Abstract
Background
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.
Methods
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.
Results
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.
Interpretation
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.
MeSH terms: Refugees, maternal health services, women, pregnancy, postnatal care, infant, newborn, emigration and immigration
Résumé
Objectifs
Les femmes issues de groupes minoritaires venant de zones de conflit et dont la connaissance du pays d’accueil est minimale font partie des nouvelles venues les plus vulnérables. Leur état de santé (et celui de leurs bébés) devient encore plus précaire pendant la grossesse et la période périnatale. Cette étude vise donc à déterminer si le système de santé canadien tient compte du statut migratoire des parturientes (réfugiées, demandeuses d’asile, immigrantes reçues et Canadiennes de naissance) ou de leur ville de résidence en réponse à leurs préoccupations de santé après l’accouchement.
Méthode
Des femmes parlant une ou plusieurs des 13 langues de l’étude (ainsi que leurs bébés) ont été recrutées dans les unités postnatales des hôpitaux des grandes villes d’accueil du Canada (Toronto, Montréal, Vancouver), soit 341 couples mère-bébé dans 10 hôpitaux; ces couples ont été suivis à domicile après l’accouchement. Notre principal intérêt était d’étudier les préoccupations négligées par le système de santé, selon les infirmières, d’après les critères de soins postnataux donnés à la mère et à son bébé entre 7 et 10 jours après la naissance.
Résultats
Notre modèle primaire n’a permis de déceler aucune différence attribuable au statut migratoire dans les préoccupations négligées [rapport de cotes réfugiées/Canadiennes de naissance = 1,40 (IC de 95 % = 0,67–2,93); demandeuses d’asile = 1,20 (0,61–2,34); et immigrantes reçues = 1,02 (0,56–1,85)], mais des différences selon la ville de résidence ont subsisté après rajustement des données pour tenir compte du statut migratoire, du revenu, de l’instruction, du lieu de naissance de la mère, de la compétence linguistique, de l’existence ou non d’une référence et du type d’accouchement [RC Toronto/Vancouver = 3,63 (IC de 95 % = 2,00–6,57); Montréal = 1,88 (1,15–3,09)]. Les probabilités de préoccupations négligées étaient plus grandes dans tous les groupes de nouvelles venues [RC réfugiées/Canadiennes de naissance = 2,42 (IC de 95 % = 1,51–3,87); demandeuses d’asile = 1,64 (1,07–2,49); immigrantes reçues = 1,54 (1,00–2,36)] après exclusion des variables pouvant offrir un lien causal.
Interprétation
Il se peut que les femmes et leurs nouveau-nés vivant à Toronto ou à Montréal aient besoin de soutien supplémentaire en réponse à leurs préoccupations sociosanitaires. Des études plus vastes confirmeraient plus définitivement l’effet du groupe d’appartenance des nouvelles venues.
Footnotes
Acknowledgements: This study was funded by the Canadian Institutes of Health Services and Policy Research and of Gender and Health Research (CIHR) (#95355), le Réseau de recherche en santé des populations, and Immigration et métropoles. Le fonds de la recherche en santé du Québec (FRSQ) provided career support to Anita J. Gagnon. CIHR (1999-2004) and the McGill University Faculty of Medicine (2004-05) provided career support to Robert W. Platt. We received in-kind contributions from the Montreal Regional Health Board interpreter services. We acknowledge the assistance of Yongjun Gao in performing the statistical analyses. re]February 24, 2006
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