Challenges in migrant women's maternity care in a high-income country: A population-based cohort study of maternal and perinatal outcomes

Introduction This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. Material and methods This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women w...

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Bibliographic Details
Published in:Acta Obstetricia et Gynecologica Scandinavica
Main Authors: Gudmundsdottir, E.Y., Gottfredsdottir, H., Halfdansdottir, B., Nieuwenhuijze, M., Gissler, M., Einarsdottir, K.
Format: Article in Journal/Newspaper
Language:English
Published: 2021
Subjects:
childbirth interventions
maternal outcome
migrant
perinatal complications
perinatal outcome
CESAREAN BIRTH
IMMIGRANTS
MIGRATION
ORIGIN
Iceland
Online Access:https://cris.maastrichtuniversity.nl/en/publications/f4dc3aa9-aa52-4b1c-9a5a-8cfd01a995e0
https://doi.org/10.1111/aogs.14186
Description
Summary:Introduction This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. Material and methods This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5-minute Apgar Results A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43, 95% CI 1.26-1.61; multiparas: 1.39, 95% CI 1.21-1.60) and instrumental births (primiparas: 1.14, 95% CI 1.02-1.27, multiparas: 1.41, 95% CI 1.16-1.72) and lower aORs of induction of labor (primiparas: 0.88, 95% CI 0.79-0.98; multiparas: 0.74, 95% CI 0.66-0.83), compared with Icelandic women. Migrant women from countries with a high Human Development Index score (>= 0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland ( Conclusions Women's citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women.

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