Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway

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Abstract

Background

Migrant women are at increased risk for complications related to pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services.

Methods

In the mixed-method MiPreg-study, we included recently migrated (≤ five years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our findings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers.

Results

Four main themes of challenges and barriers faced by the migrant women were identified: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identified a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conflicting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the first trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health.

Conclusion

A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psychosocial support and strengthening diversity- and intercultural competence training among healthcare personnel.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04131-7.

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Most cited references 31

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Why Triangulate?

S Mathison (1988)

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Maternal healthcare in migrants: a systematic review.

Claudio José Caldas Bresciani, Diogo de Abreu Meireles, Sónia Dias … (2013)

Pregnancy is a period of increased vulnerability for migrant women, and access to healthcare, use and quality of care provided during this period are important aspects to characterize the support provided to this population. A systematic review of the scientific literature contained in the MEDLINE and SCOPUS databases was carried out, searching for population based studies published between 1990 and 2012 and reporting on maternal healthcare in immigrant populations. A total of 854 articles were retrieved and 30 publications met the inclusion criteria, being included in the final evaluation. The majority of studies point to a higher health risk profile in immigrants, with an increased incidence of co-morbidity in some populations, reduced access to health facilities particularly in illegal immigrants, poor communication between women and caregivers, a lower rate of obstetrical interventions, a higher incidence of stillbirth and early neonatal death, an increased risk of maternal death, and a higher incidence of postpartum depression. Incidences vary widely among different population groups. Some migrant populations are at a higher risk of serious complications during pregnancy, for reasons that include reduced access and use of healthcare facilities, as well as less optimal care, resulting in a higher incidence of adverse outcomes. Tackling these problems and achieving equality of care for all is a challenging aim for public healthcare services.

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Somali women and their pregnancy outcomes postmigration: data from six receiving countries

R Small, A Gagnon, M Gissler … (2008)

Objective This study aimed to investigate pregnancy outcomes in Somali-born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden. Design Meta-analyses of routinely collected data on confinements and births. Setting National or regional perinatal datasets spanning 3–6 years between 1997 and 2004 from six countries. Sample A total of 10 431 Somali-born women and 2 168 891 receiving country-born women. Methods Meta-analyses to compare outcomes for Somali-born and receiving country-born women across the six countries. Main outcome measures Events of labour (induction, epidural use and proportion of women using no analgesia), mode of birth (spontaneous vaginal birth, operative vaginal birth and caesarean section) and infant outcomes (preterm birth, birthweight, Apgar at 5 minutes, stillbirths and neonatal deaths). Results Compared with receiving country-born women, Somali-born women were less likely to give birth preterm (pooled OR 0.72, 95% CI 0.64–0.81) or to have infants of low birthweight (pooled OR 0.89, 95% CI 0.82–0.98), but there was an excess of caesarean sections, particularly in first births (pooled OR 1.41, 95% CI 1.25–1.59) and an excess of stillbirths (pooled OR 1.86, 95% CI 1.38–2.51). Conclusions This analysis has identified a number of disparities in outcomes between Somali-born women and their receiving country counterparts. The disparities are not readily explained and they raise concerns about the provision of maternity care for Somali women postmigration. Review of maternity care practices followed by implementation and careful evaluation of strategies to improve both care and outcomes for Somali women is needed.

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Author and article information

Contributors

Sukhjeet Bains: sukhjeetkb@gmail.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 7 October 2021

Publication date PMC-release: 7 October 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 686

Affiliations

[1 ]GRID grid.55325.34, ISNI 0000 0004 0389 8485, Department of Obstetrics and Gynecology, Norwegian Research Centre for Women’s Health, , Oslo University Hospital, ; Rikshospitalet; PO box 4950 Nydalen, 0424 Oslo, Norway

[2 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Department of Community Medicine and Global Health, Institute of Health and Society, , University of Oslo, ; Oslo, Norway

[3 ]Department of labour, Welfare and Local Communites, Stovner District, City of Oslo, Oslo, Norway

[4 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Institute of Clinical Medicine, Faculty of Medicine, , University of Oslo, ; Oslo, Norway

[5 ]GRID grid.412414.6, ISNI 0000 0000 9151 4445, Department of Social Work, Child Welfare and Social Policy, , Oslo Metropolitan University, ; Oslo, Norway

Article

Publisher ID: 4131

DOI: 10.1186/s12884-021-04131-7

PMC ID: 8495671

PubMed ID: 34620114

SO-VID: dd5d79f3-71fe-4d7d-bafd-18b7e9d060cd

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 5 May 2021

Date accepted : 17 September 2021

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: migrant,maternity,antenatal,norway,barriers,migration,vulnerability,qualitative,questionnaire

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: migrant, maternity, antenatal, norway, barriers, migration, vulnerability, qualitative, questionnaire

Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway

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Abstract

Background

Methods

Results

Conclusion

Supplementary Information

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Advocacy for Maternal and Women’s Health

Most cited references 31

Why Triangulate?

Maternal healthcare in migrants: a systematic review.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries

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