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Reduce Differences in Health Status Build Healthy Public Policy Strengthen Community and Personal Action
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Immigration and Perinatal Risk Alex Battaglini, Sylvie Gravel, Carole Poulin, Jean-Marc Brodeur, Danielle Durand, Suzanne DeBlois, Centre d’excellence pour la santé des femmes–Consortium Université de Montréal
Do immigrant mothers, who are living in new social and cultural environments and are likely to lack social support, experience increased vulnerability to health risks during the perinatal period of pregnancy? In our study of immigrant women living in Quebec, we investigated factors associated with the immigrant experience that may increase vulnerability. Interviews were conducted with 91 immigrant mothers who were considered to be low, medium and high risk for problems during pregnancy and delivery. About one-half of the women who participated in the study had given birth in Canada, the others had given birth before they immigrated. All of the women had been living in Quebec less than six months. The participants’ babies were between three and twelve months old. All of the women shared some of the same difficulties, such as low income and financial difficulties, social isolation and emotional problems. To assess emotional problems, an adapted scale from the Hopkins symptom checklist was used. The 15- item scale includes loneliness, anxiety, sadness and guilt. Immigrant women who had no health problems during pregnancy were found to share some characteristics. For example, they had planned their migration and given birth after their arrival in Canada. They had received some college or university education, were on average younger than mothers who were assessed as either medium or high risk, and could understand either French or English. As compared to these low-risk mothers, women who were found to be at medium risk for perinatal problems had received a higher level of education, had undergone a professional de-qualification in their work as a result of immigrating, and spoke some English but little French. Some of these women had experienced problems with delivery, such as premature and/or low birthweight babies. A difficult immigration prompted by war or persecution characterized most of the high-risk immigrant mothers. These women, most of whom were refugees, were older on average than the women in the other two categories, had lower levels of education, did not speak English or French, and already had one or more children. In addition, they had often experienced a separation from their family, either from a husband or a child. All had given birth before immigrating and all had experienced problems with delivery such as premature birth, low-weight babies, hypertension, diabetes, anemia, difficult labour or bleeding. These findings suggest that factors arising from migration make some immigrant women potentially more vulnerable to complications during the birth of their children. Stress caused by war or persecution in the country of origin, loss of family members through immigration and poverty and social isolation in Canada appear to play a role in creating strains that impact upon pregnancy. Nineteen interviews were also conducted with health care providers. An analysis of this data showed that care providers do not have adequate tools for identifying high-risk pregnancies or high-risk perinatal factors in immigrant women. This situation further exacerbates perinatal risks to mother and child. In order to assess vulnerability in this population, we recommend that health care providers identify risk factors in four key areas: (1) the woman’s experience of immigration (to discover any trauma that may have been suffered); (2) economic difficulties; (3) social isolation; and (4) adaptation to the new culture. We recommend that an assessment tool be developed that would include the following questions related to these key areas:
Factors arising from migration make some immigrant women and their babies vulnerable during the perinatal period. These risk factors also have relevance to nonimmigrant women: the health care tools developed from this study can also help identify women in the general population who need additional support during pregnancy. For a copy of the synthesis paper, Rapport synthèse, Vol. 4,
No. 4, or the full report, A. Battaglini et al. « Les meres
immigrantes: pareilles, pas pareilles? » (available only in
French), contact: |
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