Pregnant Asylum Seekers Research Articles

Pregnant asylum-seekers’ perspectives regarding mental health screening: a qualitative study

Abstract Background This study aimed to identify a suitable and acceptable method to screen for depression, anxiety and PTSD in pregnant asylum seekers. Methods We conducted eight semi-structured interviews with pregnant asylum seekers. Before the interview participants filled out the Refugee Health Screener 15 (RHS-15) and a demographic questionnaire. During the semi-structured interview, we discussed the acceptability and suitability of the RHS-15 to screen and start dialogue about PTSD, anxiety and depression. To analyse data, an inductive thematic analysis was performed by two researchers. The interviews took place at the Asylum Seeker Centre of Ter Apel, the Netherlands in the months of November and December 2020. Results The following themes were identified: ‘Importance of mental health screening', ‘Talking about mental health' and ‘Use of the RHS-15'. Pregnant asylum seekers find themselves in an underserved, and disadvantaged situation. They find it meaningful and acceptable to talk about mental health with their midwife or other health care professionals, but they would not initiate a conversation on mental health spontaneously. They would appreciate encouragement in disclosing matters regarding their mental health and help with navigating the healthcare system. Barriers and enablers to talk about mental health included a language barrier, cultural differences, relationship with health care providers and practical barriers. Participants considered the RHS-15 suitable for mental health screening. Conclusions This is the first study in Europe that assesses the suitability and acceptability of mental health screening in pregnant asylum seekers from their perspective. Asylum-seeking women appreciate mental health screening during pregnancy and think the RHS-15 is an acceptable and suitable method. Further research is necessary for health care providers and policy makers to implement mental health screening for pregnant asylum seekers. Key messages The results of this study suggest that asylum-seeking women deem mental health screening during pregnancy nessesairy and find the RHS-15 a suitable and acceptible method of screening. This is the first study in Europe that investigates the opinion of pregnant asylum seekers on mental health screenings.

Perinatal Data of Women with and without Refugee Status in Berlin - Results of a Comparative Cross-Sectional Study

In Germany,1.2 million asylum seekers have entered the country in 2015-2016. More than a third of these asylum seekers were women. To understand the situation of asylum seekers' pregnancies, we examined the primary health care of this particular group to understand what, if anything, needs to improve to make the German health system more accessible to pregnant asylum seekers. we examined 960 cases of pregnant women who delivered in 2 large maternity clinics in Berlin-Charité between January 2016-August 2017. In our comparative cross-sectional study, we compared 480 asylum-seeking women with 480 local German women. For both patient populations we acquired data on various parameters. We found only two significant differences: (1) The number of antenatal appointments attended by refugee women during their pregnancy was lower than that of the control group. The average number of antenatal appointments in the local control group was 10.6 (Max.: 27, SD 2.85, Min: 2); the refugee women attended on average 8.0 appointments (Max.: 20, SD 3.385, Min: 0) (p=0.000, adjusted relative risk 0.77 95% CI 0.74-0.81). (2) The mean Hb value in the local control group was 11.1 g/dl, while in the asylum-seeking women's group it was 10.6 g/dl (p= 0.00, adjusted difference 0.54 95% CI -0.77 to -0.34). This study showed that the German health care system is capable of treating asylum-seeking women. Nevertheless, it is possible that our results do not necessarily reflect the ability of the health care system but stem from other selection parameters of the health condition of our subjects, such as the "healthy migrant effect."

Safeguarding pregnant asylum-seekers and refugees during the era of COVID-19.

As it swept across the globe, the novel coronavirus disease 2019 (SARS-CoV-2, or COVID-19) triggered an international public health emergency, preoccupying families, communities, and continents worldwide Those most affected by this virus are also the most abandoned within their respective host countries: vulnerable populations of migrants, asylum seekers, and refugees While often scapegoated for introducing new or exotic illnesses, these displaced individuals are likely the first group to be neglected in a national crisis response [1] © 2021 The Author(S) Jogh © 2021 Isgh

The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health

BackgroundMigration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women.MethodsData about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors.ResultsOut of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion.ConclusionThis study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.

Pregnancy outcomes in asylum seekers in the North of the Netherlands: a retrospective documentary analysis

BackgroundWith more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care.MethodsUsing a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors.ResultsA total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p = 0.000), labour was less often induced (36.9 vs. 43.8, p = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy.ConclusionPregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.

A systematic review of asylum-seeking women's views and experiences of UK maternity care

ObjectiveTo explore and synthesise evidence of asylum-seeking women's experiences of maternity care in the UK. DesignA systematic review and thematic synthesis of peer-reviewed qualitative evidence. Relevant databases were searched from 2000 until 2018. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. Setting and participantsUK-based studies which describe asylum-seeking women's views and experiences of maternity care. FindingsSix studies were included for thematic synthesis. Seven common themes emerged; ‘Communication challenges’, ‘Isolation’, Mental health challenges’, ‘Professional attitudes’, Access to healthcare’, ‘Effects of dispersal’ and ‘Housing challenges’. The review indicated that pregnant asylum seekers face significant barriers to accessing maternity care due to practical issues related to the challenges of their status and lack of knowledge of maternity services, together with professional attitudes. Key conclusions and implications for practiceMandatory provision of interpreter services, together with training for health care professionals could address urgent issues faced by pregnant asylum seekers. Further research and population-specific guidelines are needed to improve care for these women.

\u201cIf you can, change this system\u201d -Pregnant asylum seekers\u2018 perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany - a prospective, qualitative case study

BackgroundPregnant women and new mothers seeking asylum are highly vulnerable and have special needs, yet there is dearth of research related to this group in Germany. This paper reports on material circumstances and behavioural factors as social determinants of asylum seekers’ health during pregnancy and early motherhood. The study aim was to gain in-depth insights into these women’s experiences and perceived needs with a focus on material circumstances whilst living in state-provided accommodation in one federal state in Southern Germany.MethodsA qualitative, prospective approach was taken with individual semi-structured interviews of participants during pregnancy and up to the six-week postnatal assessment, aiming at interviewing each woman twice during pregnancy and once after giving birth. Two female interviewers performed interviews assisted by female professional interpreters on the telephone. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to perform content analysis of interview material.Results21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Content analysis of women’s perceived health-related needs revealed significant health challenges due to considerable constraints in two major themes each with associated categories: a) material circumstances and b) behavioural factors. Participants’ experiences of living conditions included significant challenges in terms of housing and neighbourhood quality e.g. poor hygiene standards with fear of disease and restless sleep due to threats of violence. Consumption potential was severely limited because of a minimal living allowance. Food was a major preoccupation for all participants. Catering services in state-provided accommodation were perceived as unsatisfactory and neglecting religious practices. Institutional food provided adequate calorific intake but participants reported loss of appetite due to bland food, limited variety, little choice and unfamiliar tastes. Self-catering was prohibited further exacerbating this problem.ConclusionsPregnant asylum seekers and new mothers living in state-provided accommodation experienced major restrictions related to material circumstances in this study. Key results identified housing and neighbourhood quality, consumption potential and nutrition as social determinants of health which women perceived to adversely affect their health, especially during pregnancy and early motherhood.

Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood: A case study exploring the role of social determinants of health

BackgroundPregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women’s experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors.MethodsIn this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material.Results21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child’s father. Social support and personal coping styles provided relief for some participants.ConclusionsThis study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women’s health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process.

Social determinants and health-related needs of pregnant refugees and asylum seekers

Abstract Migration experience and applying for asylum create unique health challenges for pregnant women and new mothers. Understanding the impact of social determinants of health on refugees and asylum seekers during pregnancy and early motherhood is important for equity and access to care. The World Health Organization’s framework on social determinants of health can serve research groups in strategically focusing their resources when investigating health needs, access to and provision of care.

Differences in pregnancy outcomes and obstetric care between asylum seeking and resident women: a cross-sectional study in a German federal state, 2010\u20132016

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.

2.11-P8How does asylum accommodation affect the health and survival of pregnant and postnatal asylum seekers and their children in the United Kingdom?

2.11-P8How does asylum accommodation affect the health and survival of pregnant and postnatal asylum seekers and their children in the United Kingdom?

Spotlight on … global health

Spotlight on … global health

The obstetric care of asylum seekers and refugee women in the UK

Key content Asylum seekers and refugees are a vulnerable group with regards to pregnancy outcomes and accessing maternity care. Asylum seekers and refugees who are pregnant and living in the UK face medical, sexual and psychosocial challenges, including dispersal late in pregnancy. The health needs of asylum seekers and refugees are complex but similar to other deprived and ethnic minority communities in the UK. Asylum‐seeking women are three times more likely to die in childbirth and up to four times more likely to experience postnatal depression than the general population because of a complex combination of physical, psychological, educational, monetary and language problems. Healthcare professionals may not be aware of the legal issues surrounding asylum seekers, and therefore may not provide adequate help and support. Learning objectives To gain knowledge of how to provide good antenatal care for this group of vulnerable women. To be able to describe the medical, sexual and psychosocial issues that face pregnant asylum seekers and refugee women in the UK. To gain awareness of the legal aspects of seeking asylum in the UK and its impact on accessing health care, especially in pregnancy. Ethical issues Should the NHS provide free health care to failed asylum seekers? Is it justified to disperse pregnant women late in the third trimester (up to 36 weeks of gestation) to prevent destitution with consequent fragmentation of care and isolation of the women?

Meeting the health and social needs of pregnant asylum seekers: Midwifery students' perspectives. Part 2: Dominant discourses and approaches to care

Pregnant women seeking asylum in the United Kingdom appear particularly vulnerable, having complex health and social care needs and could benefit from a woman centred approach to midwifery care. This article is the second of three parts and reports on the findings from one objective of a wider doctorate study. It focuses on exploring midwifery students' perceptions of how to approach the care of pregnant women seeking asylum. Although the design of the study is explored in article one, in this context, the data was subject to critical discourse analysis to meet this objective. Key words and phrases were highlighted which appeared to reveal power and ideology implicit in the language used when discussing midwifery care of the pregnant woman seeking asylum. Dominant discourses were identified which appeared to influence the way in which care was approached and the possible sources of these discourses critically analysed. The findings suggest an underpinning ideology around following policies and guidelines to meet the physical needs of the woman at the expense of her other holistic needs. Despite learning to adopt a woman centred approach in theory, once in practice some students appear to be socialised into (re)producing these dominant medical and managerial discourses with "midwifery discourse" being marginalised. In addition, some students appeared to have difficulty understanding how to adopt a woman centred approach and the importance of considering the woman's context and its impact on care. These findings have implications for midwifery educators and this article identifies that the recent Nursing and Midwifery Council requirement for students to undertake a caseloading activity could provide the opportunity for them to adopt a consistent woman centred approach in practice, rejecting dominant medical and managerial discourses. However, these discourses appear to influence midwives caring for women more widely and will be difficult to challenge.

Meeting the health and social needs of pregnant asylum seekers, midwifery students' perspectives: Part 1; dominant discourses and midwifery students

Current literature has indicated a concern about standards of maternity care experienced by pregnant women who are seeking asylum. As the next generation of midwives, it is important that students are educated in a way that prepares them to effectively care for these women. To understand how this can be achieved, it is important to explore what asylum seeking means to midwifery students. This article is the first of three parts and reports on one objective from a wider doctorate study. It identifies dominant discourses that influenced the perceptions of a group of midwifery students' about the pregnant asylum seeking woman. The study was designed from a social constructivist perspective, with contextual knowledge being constructed by groups of people, influenced by underpinning dominant discourses, depending on their social, cultural and historical positions in the world. In a United Kingdom University setting, during year two of a pre-registration midwifery programme, eleven midwifery students participated in the study. Two focus group interviews using a problem based learning scenario as a trigger for discussion were conducted. In addition, three students were individually interviewed to explore issues in more depth and two students' written reflections on practice were used to generate data. Following a critical discourse analysis, dominant discourses were identified which appeared to influence the way in which asylum seekers were perceived. The findings suggested an underpinning ideology around the asylum seeker being different and of a criminal persuasion. Although the pregnant woman seeking asylum was considered as deserving of care, the same discourses appeared to influence the way in which she was constructed. However, as the study progressed, through reading alternative sources of literature, some students appeared to question these discourses. These findings have implications for midwifery education in encouraging students to challenge negative discourses and construct positive perceptions of asylum seeking.

Meeting the health and social care needs of pregnant asylum seekers; midwifery students' perspectives: Part 3; “The pregnant woman within the global context”; an inclusive model for midwifery education to address the needs of asylum seeking women in the UK

to describe the conceptualisation and development of an inclusive educational model. The model is designed to facilitate pre-registration midwifery students' learning around the health and social care needs of pregnant women seeking asylum in the United Kingdom. current literature has identified a concern about the standard of maternity care experienced by asylum seeking women accessing maternity services in the United Kingdom. In response to this, a doctorate study was undertaken which focused on examining the way in which a group of midwifery students approached the provision of care for asylum seekers. This study revealed difficulties that these students had both in identifying these women's needs and also in the wider care issues in practice. Consequently, one of the recommendations was to ameliorate these difficulties through midwifery education. the key findings from this study were used together with relevant supporting literature to construct "the pregnant woman within the global context" model for midwifery education. The model is designed to facilitate a holistic assessment of need rather than focusing on the physical assessment at the expense of other aspects of care. It incorporates wider factors, on a global level, which could impact on the health and social care needs of a pregnant woman seeking asylum. It also prompts students to consider the influence of dominant discourses on perceptions of asylum seek;ing and is designed to encourage students' to question these discourses. this model can be used in midwifery education to prepare students in caring for pregnant women seeking asylum. It may be especially helpful when students have close contact with pregnant women seeking asylum, for example through caseloading. Further research is recommended to evaluate the effectiveness of this model in enhancing the care of asylum seeking women in the United Kingdom.

Sure Start Midwife: Giving a voice to the voiceless

Making a difference (Department of Health, 1999) called for an enhanced midwifery role in maximizing women's health and in contributing to public health targets. The Sure Start programme is now working in areas of deprivation right across the country. It is now recognized that improving maternity services is a vital step in tackling health inequalities. This is why some Sure Start programmes employ midwives to provide midwifery care in innovative ways for disadvantaged or isolated mothers. A Sure Start midwife with a special interest in refugees and asylum seekers presents the findings of an on-site antenatal service for pregnant asylum seekers living in emergency accommodation and awaiting dispersal. This article, in presenting some of the issues relating to the care of pregnant asylum seekers urges midwives to increase their knowledge and understanding of the health needs and cultural issues that affect this group of women in order to deliver appropriate care.

Caring for pregnant asylum seekers

This summer I provided advice to women working with Legal Action for Women (LAW), based at the Crossroads Women's Centre, which was challenging the imminent deportation of a pregnant woman. It is still difficult to believe that a country like ours which prides itself on fair justice could create a system that is as inhumane as it is to asylum seekers. Often it takes one ‘case’ to portray the extent of the problem; this experience was a vivid reminder to me.

Sheila Kitzinger's letter from Europe: pregnant asylum seekers: the dispossessed.

BirthVolume 31, Issue 3 p. 236-238 Sheila Kitzinger's Letter from Europe: Pregnant Asylum Seekers: The Dispossessed First published: 27 August 2004 https://doi.org/10.1111/j.0730-7659.2004.00310.xCitations: 2 Sheila Kitzinger, MBE, MLitt, is an author and lecturer on the sociological and anthropological aspects of birth, breastfeeding, and early parenthood. Her website is: http://www.sheilakitzinger.com. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume31, Issue3September 2004Pages 236-238 RelatedInformation