WUNRN
NHV - Nordic School of Public Health
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6/18/2008 |
PREGNANCY SAFETY ISSUES FOR IMMIGRANT WOMEN IN EUROPE |
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Giving birth in Europe today is still not without risk. For a particularly vulnerable group of women, immigrant mothers, studies in different European countries show a negative trend in their perinatal health situation. Country specific examples of this development were discussed at a conference, Perinatal health in immigrants in northern Europe, held at the Nordic School of Public Health. Perinatal health continues to be a problem in the European region. While the situation is generally better in the European Union and Nordic countries in comparison to Caucasus for example, significant problems remain within these countries. There are subgroups that suffer mortality rates for both mothers and babies that are as serious as those in sub-Saharan Africa. Immigrants are an example of such a subgroup, and constituted the focus of the conference. While studies show that adverse perinatal outcomes such as stillbirth, disabilities and illnesses, resulting from pregnancy and childbirth, are found to be more prevalent among immigrants, they do not depict immigrants as a homogenous group. As a Danish registry linkage study shows, there can be significant disparities in stillbirth within an overall immigrant population. In Denmark, the five largest immigrant groups originate from Turkey (by far the largest group), Lebanon, Pakistan, Former Yugoslavia and Somalia. In the study, no risks for stillbirth could be found for the Lebanese and Former Yugoslavian groups: - They did as well as the Danish group, said Sarah Fredsted Villadsen (University of Copenhagen) who presented the study during the conference. In Sweden, a study of the incidence and risk for anal sphincter tears (AST) in childbirth shows that women born in Africa and Asia have significantly higher risk for AST compared to women born in Sweden. The study, conducted at the Department of Woman and Child Health, Karolinska Institutet, however also showed that mothers originating from Turkey and Former Yugoslavia had a lower risk for the same condition. Eamonn Sheridan, geneticist at the Leeds Institute of Molecular Medicine, presented yet another example of a vulnerable immigrant group that stands out from the rest, namely Pakistani women in the British northern city of Bradford. Bradford's infant mortality rate is amongst the highest in the country, with a proportionally higher numbers of genetic diseases than that of other cities. When studying family trees of Pakistani immigrant women through a comprehensive child birth cohort study (Born in Bradford) launched in 2006, a research team has found that the incidence of consanguinity is not only very high in Bradford, but seems to be on the rise. It is also a known fact that the vast majority of the Pakistani immigrants originate the same region of Kashmir. While there is nothing new about immigrant Pakistani women having poor birth outcomes and that the community practices consanguinity, said Eamonn Sheridan, there is a problem if their cultural practices can be linked to the causes of Bradford’s excess mortality and abnormally high incidences of genetic diseases. Eamonn Sheridan self-critically concluded that geneticists have repeatedly failed to engage with this issue: - When we go out and say to the women not to marry their cousins, it has no impact. And who is surprised there? Socio-economic and socio-cultural aspects of the perinatal health problem among immigrants was central for the discussions at the conference. Besides consanguinity other issues such as maternal age, female circumcision, cultural health beliefs, pre-migration factors, educational and income levels were discussed. Cultural practices and beliefs are however not exclusive to immigrant families. - Caregivers have traditions and cultures as well, not just the care takers, said Birgitta Essen from the University of Uppsala, during her presentation “Perinatal morbidity in immigrants – do socio-cultural factors matter?” Birgitta Essen’s thesis describes an increased risk of perinatal morbidity found among a subgroup of women from Ethopia and Somalia living in Sweden. These women had certain maternal pregnancy strategies that stemmed from their cultural beliefs and experiences from home countries, such as avoiding caesarian section or not seeking perinatal care when needed. Yet these strategies could not account for all the potentially avoidable deaths. Deficiencies in medical care and verbal miscommunication were also important explanatory issues. Health care personnel have very specific opinions about certain women and birth outcomes according to Birgitta Essen, and lack the ability to tackle the situation in a more appropriate way: - It does not trigger our ability to solve the problem in the same way as obvious biomedical solutions, she said. Other reasons beyond socio-economic and socio-cultural factors among the immigrant minorities where thus also raised during the conference, and included problems with translation services, equal access to care and discrimination. The conference was organized by the Migration and Health programme at the Nordic School of Public Health in collaboration with the COST network on Migration and Health and the Nordic network on health in refugee children. Text by: Emma Ricknell |
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