Consequences of Housing Conditions on Maternal Health of Forced Migrant Women

Abstract Background Housing is a major social determinant and contextual factor of health. Forced migrants are restricted in their freedom of choosing and shaping their housing conditions. This qualitative study highlights the impact of housing restrictions on reproductive and maternal health from the lived experience of forced migrant women who recently gave birth to a child. Methods Qualitative problem-centered interviews were conducted with 33 refugee mothers (Mage = 31 years) 1-9 month postpartum. Interviewees came from 19 countries of origins, spoke 22 languages, and had lived in Germany for an average of three years. The mothers’ perspectives were complemented by 75 qualitative interviews with maternal health care professionals, (HCPs: midwives, gynecologists, social workers). Interview transcripts were analyzed via framework method regarding (1) type of housing: shared accommodation vs. private apartment, (2) region: rural vs. urban, (3) exhausting and supporting conditions as well as (4) consequences on maternal health. Results Interviewees living in shared accommodations reported exhausting conditions hindering self-determined upbringing of their newborn, e.g., confined living spaces, racism of staff, shared kitchen and bathrooms, lack of privacy, mobility, access to medical care, hygiene. Reported consequences on maternal health ranged from physical stress to social stress and mental stress (e.g., sleeping problems, depression, fear, worrying about health of the newborn). Interviewees living in private apartments showed higher autonomy and contentment. HCPs reported missing time and staff to provide adequate support. Conclusions Both refugee women and HCPs reported housing as main stressor during pregnancy and childbed, resulting in higher physical, social, and mental stress. Strategic social support for finding suitable private apartments for new families is needed as well as comprehensive visiting midwifery care in accommodations. Key messages • Living conditions in shared accommodations are unacceptable from a public health and human rights perspective, especially for women during pregnancy and childbed. • Negative effects on maternal health and self-determination of families were shown.


Background:
Housing is a major social determinant and contextual factor of health. Forced migrants are restricted in their freedom of choosing and shaping their housing conditions. This qualitative study highlights the impact of housing restrictions on reproductive and maternal health from the lived experience of forced migrant women who recently gave birth to a child.

Methods:
Qualitative problem-centered interviews were conducted with 33 refugee mothers (Mage = 31 years) 1-9 month postpartum. Interviewees came from 19 countries of origins, spoke 22 languages, and had lived in Germany for an average of three years. The mothers' perspectives were complemented by 75 qualitative interviews with maternal health care professionals, (HCPs: midwives, gynecologists, social workers). Interview transcripts were analyzed via framework method regarding (1) type of housing: shared accommodation vs. private apartment, (2) region: rural vs. urban, (3) exhausting and supporting conditions as well as (4) consequences on maternal health.

Results:
Interviewees living in shared accommodations reported exhausting conditions hindering self-determined upbringing of their newborn, e.g., confined living spaces, racism of staff, shared kitchen and bathrooms, lack of privacy, mobility, access to medical care, hygiene. Reported consequences on maternal health ranged from physical stress to social stress and mental stress (e.g., sleeping problems, depression, fear, worrying about health of the newborn). Interviewees living in private apartments showed higher autonomy and contentment. HCPs reported missing time and staff to provide adequate support.

Conclusions:
Both refugee women and HCPs reported housing as main stressor during pregnancy and childbed, resulting in higher physical, social, and mental stress. Strategic social support for finding suitable private apartments for new families is needed as well as comprehensive visiting midwifery care in accommodations.

Key messages:
Living conditions in shared accommodations are unacceptable from a public health and human rights perspective, especially for women during pregnancy and childbed. Negative effects on maternal health and self-determination of families were shown.

Background:
The risk of substances use increases during adolescence. In Sousse (Tunisia), an upward trend of these risk behaviors has been observed during the last years among young adolescents. Among older adolescents, the trend of their use is unknown.

Objectives:
To determine the incidences and the most influencing factors on substances use among high school students in Sousse between 2018 and 2019.

Methods:
A prospective longitudinal study was conducted among a cohort of high school students from Sousse. The same pretested questionnaire served to collect data in 2018 and 2019 from the same participants in their classes and in the presence of pre-trained investigators.

Results:
A total of 404 high school students have participated in the study. Their median age was of 17 (IIQ: 15.8-17.6) years. Girls represented 66.8% of participants. The incidence rates of lifetime tobacco use, alcohol consumption, lifetime inhalants use and lifetime illicit substances use between 2018 and 2019 were 13%, 3.5%, 1.8% and 2 .9% respectively. Lifetime tobacco use was the main predictor of inhalants experimentation. This latter was the main predictor of becoming a user of e-cigarettes while alcohol consumption was the most influencing factor on cannabis experimentation among high school students. On the other hand, illicit substances use among friends predicted ecigarette use, alcohol consumption, and cannabis experimentation among participants.

Conclusions:
The existing prevention programs aiming at reducing tobacco use and substances use in the schools of Tunisia should be reinforced and integrate a comprehensive and multi-sectoral prevention program. The implementation of a national observatory of substances use would ensure the continuous improvement of this program.

Key messages:
There is an upward trend on using substances among the adolescents of Sousse, Tunisia. Tobacco experimentation and alcohol consumption are the gateway to later substances experimentation among the adolescents of Sousse, Tunisia.