Abstract
BackgroundDespite large numbers of asylum seekers, there is a lack of evidence on pregnancy outcomes and obstetric care of asylum seeking women in Germany.MethodsCross-sectional study (2010–2016) using administrative data of the main referral hospital for pregnant asylum seekers of the reception center of a large federal state in South Germany. Inclusion criteria: women aged 12–50 years, admitted in relation to pregnancy, childbirth or post-partum complications. Outcomes: differences between asylum seekers and residents in the prevalence of high-risk pregnancy conditions, abortive outcomes/stillbirths, peri- and postnatal maternal complications, neonatal complications, and caesarean sections. Analysis: odds ratios (OR) and 95% confidence intervals (CI) obtained by single and multiple logistic regression analysis. Attributable fractions among the exposed (Afe) and among the total population (Afp) were calculated for selected outcomes.ResultsOf 19,864 women admitted in relation to pregnancy, childbirth or post-partum complications, 2.9% (n = 569) were asylum seekers. Adjusted odds for high-risk pregnancy conditions (OR = 0.76, 95%CI: 0.63–0.91, p < 0.0001), caesarean sections (OR = 0.84, 95%CI 0.66–1.07, p = 0.17) and perinatal complications (OR = 0.65, 95%CI: 0.55–0.78, p < 0.0001) were lower; those for abortive outcomes/stillbirths (OR = 1.58, 95%CI: 1.11–2.20, p = 0.01) and postnatal complications (OR = 1.80, 95%CI: 0.93–3.19, p = 0.06) higher among asylum seeking women relative to residents in models adjusted for age, length of admission, and high-risk pregnancy conditions. The Afe for abortive outcomes and stillbirths among asylum seekers was 40.3% (95% CI, 16.3–56.5) and the Afp was 1.8%. The Afe for postnatal complications was 53.1% (95% CI, 7.1–74.0) and the Afp was 3.1%.ConclusionAsylum seeking women are at higher risk of abortive outcomes/stillbirths and show a tendency towards higher postnatal complications. This excess risk calls for adequate responses by health care providers and policy makers to improve outpatient postnatal care in reception centers and mitigate adverse birth outcomes among asylum seeking women. Although further research is needed, scaling-up midwivery care, improving outreach by maternity care teams, and routinely identifying and addressing mental illness by psychosocial services could be ways forward to improve outcomes in this population.
Highlights
Despite large numbers of asylum seekers, there is a lack of evidence on pregnancy outcomes and obstetric care of asylum seeking women in Germany
We focus on differences between asylum seekers and residents in the prevalence of (i) high-risk pregnancy conditions, (ii) abortive outcomes and stillbirths, (iii) peri- and postnatal maternal complications, and (iv) neonatal complications
Until 2015, the state reception center quasi-randomly received about 13% of newly arriving asylum seekers to Germany based on administrative quota, as it acted as sole reception center for the state of Baden-Württemberg
Summary
Despite large numbers of asylum seekers, there is a lack of evidence on pregnancy outcomes and obstetric care of asylum seeking women in Germany. Asylum seeking pregnant women are considered a vulnerable population group with special needs [1]. The Asylum Seekers’ Benefits Act (Asylbewerberleistungsgesetz), which regulates legal entitlements to healthcare for asylum seekers in Germany, grants unrestricted access to needed health care for this population [2, 3]. Adverse living conditions and health system factors of the country of origin, negative experiences and stressors during the peri-migration phase, as well as structural factors related to reception in destination countries may put asylum seeking pregnant women at high risk of adverse birth outcomes [6,7,8]. Adverse birth outcomes may lead to an increased utilization of immediate postnatal services [10], and to increased costs to the healthcare system throughout infancy, childhood, and adulthood [11]
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