Maternal and perinatal health in undocumented migrants: estimating access and outcomes through HMIS

Abstract Background Vulnerability and inequality are exacerbated in undocumented migrants, the most invisible to health systems. Objectives To estimate maternal and perinatal health needs in undocumented migrants and test a methodology for systematic monitoring & evaluation. Methods Population-based retrospective cohort study based on routine data through maternity records and temporary registration code in a sub-national Health Management Information System. Results 420924 deliveries including 1524 undocumented migrants having accessed maternity care through the NHS in Lombardy Region (Italy) from 2016 to 2021 were included. Demographics and social determinants: undocumented migrants were born in Europe (non-EU) (36%), Americas (30%), Africa (6%), Western Pacific (3%), South-East Asia (2%), Italy (2%), were stateless (7%); 52% had no/low schooling, 92% were unemployed and 52% non-married, compared to 15%, 20%, and 44% Italians. Obstetric history and antenatal care: 22% undocumented migrants had a previous abortion and 15% a previous cesarean delivery; 58% had ≥5 antenatal visits, 67% first ANC visit in trimester 1, 64% ≥ 2 ultrasounds incl. first in trimester 1, 6% full laboratory tests, compared to 90%, 97%, 97%, and 66% Italians. Intra-partum and perinatal care: 45% undocumented migrants delivered in a public hospital with neonatal intensive care unit; 69% had a normal delivery, 5% instrumental delivery, 10% and 27% emergency and total cesarean section; 2.6% neonates had emergency resuscitation and 49% were breastfed <2h from birth. Outcomes: 81% physiological pregnancies, 2.3% severe hemorrhage, 4.8% intra-uterine growth retardation, 9.3% pre-term delivery, 17% small for gestational age, 7% low birth weight, 0.6% poor Apgar score, 3% malformations. Conclusions Maternal and perinatal health was poor in undocumented migrants, varying by birthplace. Social determinants, health coverage and outcomes showed vulnerability and inequality compared to the general population. Key messages • Tailored interventions are needed: outreach health promotion on safe motherhood and neonatal care, healthcare provider training, cultural mediation, translation, and functional language learning. • A systematic monitoring and evaluation system needs to routinely collect, integrate, and analyze data on key indicators.


Aim:
To examine whether individuals who migrated to Sweden as refugees in childhood are more likely to experience poor mental and general health and violence in adulthood, compared to individuals born in Sweden, or who were migrants but not refugees.

Methods:
This study included 151,614 individuals who answered the Swedish National Public Health Survey in 2018 or 2020. We grouped the participants into refugees in childhood, migrants in childhood, or non-migrants. Information about outcomesmental health, general health, and risk behaviors -was collected through questionnaires. We analyzed the associations using logistic regressions.

Results:
Overall, having been a refugee in childhood was generally not associated with poor general health and mental ill-health, risk behaviors, or exposure to violence, compared to those who were migrants or born in Sweden. However, there were some exceptions. For example, young men, who were refugees in childhood, had a higher likelihood of suicide attempts than non-migrants. Interestingly, childhood refugees and childhood migrants were less likely to use drugs and to have risky alcohol use as adults, compared to non-migrants, but were more likely to be risk gamblers.

Conclusions:
Being a refugee in childhood was not, in general, associated with negative health consequences in adulthood with some exceptions, such as gambling, that will be discussed in the presentation.

Key messages:
In this study, refugee experience in childhood is not, in general, associated with worse health outcomes in adulthood.
There are certain risk groups that need to be highlighted such as young males with refugee experience in childhood.

Background:
Vulnerability and inequality are exacerbated in undocumented migrants, the most invisible to health systems.

Objectives:
To estimate maternal and perinatal health needs in undocumented migrants and test a methodology for systematic monitoring & evaluation.

Conclusions:
Maternal and perinatal health was poor in undocumented migrants, varying by birthplace. Social determinants, health coverage and outcomes showed vulnerability and inequality compared to the general population. Key messages: Tailored interventions are needed: outreach health promotion on safe motherhood and neonatal care, healthcare provider training, cultural mediation, translation, and functional language learning. A systematic monitoring and evaluation system needs to routinely collect, integrate, and analyze data on key indicators.