complaints, especially in cases of pre-eclampsia. They also reported delays in receiving information about diagnosis and treatment. Obstetricians who reviewed 20 of these cases judged sub-standard care to have played a role in the development of complications in 16 of them. The women themselves had problems identifying medically significant complications, presenting their complaints to health care providers effectively, and taking an active role as patients. Even highly educated migrant women showed low health literacy skills in their interaction with doctors. Patients' perspectives are valuable as one of the tools to evaluate the quality of maternity care. Communication by maternal health professionals can be improved through more sensitivity to social factors that affect immigrant women's health problems. Women with limited health literacy should be empowered through education about danger signs in pregnancy and information about preferences and policies in obstetrics in the Netherlands. They should also be invited to participate in medical decision-making.

Empirical relationships between health literacy and treatment decision making: A scoping review of the literature

“…Ten studies examined empirical relationships between assessments of patients' HL and patients' understanding of information [9,14,15,17,19,23,33,35,50,51]. Across these studies, patients' understanding was variously defined and measured by researchers and the findings were also variable.…”

“…First, the PDA(s) used in these studies were not developed to reflect the needs of patients with diverse levels of HL. Second, level of education was used in one study as an indicator of HL despite the fact that: (1) the relationship between HL and level education has been disputed in the literature, and (2) three studies included in this review reported a lack of correlation, or congruence, between level of education and level of HL 15 [18,34,51]. Third, in four studies, the care or treatment preferences of patients were elicited using PDAs that reflected a medical condition that most, if not all, patients in the study population did not have at the time of the study [38,39,40,41].…”

Health Status Inequality among Immigrants in Switzerland

“…More specifically, evidence suggests that immigrant status is associated with health adverse working conditions [1] [2]. With respect to health opportunities, several studies find poor health literacy, poor access to health services or poor utilization of health services among immigrants as compared to natives [3]- [7]. Evidence of unfavourable health behaviour of immigrants, such as lack of physical activity and unhealthy dietary habits and resulting risk factors such as overweight and obesity [8]- [12], has also been documented.…”

The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework

“…7,8,16 Moreover, the women are able to provide information after the event, including the difficulties they faced in reaching timely obstetric treatment, 18 information that families of women who died may not be able to provide. 15,18,44 Indeed, some authors suggest that information on maternal near-miss events could be key for improving quality of care. 19,25 The high number of women arriving in poor clinical condition at referral facilities 19,34 may be considered as an indicator of the effectiveness of emergency referrals, while the number of near-misses may be an indicator of the performance of obstetric services.…”