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Table 2 Summary of results for all included study populations (migrant including asylum seeker and refugee women)

From: Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews

Author, year Number of studies Publication date range Sample size1 Topic area of results Summary of author conclusions
Alhasanat and Fry-McComish 2015 [16] 26 1998–2013 (date range of migrant studies) 9089 Perinatal health outcomes (mental health); access, utilisation and experience of perinatal healthcare Some similarities in the risk factors for postnatal depression amongst migrant women and Arabic women in their country of birth: lack of social support, stressful life events, lack of emotional support from the partner, history of antenatal depression and marital dissatisfaction. Immigration stress and lack of access to health care services were found amongst migrant women. Lack of social support was more predominant in studies on migrant women
Anderson et al. 2017 [5] 53 1986–2015 119,076 (for the 52 studies which reported sample size) Perinatal health outcomes (mental health) Depression is common amongst pregnant and postpartum migrant women, although there is no evidence for an overall increased risk of depression amongst migrant women when compared to non-migrant women
Aubrey et al. 2017 [9] 54 2002–2016 (data for only 10 included studies reported) Not reported Access to and utilisation of perinatal healthcare A key finding of both qualitative and quantitative studies was a preference for female providers because of religious reasons and comfort with a female provider. Provider competence was prioritised over gender
Balaam et al. 2013 [30] 16 2000–2010 393 (excluding men and health professionals) Access, utilisation and experience of perinatal healthcare Migrant women’s vulnerable situation when pregnant and giving birth must be improved
Bollini et al. 2009 [26] 65 1966–2004 18,322,978 women including 1,632,401 migrant women Perinatal health outcomes (neonatal intensive care, offspring mortality, preterm birth, low birth weight, congenital anomalies, postpartum haemorrhage) Risk ratios for low birth weight, preterm delivery, perinatal mortality and congenital anomalies between immigrant and native-born women were more similar in countries with strong integration policies. There was a migrant penalty for those European countries with weak integration policies
Collins et al. 2011 [18] 8 1998–2008 4574 (for the 7 studies which reported sample size) Perinatal health outcomes (mental health) Nearly all studies found rates of probable postnatal depression were higher in migrant women than native-born women
De Maio 2010 [19] 51 2006–2010 Not reported Perinatal health outcomes (mental health, low birth weight, preterm birth, placental dysfunction); access to and utilisation of perinatal healthcare Mental health issues are less prevalent amongst migrants than the Canadian-born population. However, this advantage diminishes as length of residence in Canada increases. Living in areas with a high density of migrants may help immigrants to retain this advantage
Downe et al. 2009 [31] 8 1998–2006 569 (excluding men and health professionals) Perinatal healthcare access and experiences A non-threatening, non-judgemental antenatal service run by culturally sensitive staff may increase access to antenatal care for marginalised women. Multiagency initiatives aimed at raising awareness of, and providing access to, antenatal care may also increase uptake
Falah-Hassani et al. 2015 [17] 24 1995–2013 63,926 Perinatal health outcomes (mental health) The prevalence of depressive symptoms is 1.5–2.0 higher in migrant women compared with non-migrant women. Migrant women were more likely to develop depressive symptoms if they had shorter residency in the destination country, lower levels of social support, poorer marital adjustment and insufficient household income
Fellmeth et al. 2017 [6] 45 1986–2013 19,439 (including 7985 migrant) Perinatal health outcomes (mental health) Higher prevalence of postnatal depression in migrant women. Local language ability, length of residency and adhering to traditional birth practices were protective factors
Gagnon et al. 2009 [25] 133 1968–2005 20,152,134 Perinatal health outcomes (maternal and offspring mortality, mode of delivery, low birth weight, preterm birth, maternal health, congenital anomalies, maternal and infant infections, infant morbidities); access to and utilisation of perinatal healthcare Of 9 outcome categories, 2 appear to be better amongst migrant women (health-promoting behaviour and birth weight), 6 appear worse (infection, congenital anomalies and infant morbidity, prenatal care, maternal health, feto-infant mortality and mode of delivery) and 1 did not differ in most studies (preterm birth)
Gissler et al. 2009 [27] 34 1980–2002 Not reported Perinatal health outcomes (offspring mortality) In the European studies, all non-refugee migrants had higher crude stillbirth rates, perinatal mortality rates, neonatal mortality rates and infant mortality rates
Hadgkiss and Renzaho 2014 [14] 32 2002–2012 Not reported Perinatal health outcomes (offspring mortality, mode of delivery, birth weight, preterm birth, complex obstetric issues) This study highlights the health inequities faced by asylum seekers residing in the communities of host countries, internationally
Heaman et al. 2013 [35] 29 1996–2007 24,362,611 Access to and utilisation of perinatal healthcare Migrant women were more likely to receive inadequate prenatal care than receiving-country women. Inadequate prenatal care varied widely by country of birth, indicating that this is not a homogeneous group
Higginbottom, et al. 2012 [23] 30 Not reported Not reported Perinatal health outcomes (mental health); access to and utilisation of perinatal healthcare New migrants are ten times more likely than Canadian-born women to experience personal barriers when accessing healthcare. Language is a particular problem, and current interpreting services are either underutilised or unavailable
Higginbottom et al. 2014 [32] 22 1990–2011 510 (for 21 studies that reported data, excluding 2 studies exclusively with health professionals) Access, utilisation and experience of perinatal healthcare Experiences in maternity healthcare for migrant women are deeply embedded in the social position of the women which influences the availability of social supports, communication possibilities with health professionals and socio-economic status, all of which relate to the organisational environment. Furthermore, migrants and healthcare staff have different beliefs and values which form their perceptions on how maternity healthcare should be provided. Cultural knowledge, beliefs, religious and traditional customs were most relevant for migrants, whereas healthcare staff emphasise biomedical needs
Higginbottom et al. 2015 [36] 24 1995–2011 10,339 Access, utilisation and experience of perinatal healthcare Analysis of these 24 studies led to the development of five interrelated themes: utilisation of prenatal care and educational classes; adequacy of perinatal care; barriers to maternity care in the pre- and postnatal periods; isolation and limited social support; and outcomes related to the access to and the use of services
Mengesha et al. 2016 [10] 22 1998–2014 1943 Access, utilisation and experience of perinatal healthcare Although culturally and linguistically diverse women in Australia have the opportunity to obtain necessary health services, they experience numerous barriers in accessing and utilising sexual and reproductive healthcare
Merry et al. 2013 [28] 76 1956–2010 1,029,454 Perinatal health outcomes (mode of delivery) Sub-Saharan African, Somali and South Asian migrants consistently have higher caesarean rates while Eastern-European and Vietnamese migrants have lower overall caesarean rates compared to receiving-country-born women. North African, West Asian and Latin American migrant women have higher emergency caesarean rates
Merry et al. 2016 [7] 33 2012–2015 Not reported Perinatal health outcomes (mode of delivery) Women from sub-Saharan Africa and South Asia consistently show overall higher rates of caesarean compared with non-migrant women. Women from Latin America, North Africa and Middle East consistently show higher rates of emergency caesarean. Higher rates are more common with emergency caesareans than with planned caesareans
Nilaweera et al. 2014 [22] 15 2003–2012 102,427 (quantitative studies), 84 (qualitative studies) Perinatal health outcomes (mental health); access, utilisation and experience of perinatal healthcare The prevalence of clinically significant symptoms of postnatal depression and diagnosed postnatal depression for South Asian women who migrate to high-income countries is between 5 and 20%. This rate is likely to be under-reported because of a lack of specific sub-group analyses and studies on South Asian countries. Barriers to accessing healthcare need to be addressed including proficiency in English language, unfamiliarity with local services and lack of attention to mental health by healthcare providers
Pedersen et al. 2014 [24] 13 1969–2008 42,290,654 women including 6,102,663 migrant Perinatal health outcomes (maternal mortality) Migrant women in Western European countries have a doubled risk of dying during or after pregnancy when compared with indigenous-born women. A higher risk of death from direct causes suggests sub-standard obstetric care may be responsible for the majority of the excess deaths amongst migrant women
Schmied et al. 2017 [8] 15 1999–2015 256 Perinatal health outcomes (mental health); access, utilisation and experience of perinatal healthcare Women who are migrants report higher levels of depressive symptoms, which can severely compromise mother-baby interaction and subsequent attachment relationships
Small et al. 2014 [33] 22 1990–2012 Sample sizes ranged from 6 to 432, with a total of 2498 migrant women Access, utilisation and experience of perinatal healthcare What migrant and non-migrant women want from maternity care is similar: safe, high-quality, attentive and individualised care, with adequate information and support. Migrant women were less positive about their care than non-migrant women. Communication problems and lack of familiarity with care systems negatively affected migrant women’s experiences, as did perceptions of discrimination and care which was not kind or respectful
Tobin et al. 2017 [20] 13 2004–2013 139 Perinatal health outcomes (mental health); access, utilisation and experience of perinatal healthcare Migrant women with postnatal depression may lack understanding of their condition, are often isolated, alone, fear stigmatisation and risk being considered an unfit mother. Raising awareness with healthcare providers of the meaning of postnatal depression for migrant women is key to the provision of effective care
Villalonga-Olives et al. 2016 [29] 68 1994–2013 80,572,311 (6 studies no data reported) Perinatal health outcomes (low birth weight) The prevalence of low birth weight amongst migrants varies by the host country characteristics as well as the composition of migrants to different regions. The primary driver of migrant health is the migrant ’regime’ in different countries at specific periods of time. The ’healthy migrant effect’ in the USA is largely missing from Europe
Wikberg and Bondas 2010 [34] 40 1988–2008 More than 1160 women from more than 50 cultures Experience of perinatal healthcare Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. There are specific cultural and maternity care features in intercultural caring: an inner core of caring consisting of respect, presence and listening, as well as external factors such as economy and organisation that affect intercultural caring. Legal status, power relationships and racism influence intercultural caring
Winn et al. 2017 [11] 19 1995–2015 Not reported Access, utilisation and experience of perinatal healthcare Three main meta-themes were developed: (1) Expectations Of Pregnancy As Derived From Home, (2) Reality Of Pregnancy In The Host Health Care System. These two themes were connected by our third meta-theme: Support
Wittkowski et al. 2017 [21] 16 1996–2011 337 Perinatal health outcomes (mental health); access, utilisation and experience of perinatal healthcare Migrant mothers living in Western countries are subject to multifaceted and multifactorial stressors following the birth of their child, possibly making them more susceptible to developing postnatal depression and influencing their subsequent healthcare behaviour. These stressors are related to migration or being a migrant in a Western society as well as cultural influences which are harder to comply with as a migrant living in a different country, removed from their socio-cultural context. Social support appears to play an integral and mediating role for migrant mothers living in Western countries
  1. 1. If the total sample size was not explicitly reported by the authors of the systematic review, then it was calculated from the table of included studies where possible