Maternal Health Literacy among Migrant Women: A Co-Design Study in Portugal

BackgroundIn China, with the urbanization, women migrated from rural to big cities presented much higher maternal mortality rates than local residents. Health knowledge is one of the key factors enabling women to be aware of their rights and health status in order to seek appropriate health services. This study aims to assess the knowledge and attitude on maternal health care and the contributing factors to being knowledgeable among rural-to-urban migrant women in Shanghai.MethodsA cross-sectional study was conducted in a district center hospital in Shanghai where migrants gathered. Totally 475 rural-to-urban migrant pregnant women were interviewed and completed the self-administered questionnaire after obtaining informed consent.ResultsThe mean score of knowledge on maternal health care was 8.28 out of 12. However, only 36.6% women had attended the required 5 antenatal checks, and 58.3% of the subjects thought financial constrains being the main reason for not attending antenatal care. It was found that higher level of education (OR = 3.3, 95%CI: 1.8–3.8), husbands' Shanghai residence (OR = 4.0, 95%CI: 1.3–12.1) and better family income (OR = 3.3, 95%CI: 1.4–8.2) were associated with better knowledge.ConclusionsRural-to-urban migrant women's unawareness of maternal health service, together with their vulnerable living status, influences their utilization of maternal health care. Tailored maternal health education and accessible services are in demands for this population.

In South Asia, maternal health remains an important public health challenge and poor maternal health literacy (MHL) of mothers has been identified as a root cause of maternal deaths. However, systematic literature reviews conducted to identify ‘contemporary’ factors hindering the improvement of MHL among mothers in South Asian countries are rare. Hence, this systematic review aims to identify the contemporary factors that impede the MHL among mothers in South Asia. Research articles for the review were selected using preferred reporting items for systematic reviews and meta-analysis (PRISMA). Initially, 264 articles were retrieved from 11 prominent publishing databases, including Taylor and Francis, Elsevier, and Sage. Of these, 21 articles published on six South Asian countries between January 2020 and May 2025 were selected, considering inclusion and exclusion criteria. Nutbeam’s health-literacy classification was used to direct the thematic analysis. As findings, ‘lack of formal education of mothers’, ‘cultural barriers’, ‘misconceptions regarding formal healthcare sector’, ‘low maternal age’, ‘less exposure to media’, ‘less access to digital technology and low digital literacy’, ‘low family income’, ‘family structures’, ‘work obligations’, ‘partner’s involvement’, ‘area of residence’, ‘shyness and discomfort of sharing gynecological issues’, ‘influence of the religion’, and ‘gender inequality in decision-making’ were recognized. These findings provide an overview of reasons behind low MHL among mothers in socio-culturally diverse South Asia, and highlight the importance of overcoming such factors through practical implications to contribute to achieving low maternal mortality rates as per UN Sustainable Development Goal 3.1, ‘reducing the global maternal mortality ratio’ by 2030.

Maternal health literacy affects maternal and child health outcomes. The findings of previous studies have shown, that mothers with low maternal health literacy have inappropriate healthcare behaviors, especially among postpartum women. However, there is still a paucity of studies on the correlates of maternal health literacy in postpartum mothers. This study aimed to examine the predictive power of age, education level, family income, social support, and media use on maternal health literacy in postpartum women. A cross-sectional study was conducted among eligible postpartum women who delivered at full term and were admitted to the postpartum unit at two university hospitals. The purposive sampling method was employed. Data were initially collected at the postpartum unit. Then, after six weeks, data collection was performed online. The instruments used included the personal record form, the Social Support in Postpartum Questionnaire, the Media Use Questionnaire, and the Maternal Health Literacy Scale. After six weeks, nine women had not responded to the questionnaire at 6weeks postpartum, and after identifying the outliers, 112 postpartum women were selected for analysis. Descriptive statistics and Multiple Linear Regression were used for data analysis in PASW Statistics version 18. Age, education level, family income, social support, and media use together statistically significantly predicted maternal health literacy among postpartum mothers, accounting for 32.90% (R2 = 0.329, F = 10.382, p < 0.001). Specifically, social support (β = 0.545, p < 0.001) and family income (β = 0.174, p < 0.05) were statistically significant predictors of maternal health literacy. Postpartum mothers should be supported in their efforts to access maternal health information with the assistance of family members to promote maternal health literacy.

This study aim to capture the most comprehensive evidence-based dimensions of maternal health literacy, including summarizing the definitions, theoretical frameworks, measuring instruments, and the association between maternal health literacy and health behaviours. Maternal health literacy has been recognized as an important approach to achieving high-quality maternal and child health; however, little is known about maternal health literacy comprehensively and scientifically. An integrative review retrieved articles from 11 databases, following the methodology of Whittemore and Knafl. Inductive content analysis and narrative synthesis were conducted, guided by the aim of this review. A total of 5580 articles were retrieved and 23 articles were finally identified. Existing definitions and theoretical frameworks took less consideration of maternal applicability and failed to summarize maternal health literacy from a dynamic and systematic perspective. Measurement instruments were set up with many items that make it difficult to quickly screen for poor maternal health literacy. Most articles proved the association between maternal health literacy and health behaviours through correlation analysis or regression analysis but less explored the influence pathways between them. The definition and theoretical framework need to focus on maternal applicability and explain the process of individual mothers acquiring and understanding health knowledge and skills from a dynamic and systematic perspective. A rapid instrument for maternal health literacy should be developed and high-quality empirical research was conducted to understand the associated mechanisms between maternal health literacy and health behaviours. It is necessary to strengthen maternal and child health education of primary health care nurses and enhance their ability to help perinatal women use maternal and child health information effectively.

Migrant and refugee pregnant women constitute a highly vulnerable group to mental disorders. The rates of mental illness of migrants and refugees are higher than those of host populations, with migrant women being more likely to suffer from prenatal depression. A Policy Paper was developed based on a literature review conducted in Medline, Scopus and Google Scholar. Filtering criteria were: year of publication (2002–2017), study topic relevance, and English language. A total of 63 documents were identified. Most of the documents were scientific papers while a large number of documents were reports of EU committees and networks on migrant issues or annual reports of international bodies. From the analysis of existing evidence, four major topics emerged for the perinatal health of migrant women: 1) Prevalence and risk factors for antenatal mental disorders, 2) Assessment of mental disorders, 3) Healthcare professionals’ training on supporting migrant and refugee pregnant women, and 4) Interventions for the mental health of migrant women. Midwives and other members of interdisciplinary teams have to be trained and culturally competent to successfully meet the needs of migrant and refugee pregnant women.

BackgroundEffective healthcare utilization throughout pregnancy is essential in protecting mother and child health, but the maternal healthcare utilization and its associated factors among migrant women are still underexplored.MethodsThe data came from the 2018 China Migrants Dynamic Survey. Our analysis included 6337 pregnant migrant women. Prenatal healthcare utilization comprises receiving at least 5 antenatal care (ANC) times and establishing the maternal health record within the first 12 weeks of pregnancy. Postnatal healthcare utilization refers to whether an individual received a postpartum visit and a physical health examination within 28 days and 42 days following delivery. A multivariate binary logit model was employed to investigate the factors related to maternal healthcare utilization.Results67.15% of the 6337 participants established health records within the first 12 weeks of pregnancy, and 88.35% received at least five ANC visits. 76.88% and 84.20% of migrant pregnant women received a postpartum visit and a health examination respectively. Age was positively correlated with receiving at least five ANC visits (OR:1.245, 95% CI: 1.038–1.493), a postpartum visit within 28 days (OR: 1.272, 95% CI: 1.107–1.460) and a physical examination within 42 days after delivery (OR=1.174, 95% CI: 1.002–1.376). Education, household income, health insurance and maternal health education were positively associated with prenatal and postnatal healthcare utilization (P<0.05). Number of Children negatively correlated with ANC times (OR: 0.742, 95% CI: 0.613–0.898) and receiving health examination after delivery (OR: 0.720, 95% CI: 0.610–0.849).ConclusionThere is still potential for improvement in the maternal healthcare utilization, particularly in postnatal healthcare. Strengthening the follow-up, focusing on those who are younger, have lower socioeconomic status, and are members of ethnic minorities, and continuing to strengthen maternal health education for them can promote the maternal healthcare utilization before and after delivery.

In European countries, toxoplasma antenatal screening is recommended to prevent toxoplasmosis. The seroprevalence of these infections in immigrants can be different than in native population. From February 2006 to June 2010, a cross-sectional study was carried out in all pregnant women attended at a reference unit in Elche, Spain. An enzyme immunoassay was used for detection of IgG antibodies against Toxoplasma gondii. For each immigrant woman, one Spanish pregnant woman of the same age cared for in the same day was recruited (Spanish control group). A total of 1,627 migrant pregnant women participated in this study. The adherence to screening among migrants was 91.9% (95% CI, 90.5-93.1%), similar than that found in Spaniards (92.2%; 95% CI, 90.8-93-4%). Among migrant women, 619 were positive for IgG anti-T. gondii antibodies (41.4%; 95% CI, 38.9-43.9%), compared with 12.0% (95% CI, 10.5-13.8%) among Spaniards (odds ratio (OR), 5.2 (95% CI, 4.3-6.3). Seroprevalence in pregnant women from Latin America, northern Africa, Eastern Europe, Africa Sub-Saharan and Western Europe was higher than in the Spanish control group (OR, 5.4, 5.8, 6.5, 5.4, and 2.4, respectively; p < 0.001). No Asian pregnant woman was immune. Seroprevalence increased with increasing age in migrant pregnant women: 15-25 years, 38.2%; 26-35 years, 40.7%; and 36-45 years, 52.8%. The seroprevalence of T. gondii infection in migrant pregnant women living in Spain was higher than in the native population. However, no cases were found in Asian immigrants, highlighting the importance of primary prevention of this infection in pregnant women coming from that geographic region.

Introduction: Migrant pregnant women may require antenatal hospitalization due to complications of pregnancy. The aim of this study was to investigate the indications for admission, the baseline and the obstetric characteristics of migrant women hospitalized in a high-risk pregnancy unit (HRPU) and compare them with the native-Greek individuals. Materials and Methods: A retrospective cohort study was conducted during the period 2005-2019. All pregnant women at ≥ 24 gestational weeks admitted in a University hospital HRPU were eligible for the study. Epidemiological characteristics, along with the indications for admission were studied and comparisons of several parameters between native-Greek and migrant pregnant women were conducted. Results: Overall, 3,823 women were included in the study, of which 838 (21.9%) were migrant women. The main indication for hospital admission was threatened preterm labor (38.0%). When we compared the two groups in terms of indications for admission, we found that maternal indications were more common in migrants than Greek pregnant women (32.8% vs 26.8%; p=0.001; OR:1.332; 95% CI:1.129-1.571). Compared to native women, migrants were younger (28.7±6.1 vs 30.9±6.4 years, p&lt;0.001), more often multiparous (p&lt;0.001; OR:3.883 95% CI:3.307-4.561), reported more often spontaneous conception (p&lt;0.001; OR:0.425 95% CI:0.271-0.667) and were more likely to smoke during pregnancy (p=0.043; OR:1.209 95% CI:1.006-1.452). Conclusions: During the study period, threatened preterm labor followed by maternal complications were the most common indications for hospitalization. Migrant women were admitted to the HRPU more often than Greek ones for maternal complications. Finally, migrant status was associated with the method of conception, parity and smoking.

Maternal health literacy (MHL) plays a vital role in pregnancy outcomes, healthcare researchers should further analyze, refine, and develop this concept. This study aims to clarify the definition of MHL in pregnant women through a analysis of the concept. Walker and Avant's concept analysis approach was used to analyze the concept of MHL. A search of the literature was completed using the databases PubMed, CINAHL, Web of Science (WOS), and the Science and Technology Index (SINTA) for years 2001-2021; literature search included grey literature, publications from the government and academic institutions, and available both in English and Indonesia. A total of 12 articles were reviewed. MHL is a multifaceted and comprehensive concept. This study presents a working definition of MHL during pregnancy as the skills enabling women to access, comprehend, evaluate, and apply health information related to pregnancy, which are necessary for making decisions for improving and maintaining both maternal and fetal health. Guided by Walker and Avant's method, the major attributes and outcomes are determined in this study. Healthcare professionals can utilize this analysis to familiarize their institutions with the MHL concept, emphasize its importance, and apply it to practice. This contributes to enhancing the body of knowledge on MHL and potentially improving maternal health outcomes.

Measuring a country’s health requires considering maternal and child health indices. Despite international efforts, the Sustainable Development Goals for maternal mortality and child health are still difficult to achieve. The current study aims to understand the maternal and children’s outcomes of maternal health literacy (MHL). A scoping review was conducted on maternal health literacy outcomes. We searched for English language publications on MHL and its effects on mother and child health that were published between 2005 and 2024 in PubMed, Scopus, and Google Scholar. PRISMA chart is used for the study selection process and the data findings were compiled and summarized narratively. A total of 13 articles were included in this scoping review. MHL gives women the ability to get, comprehend, assess, and use health information, which has an impact on pregnancies, deliveries, and postpartum care. Higher MHL may result in better mother and newborn health outcomes since studies link it to increased use of prenatal care, skilled delivery attendance, and postnatal care services. MHL may also have an impact on things like breastfeeding habits, vitamin supplementation, and warning sign knowledge. MHL investments are essential for enhancing the health of mothers and children. By providing women with the knowledge, they need to make educated decisions, MHL may encourage healthier habits and improve the health of both mothers and their offspring.

Violence associated with pregnancy is a major public health concern, but little is known about it in recent migrant women. This study looked at (1) risk factors for violence associated with pregnancy among newly arrived migrant women in Canada and (2) if those who experienced violence associated with pregnancy had a different health profile or use of healthcare services for themselves or their infants during pregnancy and up to 4 months postpartum compared to other childbearing migrant women. Pregnant migrant women in Canada <5 years were recruited in 12 hospitals in 3 large cities between 2006 and 2009 and followed to 4 months postpartum. Data were collected on maternal background, migration history, violence associated with pregnancy, maternal and infant physical and mental health, and services used. Of a total of 774 pregnant migrant women, 59 (7.6%) women reported violence associated with pregnancy. Migrant women who experienced violence, compared to those who did not, were at increased risk of violence if they lived without a partner, were asylum seekers, migrated <2 years ago, or had less than high school education. Women who reported violence were less likely to have up-to-date vaccinations, take folic acid before pregnancy, more likely to commence prenatal care after 3 months gestation and to not use contraceptives after birth. They were also more likely to have a history of miscarriage and report more postpartum pain and increased bleeding. They were also more likely to have inadequate social support and report more depression, anxiety, somatization, and posttraumatic stress disorder (PTSD) on standardized tests. No differences were found in the health status of the infants of women who experienced violence compared to those who did not. Clinicians should sensitively ask recent migrant women (asylum seekers, refugees, and nonrefugee immigrants) about violence associated with pregnancy and appropriately assess, treat, and refer them.

BACKGROUND:A healthy pregnancy and its outcomes are highly dependent on maternal health literacy. This is the first study that targets the association between maternal health literacy and pregnancy outcomes of women in Afghanistan.MATERIALS AND METHODS:This is a cross-sectional study on 200 women who received a prenatal care program and have given birth at Barchi National – 100 beds hospital in Kabul, the capital city of Afghanistan. As a convenient sample, they answered Maternal Health Literacy and Pregnancy Outcome Questionnaire with 5-point Likert scales. We tested the correlation between maternal health literacy and pregnancy outcome scores via the Pearson's correlation coefficient. The potential association of socio-demographic and fertility variables with both maternal health literacy and pregnancy outcome was tested via independent samples t-test or one-way ANOVA. All analysis was performed with a 95% confidence level and a significant level was defined as a P value ≤0.05.RESULTS:The maternal health literacy of Afghan women is inadequate. Maternal health literacy is linked to pregnancy outcome, and both were associated with education level, age, number of gravidities, number of received care, and time that onset the prenatal care. Nutshell, we found evidence of a positive and significant correlation between maternal health literacy and pregnancy outcome.CONCLUSION:This study brings forth the novel data on maternal health literacy of Afghan women, the members of society that face health crises for more than half a century. This study calls for recognition that inadequate maternal health literacy in Afghanistan significantly influences prenatal care quality and perpetuates the biggest challenge for maternal and child health through pregnancy outcomes.

BackgroundGiven the prevalence of obesity and physical inactivity among Chinese adolescents, assessing the role of parents in this situation is important. Therefore, the main aim of this study was to evaluate the association between parental health literacy levels and adolescents' physical activity and obesity in China.MethodsIn this cross-sectional study, a sample of 4,717 Chinese high school students and their parents participated. Parental health literacy was measured using the Chinese version of the Health Literacy Survey 2019-12-item questionnaire (HLS19-Q12), and adolescents' physical activity was assessed using the short version of the International Physical Activity Questionnaire (IPAQ). Body mass index (BMI) was calculated using standardized measurements of weight and height (kg/m2). Statistical analyses, including independent t-test and multiple linear regression (to examine predictors of adolescent physical activity and BMI) were performed using SPSS 26.0 software. The significance level was set at p < 0.05.ResultsA total of 31.95% of adolescents were overweight or obese, and 48.15% had low physical activity, which was significantly lower in girls than in boys (p = 0.01, Cohen's d = 0.212). Only 21.39% of parents had excellent health literacy. Higher maternal health literacy was significantly associated with increased physical activity in boys, whereas both maternal and paternal health literacy were associated with higher physical activity in girls, with maternal health literacy showing a stronger association than paternal health literacy (p < 0.001). Furthermore, low physical activity was the only factor significantly associated with higher BMI among students (p < 0.001).ConclusionThe findings highlight the importance of addressing the health literacy of parents, especially mothers, in promoting adolescent physical activity and preventing obesity. Health promotion programs and educational policies should consider family-based approaches to effectively address gender-specific needs and improve adolescent health outcomes.

Introduction: Gaining insight into the maternal health literacy situation among pregnant women in Indonesia is crucial, as it forms the foundation for crafting precise interventions to enhance the well-being of mothers and infants on a national scale. Objective: This study aimed to explore the perspective of maternal health literacy among pregnant Indonesian women. Method: We employed a qualitative phenomenology method to explore maternal health literacy. Purposive sampling was used to collect participants' data. The data saturation was achieved at the thirteenth pregnant woman. The collected data were analyzed using Colaizzi's strategy to identify themes and subthemes within the phenomenon. Results: Four themes and seventeen subthemes emerged to explain maternal health literacy among pregnant women in this study. These themes include the ability to understand health-related information, search for information related to maternal health during pregnancy, assess and evaluate obtained information regarding pregnancy and maternal health, and decision-making, action, and maternal health behavior. Recommendation: The findings have the potential to benefit multiple sectors and contribute to efforts to improve maternal health in Indonesia. Culturally tailored health education programs, community engagement, empowerment, decision-making support, strengthening healthcare infrastructure, and integrating technology and telemedicine are all essential components

BackgroundSocial integration has been demonstrated to be associated with the health care use among migrants, but few studies have focused on migrant pregnant women. This study aims to explore the association between social integration and childbirth at woman’s hometown (childbirth return) of internal migrant pregnant women in China.MethodUsing the data of “Monitoring Data of Chinese Migrants” in 2014, a total of 3412 internal migrant pregnant women were included in this study. Social integration was measured by economic integration, acculturation, and identification. The childbirth locations of internal migrant pregnant women were divided into current residency and the woman’s hometown. Univariate logistic regression and two multivariable logistic regression models were employed to assess the association between social integration and childbirth return among internal migrant pregnant women.ResultOur study finds that 24.56% of migrant pregnant women choose to have a childbirth return. As for social integration, those who have their own house (OR = 0.351 95% CI 0.207–0.595) in current residence, who have been staying in current residence for at least 5 years (OR = 0.449; 95% CI 0.322–0.626), and who are willing to stay in the current residence for a long time (OR = 0.731; 95% CI 0.537–0.995) are less likely to have a childbirth return. Apart from social integration, our results also show that those migrant pregnant women who are older, who have higher education level, who have at least two family members in current residence, with a migration reason of work and business, who have established health record in the current residency, and who were not covered by medical insurances, are less likely to have a childbirth return.ConclusionSocial integration is negatively associated with childbirth return among internal migrant pregnant women in China. To improve the utilization of maternal care services for migrant pregnant women in current residence, targeted policies should be made to improve social integration status for migrant pregnant women.