O Wahoush, G Dougherty, J-F Saucier, C-L Dennis,
E Stanger, B Palmer, L Merry, DE Stewart
Introduction: Childbearing refugee and asylum-seeking women in industrialized countries may have harmful health outcomes and unmet health and social needs. The forced nature of their migration, separation from their families, lack of knowledge of host country language(s) and for some, a precarious immigration status and limited access to healthcare services, increases their vulnerability. Research Questions: (1) Do refugee or asylum-seeking women and their infants, experience more or different harmful childbearing health outcomes than non-refugee immigrant or receiving country-born women? (2) Are harmful postpartum health outcomes un-addressed by the health care system associated with immigration status?
Methods: Multi-site prospective (birth to 4 months) cohort study. Refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women were recruited from one of six Montreal hospital postpartum units. Health data were collected from medical records; general health and background information were obtained through questionnaires. Research nurses collected data on maternal and infant health, services used, and migration history during home visits at 7-10 days and 4-months post-birth. These data were then classified by a nurse expert (blinded to research questions and immigration status) as providing evidence for the existence of a professional concern and whether it had been 'un-addressed' or 'addressed' by the healthcare system (based on professional practice guidelines).
Results: Of the 750 participants, all three migrant groups experienced more professional concerns compared to Canadian-born women including: greater postpartum depression risk at 4 months, lack of social support, skipping meals due to lack of resources, and/or not knowing what to do in an emergency. These concerns were addressed by the health care system less often among all migrant groups, with refugee women having the highest mean rate of unaddressed concerns.
Relevance: Knowledge of the extent of need of childbearing women in all migrant groups as well as the response of the healthcare system to those needs will inform both immigration and health policy makers as well as providers of services.