Abstract
BackgroundSeveral European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988–2010.MethodsA subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the ‘migration three delays’ framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context.ResultsMajor and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups.ConclusionsSuboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.
Highlights
Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women
Differences in maternal mortality between immigrants and host country women are observed in several European countries, often with elevated risk for women coming from low-income countries (LIC) or middle-income countries (MIC) [1,2,3,4]
We aimed to identify suboptimal factors of maternity care related to maternal death as it occurred in Sweden over a period of increased migration of childbearing women from LIC and MIC [21]
Summary
Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. Scrutinising the road to death may clarify why the incidence is higher for different groups of women [4,16,17] and why women representing high risk groups face barriers to care-seeking or regular utilisation of available maternity care services [8,18,19]. Assessing both the quality of maternity care that a woman received and her own pregnancy care strategies may be essential [20]
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