Use of maternal health services: comparing refugee,immigrant and US-born populations

Objectives To determine use of recommended maternal healthcare services among refugee and immigrant women in a setting of near-universal insurance coverage. Methods Refugee women age ≥18 years, who arrived in the US from 2001 to 2013 and received care at the same Massachusetts community health center, were matched by age, gender, and date of care initiation to Spanish-speaking immigrants and US-born controls. The primary outcome was initiation of obstetrical care within the first trimester (12 weeks gestation). Secondary outcomes were number of obstetrical visits and attending a postpartum visit. Results We included 375 women with 763 pregnancies (women/pregnancies: 53/116 refugee, 186/368 immigrant, 136/279 control). More refugees (20.6 %) and immigrants (15.0 %) had their first obstetric visit after 12 weeks gestation than controls (6.0 %, p < 0.001). In logistic regression models adjusted for age, education, insurance, BMI, and median census tract household income, both refugee (odds ratio [OR] 4.58, 95 % confidence interval [CI] 1.73–12.13) and immigrant (OR 2.21, 95 % CI 1.00–4.84) women had delayed prenatal care initiation. Refugees had fewer prenatal visits than controls (median 12 vs. 14, p < 0.001). Refugees (73.3 %) and immigrant (78.3 %) women were more likely to have postpartum care (controls 54.8 %, p < 0.001) with differences persisting after adjustment (refugee [OR 2.00, 95 % CI 1.04–3.83] and immigrant [OR 2.79, 95 % CI 1.72–4.53]). Conclusions for Practice Refugee and immigrant women had increased risk for delayed initiation of prenatal care, but greater use of postpartum visits. Targeted outreach may be needed to improve use of beneficial care.     

Influence of Maternal Birthplace on Postpartum Health and Health Services Use

This study examined differences in health status, rates of postpartum depression, perceptions of health services, unmet service needs, and barriers to service use among women born in and outside of Canada at 6 weeks following postpartum discharge from hospital. A secondary analysis of data gathered for a longitudinal cross-sectional survey of postpartum health and service use was conducted. Data from participants recruited from two urban hospitals were used for this analysis (n = 1,045). Analyses examined differences between women born in and outside of Canada. Immigrant women were significantly more likely to experience fair/poor postpartum health status and risk for postpartum depression. Immigrant women were also more likely to rate community health services as fair/poor, and were less likely to be able to get care for emotional health problems. Postpartum health services need to be responsive and accessible in order to meet the needs of immigrant women.     

International migration to Canada: The post-birth health of mothers and infants by immigration class

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women–infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.     

“They Can’t Understand It”: Maternity Health and Care Needs of Immigrant Muslim Women in St. John’s, Newfoundland

Objectives The purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada. Methods A purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women. Results Women experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration. Conclusions Maternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women.     

Challenges in the Provision of Sexual and Reproductive Health Care to Refugee and Migrant Women: A Q Methodological Study of Health Professional Perspectives

This Q methodological study was conducted to examine the perspectives of health professionals in providing sexual and reproductive health (SRH) care to refugee and migrant women. Forty-seven health professionals rank-ordered 42 statements and commented on their rankings in subsequent open-ended questions. A bi-person factor analysis was performed and factors were extracted according to the centroid method with a varimax rotation. Seven factors each with a distinct and meaningful viewpoint were identified. These factors are: “Communication difficulties—hurdles to counselling”, “Lack of access to culturally appropriate care”, “Navigating SRH care”, “Cultural constraints on effective communication”, “Effects of the lack of cultural competency”, “Impacts of low income and language barrier” and “SRH services are accessible, but not culturally relevant”. A more culturally adaptive healthcare model that considers refugee and migrant women’s linguistic, cultural and socio-economic backgrounds; and engages health professionals on an ongoing process of building cultural competency is central to improve SRH access to these women.     

Barriers to health care for abused Latina and Asian immigrant women

This study identifies social, political, and cultural barriers to help seeking from health care organizations faced by abused Latina and Asian immigrant women. Qualitative data were collected through four semistructured ethnic-specific focus group interviews with 28 abused Latina and Asian immigrant women. Participants who had suffered intimate partner abuse were recruited through urban community-based organizations in San Francisco, California. Sociopolitical barriers to help seeking and patient-provider communication included social isolation, language barriers, and, for some, discrimination and fears of deportation. Sociocultural barriers included dedication to the children and family unity, shame related to the abuse, and the cultural stigma of divorce. Abused Latina and Asian immigrant women face significant social, cultural, and political barriers to patient-provider communication and help seeking. Medical and social service providers and policy makers may improve the quality of care for these women by understanding and addressing these barriers.     

Weight During the Postpartum Period: What Can Health Care Workers Do?

To describe the gestational month-to-month weight change, obstetric and lifestyle factors influencing postpartum weight retention (PPWR) and to suggest possible interventions to prevent PPWR. This study was part of a larger research project concerning maternal weight change after childbirth. 343 women were recruited on five maternity wards in the Antwerp region, Belgium. Weight and height were assessed by the researchers during two home visits at 3 and 14 months postpartum and participants completed a questionnaire investigating obstetric and lifestyle factors during the first home visit. The monthly weights in between the home visits were self-reported by the participants. Full data were available for 75 women. One year after childbirth 52.0 % of the women faced postpartum weight retention. The different monthly weight points within the changes differed significantly from each other up to sixth months postpartum. Prepregnancy weight, exceeding the recommendations from the Institute of Medicine (IOM) concerning weight gain during pregnancy, smoking behaviour and exercising during pregnancy significantly influenced the postpartum weight change. The amount of weight gained during pregnancy, breastfeeding, possible postpartum depression and experiencing a shortage of information concerning the weight change after childbirth significantly influenced postpartum weight retention. Weight gain during pregnancy, exceeding IOM-criteria, breastfeeding, depression and lack of information determine PPWR and can be modulated by interventions such as routine weighing or screening of pregnant women. Several of these influencing factors can be preventively influenced by health care workers. Overall, we believe women could benefit from more guidance before, during and after pregnancy. Moreover, we recommend to reintroduce routine weighing of pregnant women as weight gain during pregnancy seems one of the most important factors involved in PPWR.     

Prenatal Predictors of Maternal Attachment and Their Association with Postpartum Depressive Symptoms in Mexican Women at Risk of Depression

Objectives Although maternal attachment is an important predictor of infant developmental outcomes, little is known about its pre- and postnatal predictors. The purpose of this secondary data analysis is to assess several risk factors for maternal attachment at 6 months postpartum in a sample of Mexican women at risk of depression. The predictors included were prenatal depressive symptoms, pregnancy intendedness, partner relationship, social support, maternal history of childhood sexual abuse, and postpartum depressive symptoms. Methods A total of 156 pregnant women seeking antenatal care at three health centers were selected because they displayed depressive symptoms (CES-D?≥?16) or had previously suffered depression. Women were interviewed during pregnancy and at 6 months postpartum. A step-wise multivariate logistic regression was conducted to evaluate the pre- and postpartum risk factors for postpartum depression related to low maternal attachment. Results Pre- and postpartum depressive symptoms increased the risk of low maternal attachment by factors of 3.00 and 3.97, respectively, compared with women who did not present these symptoms; low level of adjustment with the partner increased the risk by a factor of 3.11, low social support by a factor of 2.90, and CSA by a factor of 2.77. Conclusions for practice Prevention programs during pregnancy to reduce depressive symptoms should strengthen strategies to promote maternal attachment by improving partner relations and increasing social support. However, evidence shows that such programs alone are insufficient, so direct interventions should also be implemented. Women with a history of childhood sexual abuse should be given additional attention during prenatal care.     

Shifting Landscapes: Immigrant Women and Postpartum Depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.     

Transnational health resources, practices, and perspectives: Brazilian immigrant women's narratives

This paper examines the representations of transnational health resources, practices, and perspectives in the narratives of Brazilian immigrant women. The results of this qualitative narrative research indicated that in taking care of their health, these Brazilian immigrants often relied on a combination of personal and collective transnational resources. They engaged in a variety of premigration and transnational health practices and demonstrated a high degree of personal responsibility for their health, although they frequently delayed or postponed seeking formal health care. In responding to health and illness concerns, these immigrant women moved back and forth across informal and formal health care systems, crossing multiple national, cultural, and health care system borders. Their stories illustrated the transnational nature of personal, cultural, and political perspectives on health and health care and highlighted the layered complexities of immigrant women's health practices and resources.     

产后抑郁症发生率及相关因素分析

目的:了解深圳市产后抑郁症的发病情况,探讨产后抑郁症的相关因素及早期干预措施。方法:用随机数字表随机抽取深圳市100家社康中心为调查点,采用流调用抑郁量表(CES-D)和自编一般健康问卷对2007年3～10月在深圳市分娩的2 216例产妇进行流行病学调查,采用χ2检验、Logistic回归分析方法分析产后抑郁发生的影响因素。结果:产后抑郁发生率8.12%。产后抑郁症的主要危险因素有:配偶饮酒、职业类型及文化程度、对胎儿性别期望,产妇对分娩过程恐惧、产后形体改变、抚养孩子信心不足,差异具有显著统计学意义(P<0.01)。孕期接受保健指导、心理调适、保健人员对产后家庭进行健康教育和社会支持是保护因素。结论:产后抑郁症应受到广大医务工作者的足够重视,加强产前保健,拓展产后家访内容,开展产后抑郁症早期筛查与监测,早期发现危险因素,采取积极主动的心理辅导,是维护和促进产妇心理健康、提供心理卫生"三级预防"、减少孕产妇死亡重要措施之一。     

Factors associated with attitudes toward seeking mental health treatment postpartum

Attitudes toward seeking mental health treatment are a major predictor of seeking such treatment. Rates of seeking mental health treatment for postpartum depression are low despite contacts with health-care providers and available treatment. This study examined factors associated with four dimensions of attitude toward seeking mental health treatment among Israeli women in the postpartum period. Women (N = 1,059) were recruited (June 2008–February 2009) from a medical center’s maternity department within the first two days following delivery and completed a sociodemographic survey and the Attitudes Toward Seeking Professional Psychological Help Scale. Low recognition of need for mental health treatment was associated with having a below average income and no personal and family depression history; low stigma tolerance was associated with being younger, having more children, and defining oneself as ultra-orthodox; low interpersonal openness was associated with having a below average income. Moreover, low confidence in mental health practitioners was associated with being younger and non-ultra-orthodox. Understanding which women are likely to score low on various dimensions of attitude can help target interventions for improving these factors, reducing barriers to receiving mental health treatment among specific groups of women. Research should continue to explore specific attitude dimensions among various populations.     

Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016–2018

Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016–2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00584-5.     

孕期健康教育对产后抑郁症发病的影响

目的:探讨孕期健康教育对产后抑郁症发病的影响。方法:随机抽取2007年1～10月在济南市妇幼保健院进行产后6周复查的520例产妇,对其进行问卷调查,包括一般情况和Edinburgh产后抑郁量表(EPDS),所有资料采用SPSS11.5统计软件进行处理,并做统计学分析。结果:①EPDS评分≥13分诊为产后抑郁症,472例中,产后抑郁症85例,检出率为21.96%。②多因素非条件Logistic回归分析结果显示,孕期保健知识(P=0.003)、孕期产后抑郁症的相关宣教(P=0.045)、家人的帮助(P=0.001)、担心孕期并发症(P=0.035)与产后抑郁症相关,有统计学意义,其OR值分别为0.392、0.601、0.373、1.594。结论:产后抑郁症病因复杂,影响因素多。孕期健康教育是产后抑郁症的保护性因素,加强孕期健康教育有助于预防产后抑郁症的发生。     

Depression and post-traumatic stress disorder among Haitian immigrant students: implications for access to mental health services and educational programming

Background  

Previous studies of Haitian immigrant and refugee youth have emphasized "externalizing" behaviors, such as substance use, high risk sexual behavior, and delinquency, with very little information available on "internalizing" symptoms, such as depression and anxiety. Analyzing stressors and "internalizing" symptoms offers a more balanced picture of the type of social and mental health services that may be needed for this population. The present study aims to: 1) estimate the prevalence of depression and post-traumatic stress disorder (PTSD) among Haitian immigrant students; and 2) examine factors associated with depression and PTSD to identify potential areas of intervention that may enhance psychosocial health outcomes among immigrant youth from Haiti in the U.S.     

Shifting landscapes: immigrant women and postpartum depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.     

Life with a new baby: How do immigrant and Australian‐born women's experiences compare?

Objective: Little is known about immigrant mothers’ experiences of life with a new baby, apart from studies on maternal depression. Our objective was to compare the post‐childbirth experiences of Australian‐born and immigrant mothers from non‐English speaking countries. Methods: A postal survey of recent mothers at six months postpartum in Victoria (August 2000 to February 2002), enabled comparison of experiences of life with a new baby for two groups of immigrant women: those born overseas in non‐English‐speaking countries who reported speaking English very well (n=460); and those born overseas in non‐English‐speaking countries who reported speaking English less than very well (n=184) and Australian‐born women (n=9,796). Results: Immigrant women were more likely than Australian‐born women to be breastfeeding at six months and were equally confident in caring for their baby and talking to health providers. No differences were found in anxiety or relationship problems with partners. However, compared with Australian‐born women, immigrant mothers less proficient in English did have a higher prevalence of depression (28.8% vs 15%) and were more likely to report wanting more practical (65.2% vs 55.4%) and emotional (65.2% vs 44.1%) support. They were more likely to have no ‘time out’ from baby care (47% vs 28%) and to report feeling lonely and isolated (39% vs 17%). Conclusion and implications: Immigrant mothers less proficient in English appear to face significant additional challenges post‐childbirth. Greater awareness of these challenges may help to improve the responsiveness of health and support services for women after birth.     

Psychocultural influences on health care acceptability among elderly U.S. Pacific Islanders

There is widespread recognition of the influence of ethnic variation on immigrant response to health care services, but far less is known about source of variation among nonimmigrant ethnic enclaves. Pacific Islander populations under U.S. administration for more than a century illustrate the potential influences of cultural factors on health care. Focus groups among elderly Samoan, Native Hawaiian, and Chamorro residents of southern California in 2002 found ethnic variation in such characteristics as expectations of publicly financed health care and in the willingness to discuss alternative sources of help with clinicians. These variations appear influenced by the colonial health care experience of these U.S. territories and, in the case of Samoan women, in distinctive perceptions of the role of prayer and traditional healing methods in care. Such psychocultural factors appear more potent than English language proficiency as an influence on the acceptability of health care among Pacific Islander elders.     

Attitudes toward cervical cancer screening among Muslim women: a pilot study

Background: Immigrant Muslim women have low rates of health care utilization, especially preventive care such as breast exams, mammograms, and cervical cancer screening. Religious and cultural beliefs, such as the value placed on modesty and premarital virginity, contribute to reluctance to seek health care. In addition, it has been unclear whether discussions of health care behavior that involve sexuality and reproductive health would be welcomed among immigrant Muslim women. Purposes: (1) To examine the impact of religious and cultural values on health care behavior of Muslim women from immigrant backgrounds in the San Francisco Bay Area, particularly with regard to cervical cancer screening; (2) To determine whether these women would welcome discussing values and beliefs regarding sexuality and reproductive health. Methods: Our key informants were five Muslim women who identified pelvic and Pap smear screening exams as major sources of anxiety for their community, and therefore major barriers to health care. Three focus groups were then convened, including 15 women ages 18-25, to discuss these issues in more detail. Results: Many Muslim women from immigrant backgrounds face challenges in obtaining adequate health care due to some common barriers of language, transportation, insurance, and family pressures. Additionally, many Muslim women resist screening practices that are the standard in the US but which threaten their cultural and religious values. Equally important, many health care professionals contribute to the women's challenges by making inappropriate recommendations regarding physical exams and reproductive health. The women were enthusiastic and candid in discussing these highly sensitive and taboo topics.