[Show abstract][Hide abstract] ABSTRACT: 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.
Social Science [?] Medicine 11/2012; · 2.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE: To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators? METHODS: Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed. RESULTS: Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8-27.3). Cesarean section rates of African women were consistently high (31-33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %). CONCLUSION: Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.
Archives of Gynecology 11/2012; 287(4). · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is a paucity of literature on how to conduct research with migrants, particularly those who do not speak the host country language, those who are newly arrived, and those who have a precarious immigration status. In qualitative research, interviewing is a common method for obtaining rich data and participants' points of view. Gathering and presenting all perspectives when interviewing vulnerable migrant women on health-seeking behaviors is challenging. In this article, we explore the process of developing and implementing a data collection plan and an interview guide for a study carried out with migrant women to explore the inhibitors/facilitators for following through on professional referrals for postbirth care. Adaptability and careful attention to multiple factors throughout the process are essential to maximizing participation and enhancing the trustworthiness of the data. Appropriate health policy and care delivery can only originate from health research with diverse migrant populations.
Qualitative Health Research 03/2011; 21(7):976-86. · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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 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: All 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 less often among all migrant groups, with refugee women having the highest mean rate of un-addressed 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 immigration and health policy makers as well as providers of services.
12th World Congress on Public Health World Health Organization; 04/2009
[Show abstract][Hide abstract] ABSTRACT: To determine if postpartum depression (PPD) symptoms are more common in newcomer women than in Canadian-born women.
Refugee, nonrefugee immigrant, asylum-seeking, and Canadian-born new mothers were administered questionnaires for depression, social support, interpersonal violence, and demographic information. We created a PPD variable based on a score of > or = 10 on the Edinburgh Postnatal Depression Scale (EPDS) and performed a logistic regression analysis for PPD.
Immigrants (35.1%), asylum seekers (31.1%), and refugees (25.7%) were significantly more likely than Canadian-born (8.1%) women to score > or = 10 (P = 0.008) on the EPDS, with the regression model showing an increased risk (odds ratio) for refugee (4.80), immigrant (4.58), and asylum-seeking (3.06) women. Women with less prenatal care were also more likely to have an EPDS of > or = 10 (P = 0.03). Newcomer women with EPDS scores of > or = 10 had lower social support scores than Canadian-born women (P < 0.0001).
Newcomer mothers have an increased risk for PPD symptoms. Social support interventions should be tested for their ability to prevent or alleviate this risk.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 02/2008; 53(2):121-4. · 2.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canadian-born women. Our research questions are: (1) Do refugee or asylum-seeking women and their infants, experience a greater number or a different distribution of harmful health events during pregnancy, at birth, and during the postpartum period than non-refugee immigrant or Canadian-born women? (2) Are the harmful health events experienced postpartum by asylum-seeking women and their infants, addressed less often (compared to refugees, non-refugee immigrants, and Canadian-born women) by the Canadian health care system as delivered in each of the three major receiving cities for newcomers?
This is a four-year multi-site prospective cohort study (pregnancy to 4 months postpartum). We will seek to recruit 2400 women [200 in each of 4 groups (refugees, asylum-seekers, non-refugee immigrants, and Canadian-born) from 1 of 12 postpartum hospital units across the 3 largest receiving cities for newcomers to Canada - Montreal, Toronto, and Vancouver].
Knowledge of the extent of harmful health events occurring to asylum-seeking, refugee, immigrant, and Canadian-born women, and the response of the health care system to those events and group differences, if they exist, will inform immigration and health policy makers as well as providers of services.
BMC Pregnancy and Childbirth 02/2006; 6:31. · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prenatal maternal stress has been shown to impair functioning in nonhuman primate offspring. Little is known about the effects of prenatal stress on intellectual and language development in humans because it is difficult to identify sufficiently large samples of pregnant women who have been exposed to an independent stressor. We took advantage of a natural disaster (January 1998 ice storm in Québec, Canada) to determine the effect of the objective severity of pregnant women's stress exposure on general intellectual and language development of their children. Bayley Mental Development Index (MDI) scores and parent-reported language abilities of 58 toddlers of mothers who were exposed to varying levels of prenatal stress were obtained at 2 y of age. The hierarchical multiple regression analyses indicated that the toddlers' birth weight and age at testing accounted for 12.0% and 14.8% of the variance in the Bayley MDI scores and in productive language abilities, respectively. More importantly, the level of prenatal stress exposure accounted for an additional 11.4% and 12.1% of the variance in the toddlers' Bayley MDI and productive language abilities and uniquely accounted for 17.3% of the variance of their receptive language abilities. The more severe the level of prenatal stress exposure, the poorer the toddlers' abilities. The level of prenatal stress exposure accounted for a significant proportion of the variance in the three dependent variables above and beyond that already accounted for by non-ice storm-related factors. We suspect that high levels of prenatal stress exposure, particularly early in the pregnancy, may negatively affect the brain development of the fetus, reflected in the lower general intellectual and language abilities in the toddlers.
Pediatric Research 10/2004; 56(3):400-10. · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Minority women from conflict-laden areas with limited host-country knowledge are among the most vulnerable migrants. Their risk status and that of their infants is magnified during pregnancy, birth, and post-birth. We conducted a study to determine whether women's postnatal health concerns were addressed by the Canadian health system differentially based on migration status (refugee, refugee-claimant, immigrant, and Canadian-born) or city of residence.
Women speaking any of 13 languages were recruited (with their infants) from postpartum units in the main Canadian receiving cities for newcomers (Toronto, Montreal, Vancouver; total n = 341 pairs from 10 hospitals) and followed at home after birth. Our primary interest was 'unaddressed concerns'; nurse-identified health concerns based on standards of postpartum care for the woman/infant at 7-10 days post-birth, for which no professional attention had been given or planned.
A difference in unaddressed concerns by migration status was not found in our primary model [OR refugees vs. Canadian-born = 1.40 (95% CI: 0.67-2.93); refugee-claimants, 1.20 (0.61-2.34); immigrants, 1.02 (0.56-1.85)] although differences by city of residence remained after controlling for migration status, income, education, maternal region of birth, language ability, referral status, and type of birth [Toronto vs. Vancouver OR = 3.63 (95% CI: 2.00-6.57); Montreal, 1.88 (1.15-3.09)]. The odds of unaddressed concerns were greater in all migrant groups [OR refugees vs. Canadian-born = 2.42 (95% CI: 1.51-3.87); refugee-claimants, 1.64 (1.07-2.49); immigrants, 1.54 (1.00-2.36)] when analyses excluded variables which may be on the causal pathway.
Women and their newborn infants living in Toronto or Montreal may require additional support in having their health and social concerns addressed. The definitive effect of migrant group needs confirmation in larger studies.
Canadian journal of public health. Revue canadienne de santé publique 98(4):287-91. · 1.02 Impact Factor