Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway.

Abstract

Background: In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics.Methods: In this historic cohort study we included pregnant women aged 18-49 attending urban NGO clinics from 2009-2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes.Results: We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1-3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion: Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.

Stories of giving birth

“…Akkurat som på keiser Augustus' tid går det verst ut over fødekvinnene som kommer langveisfra. Fra 2011 har riktignok alle som oppholder seg i Norge re til nødvendig helsehjelp før og e er fødsel (2). Men siden gravide papirløse migranter ikke har re på fastlege, blir praksis ofte en annen.…”

“…Noen frykter også, ikke uten grunn, å må e betale med penger de ikke har, til tross for re på gratis helsehjelp i graviditeten (3). En nylig publisert studie viste at halvparten av 500 gravide papirløse migranter ved Norges to ideelle svangerskapsklinikker kom for sent til å mo a god nok svangerskapsomsorg, og at de hadde langt høyere forekomst av komplikasjoner enn andre gravide (2). Insidensen av Fødefortellinger | Tidsskrift for Den norske legeforening…”

“…A R E B R E A N dødfødsel hos disse var hele 1 %, preterm fødsel 10 % og hastekeisersni nesten 20 %. Og 170 av kvinnene, fra 52 ulike land, forsvant fra oppfølgingen uten at det var mulig å finne ut hvordan fødselen hadde gå (2).…”