5.O. Workshop: Migrants and differential care in the perinatal period

Abstract

Abstract Nationwide, more than 22% of births in France are to women who were born elsewhere. It is now well documented that overall, these women, like migrants throughout Europe, have higher perinatal and maternal risk levels than non-migrants. The mechanisms of these social inequalities in health have not yet been sufficiently and adequately explored. Access to and quality of care are likely to be intermediate factors in their explanation. This hypothesis is especially probable in view of recent work showing higher rates of inadequate prenatal and suboptimal perinatal care in some groups of migrant women compared to women born in France. This workshop aims to present and discuss a mixed-methods research program founded by the French National Research Agency (ANR). The program was designed to address and assess the role played by health professional's implicit bias (IB) in the provision of differential care that could explain disparities in maternal and perinatal health between certain groups of migrants and women born in France. The existence of these IB has been demonstrated in healthcare professionals in several specialties, mainly in North America, but never in the perinatal field nor in European settings. While this program has focused on care as diverse as cesarean section, epidural analgesia during labor, prevention and management of eclampsia, and Down syndrome screening, we propose to report on our approach through the issue of Down syndrome screening. IB has been shown to be less likely to induce differential care in highly protocolized emergency care settings. Conversely, non-emergency situations such as prenatal care, where there is nevertheless time pressure on health care professionnals, are more likely to be contexts for the existence of non-medically based differential care. Access to prenatal screening for Down's syndrome, where patient information plays a fundamental role, seemed to us to be a particularly interesting model for the study of differential care and the role played by IB. While the role of conscious and unconscious discrimination phenomena in the mechanisms of social health inequalities appears as increasingly probable, this workshop, based on data from a multidisciplinary research program, will shed additional light on these issues from the very concrete question of down syndrome screening. Researchers involved in this multidisciplinary project will present the results successively from epidemiological, qualitative sociological, and quantitative psycho-sociological approaches addressing differential care practices in Down syndrome screening. This mixed-methods approach will provide complementary insights into the research question. Our methods and results will then be discussed in an audience session led by moderators external to the project but experts in social health inequalities. Key messages Differential care between pregnant migrant women and native women has been evidenced in Down syndrome screening in France. Disparities in the use of Down syndrome screening according to women place of birth are almost partly related to differences in the opportunity of an informed choice.