Abstract
BackgroundPerinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences.MethodsReports were identified by searching 12 literature databases (from inception to January 2012; no language limits) and the web, by bibliographic citation hand-searches and through key informants. Studies that compared caesarean rates between international migrants and non-migrants living in industrialized countries and that did not have a ‘fatal flaw’ according to the US Preventative Services Task Force criteria were included. Studies were summarized, analyzed descriptively and where possible, meta-analyzed.ResultsSeventy-six studies met inclusion criteria. Caesarean rates between migrants and non-migrants differed in 69% of studies. Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, GDM/high BMI, feto-pelvic disproportion, and inadequate prenatal care. Suggested protective factors included: a healthy immigrant effect, preference for a vaginal birth, a healthier lifestyle, younger mothers and the use of fewer interventions during childbirth.ConclusionCertain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.
Highlights
Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated
Perinatal health disparities [14], including disparities in caesarean births have been observed between migrants and receivingcountry-born women and some literature suggests that non-medical factors such as communication barriers, support and/or care practices during labour and delivery, female genital cutting, or cultural preference may be implicated in caesarean rate differences [15,16,17]
Meta-analyses Sub-Saharan Africa African migrants had an excess of caesareans compared to receiving-country-born women: France [odds ratio (OR)=2.22, Table 1 Description of included studies
Summary
Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences. Perinatal health disparities [14], including disparities in caesarean births have been observed between migrants and receivingcountry-born women and some literature suggests that non-medical factors such as communication barriers, support and/or care practices during labour and delivery, female genital cutting, or cultural preference may be implicated in caesarean rate differences [15,16,17].
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