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Table 1 Empirical studies examining migrant and ethnic minority involvement in maternal care (n = 22)

From: Involvement in maternal care by migrants and ethnic minorities: a narrative review

AuthorsYear of publicationCountry of studyStudy approach and designStudy populationsSample sizeMain findings
Almeida and Caldas2013PortugalQualitative approachRecent mothers, with children under 36 months, whose parents were not born in Portugal (Brazilian immigrants) and Portuguese nationals, residing in Porto Metropolitan Area14 participants (7 Portuguese women; 7 Brazilian women)Brazilian women expressed dissatisfaction with the following: quality of information provided by health professionals and their communication skills, insufficient duration of appointments, bureaucracy in primary care, limited access to specialised care and insufficient preventive care. Misinformation about legal rights and inappropriate clarification in medical appointments interacted with social determinants and resulted in poorer medical care.
Almeida et al.2014aPortugalQualitative approachRecent mothers, with children under 36 months, immigrants and Portuguese natives, living in Porto Metropolitan Area31 participants (6 Portuguese women; 11 women born in Portuguese-speaking African countries; 7 women born in Eastern European countries; 7 women born in Brazil)During postpartum, women (irrespective of nationality) reported a significant lack of social and affective medical support. Immigrants reported difficulties in understanding professionals during medical consultations with their infants. Eastern European women who showed interest in engaging in shared decision-making regarding treatment reported that doctors frequently seemed unprepared to answer questions and to find it difficult to obtain information about the NHS. African women revealed language barriers and lack of active communication with professionals. Brazilian and Eastern European women reported dissatisfaction with baby follow-up in primary care.
Almeida et al.2014bPortugalQualitative approachRecent mothers, with children under 36 months, immigrants and Portuguese natives, living in Porto Metropolitan Area31 participants (6 Portuguese women; 11 women born in Portuguese-speaking African countries; 7 women born in Eastern European countries; 7 women born in Brazil)Brazilian and Eastern European women reported strictness by health care providers, which often triggered their inhibition in asking questions to clarify issues and returning when facing complications. Eastern European women reported that doctors were unprepared to answer questions and felt uncomfortable discussing health procedures with well-informed patients. They also reported language barriers to hinder their understanding of clinical procedures. Misinformation and inadequate clarification during medical appointments resulted in perceived lower quality care.
Ascoli et al.2001NetherlandsQualitative approachRefugee women from different countries of origin, with varying status within the asylum-seeking system and different living situations (single or married, urban or rural), and health care providers (doctors, nurses, midwives and others) who deal with pregnant women in their workNot reported: 4 refugee women (1 Guinean, 1 Afghan, 1 Somali and 1 Iranian); several health care workersThe experience of reproductive care by refugee women is influenced by their status and by their gender. Refugee women revealed informational needs, communication concerns and serious financial and legal issues that shape their pregnancy and delivery experiences. Weak points in the health care system: limited time for consultations and obstacles to accessibility.
Attanasio et al.2018USAQuantitative approach; prospective cohort studyWomen who gave birth, vaginally or by unplanned caesarean, to a first, singleton baby in a Pennsylvania hospital between 2009 and 20112787 participants (2325 White women; 200 Black women; 150 Latin women; 112 women with other or multiple race)Black women and those who did not have a college degree or private insurance or who underwent labour induction, instrumental vaginal or caesarean delivery were less likely to report high shared decision-making. Disproportionately less engaged decision experience for pregnant patients in more marginalised social groups.
Binder et al.2012EnglandQualitative approachSomali and Ghanaian immigrant women and white British women who had at least one child within the British health care system and who were living in Greater London between 2005 and 2006; 62 obstetric care providers (doctor and midwives) at five hospitals within the study area122 participants (10 white British women; 39 immigrant Somali women; 11 immigrant Ghanaian women; 62 obstetric care providers)Women and providers encountered difficulties in communication; language was the main barrier, especially for Somalis. Professionalism and competence were considered more important than meeting providers from one’s own ethnic group. All groups acknowledge the importance of the interpreter’s role in health communication.
Davies and Bath2001UKQualitative approachSomali women living in a Northern English city who had used maternity and women’s health services in that city13 Somali womenWomen experienced difficulties in identifying sources of information other than their GP. Poor communication with health workers was a problem in seeking information for non-English-speaking women. Fears about misinterpretation and confidentiality limit the usefulness of interpreters. Somali women perceived that they were denied information due to punitive attitudes and prejudiced views among health professionals.
Esscher et al.2014SwedenQuantitative approach; retrospective data analysisMaternal death data records among foreign-born women from low- and middle-income countries and Swedish-born women collected from Swedish official and national registries for 1988 to 2007 and from the Swedish Society of Obstetrics and Gynaecology Maternal Mortality Group for 2008 to 201075 maternal death recordsMajor and minor suboptimal factors were associated with a majority of maternal deaths, more often to foreign-born women. The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born.
Henderson et al.2013EnglandQuantitative approach; cross-sectional studyWomen aged 16 years and over, living in England in 2010, who had recently given a live birth24,319 women (20,633 self-identified as White (84.8%); 3686 self-identified as coming from seven ethnic groups: Mixed (1.3%), Indian (2.4%), Pakistani (2.5%), Bangladeshi (0.7%), Black Caribbean (0.7%), Black African (2.7%), other (5.0%))Women from minority groups access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour. They had longer lengths of hospital stay and were more likely to breastfeed, but they had fewer home visits from midwives. Throughout maternity care, they were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to trust in health staff.
Henderson et al.2018EnglandQuantitative approach; cross-sectional national surveyWomen aged 16 years or over who delivered a live single birth in October or November 20095235 women (4108 women born in the UK; 194 born in Accession countries; 169 born in the old European Economic Area; 764 born in the rest of the world)Migrants reported a poorer experience of care than UK-born women. Recent migrants from the Accession countries were significantly less likely to feel that they were spoken to so they could understand and treated with kindness and respect.
Hennegan et al.2014AustraliaQuantitative approach; cross-sectional population-based surveyWomen who had a live singleton or multiple birth in Queensland, Australia, between February and May 20106050 participants (5569 Australian-born English-speaking women; 481 women born in another country who spoke a language other than English at home)Most women felt that they were treated as an individual and with kindness and respect. Women born outside Australia were less likely to report being looked after “very well” during labour and birth and to be more critical of care.
Hennegan et al.2015AustraliaQuantitative approach; cross-sectional population-based surveyWomen who had a live singleton or multiple birth in Queensland, Australia, between February and May 20102955 participants (2722 Australian-born English-speaking women; 233 women born in another country who spoke a language other than English at home)Women born outside Australia were less likely to report pain after birth was manageable, or rate overall postnatal physical health positively. They more frequently reported having painful stitches, distressing flashbacks and feeling depressed; they were less likely to feel involved in decisions and to understand their options for care; they were more likely to report being visited by a care provider at home after birth.
Higginbottom et al.2016CanadaQualitative approach; ethnographic studyImmigrant women with current or recent (previous 2 years) experience of using maternity services; health care providers having experience with providing perinatal care to immigrant women; stakeholders who have a mandate or involvement in immigrant women’s health or service provision, including social service providers and decision-makers86 participants (34 immigrant women; 29 health care providers; 23 social services providers [including some other key stakeholders])Barriers to access and navigation of maternity services by immigrant women in Canada: communication difficulties, lack of information, lack of social support (isolation), cultural beliefs, inadequate health care services and cost of medicine/services. Immigrant women face additional challenges that influence their level of satisfaction and quality of care: lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping and culture shock.
Jonkers et al.2011NetherlandsQualitative approachImmigrant and native Dutch women with severe maternal morbidity50 women (10 native Dutch women; 40 immigrants)Immigrant women reported that health care providers paid insufficient attention to their pregnancy-related complaints; delays in receiving information about diagnosis and treatment; problems identifying medically complications, presenting their complaints to health providers effectively and taking an active role as patients. Highly educated migrants showed low health literacy skills in interaction with doctors.
Lindsay et al.2016USAQualitative approachBrazilian-born immigrant women residing in two cities in the greater Boston area (Somerville and Brighton), USA35 Brazilian-born immigrant womenParticipants expressed overall satisfaction with the US health care system. Barriers to care: sociocultural differences in care delivery and communication barriers, including inconsistent quality of interpreting services.
Philibert et al.2008FranceQuantitative approach; case-control studyWomen who died of maternal death from 1996 to 2001 as cases and a representative sample of women who gave birth in 1998 as controls13,453 women (267 women who died during the postpartum period as case subjects [20.6% non-French women]; 13,186 women as control subjects [10.6% non-French women])The risk of postpartum maternal death was twice as high for foreign women. The risk of dying from hypertensive disorder or infection was four times higher for foreign women. Among women who died, care was more often considered not optimal for foreign women.
Phillimore2016UKMixed methods approachWomen who moved to the UK within the past 5 years and utilised maternity services; maternity professionals100 participants (82 migrant women; 18 individuals working regularly with migrant women)New migrant women were more likely to book late or fail to attend follow-ups than the general population. A combination of structural, legal and institutional barriers prevents migrant women accessing effective antenatal care.
Redshaw and Heikkila2010EnglandQuantitative approach; cross-sectional studyWomen aged 16 years and over who had their baby in England within a 2-week period in October to November 20095333 women (21% born outside the UK; 14% from Black and Minority Ethnic groups)Women from Black and Minority Ethnic groups experienced poorer staff communication and feelings about not being treated with respect. Single women, those who had left education at 16 years or earlier, living in the most deprived areas and Black and Minority Ethnic women were less likely to have seen a health professional by 12 weeks about their pregnancy care or to be aware of all the options for where they could give birth.
Redshaw and Henderson2015EnglandQuantitative approach; cross-sectional studyWomen aged 16 years and over who had their baby in England within a 2-week period at the beginning of January 20144571 women (24% born outside the UK; 16% from Black and Minority Ethnic groups)Women from Black and Minority Ethnic groups and women born outside the UK were later in accessing care. Women from Black and Minority Ethnic groups experienced poorer staff communication and feelings about not being treated with respect. Single women were more likely to access care later, less likely to feel involved in decisions about their care and more likely to feel left alone and worried during their care and were less satisfied overall. Women living in the most disadvantaged areas were more likely to feel involved in decisions about their antenatal care and less likely to see a midwife after the baby had reached 2 weeks of age.
Redshaw et al.2007EnglandQuantitative approach; cross-sectional studyWomen aged 16 years and over who had their baby in England in 2 specific weeks: 2–8 January and 4–10 March 20063198 women (17% born outside the UK; 13% from Black and Minority Ethnic groups)Black and Minority Ethnic women, those born outside UK, women living in deprived areas and women who are single parents were more likely to recognise their pregnancy later, to first see a health professional later and to book later for antenatal care. They were less likely to have felt that they were treated with respect and talked to in a way that they could understand by staff during pregnancy, labour and birth and postnatal care.
Reitmanova and Gustafson2008CanadaQualitative approachImmigrant Muslim women aged 25–40 years who delivered at least one child in St. John’s, Canada, between 1995 and 20056 immigrant Muslim womenMuslim 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, labour and delivery and postpartum. There were gaps between existing services and women’s needs for emotional support and culturally and linguistically appropriate information.
Yelland et al.2015AustraliaQuantitative approach; cross-sectional consecutive population-based studiesWomen giving a live birth in Victoria, Australia, in 2 weeks in 1999 and 4 weeks in 20074516 participant women (3578 Australian-born women; 303 overseas-born women of English-speaking background; 563 overseas-born women of non-English-speaking background)Immigrant women of non-English-speaking background were more likely to report negative experiences of antenatal, intrapartum and postnatal care and to say that health professionals did not always remember them between visits, make an effort to get to know the issues that were important to them, keep them informed or take their wishes into account.