Women In Switzerland Research Articles

Swimming against the tide: Women's experience of choosing a homebirth in Switzerland

Background: Choice in childbirth, which also involves choice of place to give birth, is a fundamental right of all women. Despite the availability of health-care options for maternity services, most women living in Switzerland continue to give birth in hospital. This paper explores factors influencing the decision of Swiss women to give birth at home. Study design: A descriptive qualitative study was used. Semi-structured interviews were conducted with six pregnant women living in Switzerland who were planning a homebirth. Data were analysed using thematic analysis. Findings: Previous hospital experience, expectations of homebirth, women's attitudes to birth, and personal and societal influences were reasons women gave for choosing a homebirth. Homebirth offered women more autonomy, less medical intervention, and a more relaxing environment than traditional hospital settings. Conclusion: Women in Switzerland who choose homebirth are motivated by the same factors as women elsewhere. The findings from this study suggest a need for personalised maternity care which supports women in their childbirth choices.

Incidence of preeclampsia in pregnant Swiss women.

The epidemiology of preeclampsia in Switzerland is known only from a retrospective registry study. This analysis aimed to prospectively determine the incidence of preeclampsia in a cohort of pregnant women in Switzerland. Pregnant women presenting at gestational week 11-14 at their obstetrician's office were consecutively included and prospectively followed-up until the end of pregnancy. Ultrasound characteristics, blood pressure measurements, body mass index, and personal history were recorded. Duration of pregnancy, occurrence of preeclampsia, birth weight and Apgar scores were recorded as outcomes. There were 1,300 pregnancies with follow-up available for analysis. Median age was 30 years (interquartile range [IQR] 27-33), median body mass index (BMI) 23.3 kg/m² (IQR 21.2-26.1), median systolic blood pressure 117 mm Hg (IQR 109-126) and median diastolic blood pressure 70 mm Hg (IQR 64-77). A total of 30 women developed preeclampsia, corresponding to an incidence of 2.31% (95% confidence interval [CI] 1.62%-3.28%). Of the women with preeclampsia, 6.66% (95% CI 2.04%-21.42%) had early-onset preeclampsia, 13.33% (95% CI 5.45%-29.83%) progressed to eclampsia, whereas 10% (95% CI 3.63%-28.75%) developed HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count). Nulliparity and prior history of preeclampsia were more frequently seen in pregnancies with preeclampsia than in pregnancies without preeclampsia. BMI, as well as systolic and diastolic blood pressure were higher in pregnancies subsequently developing preeclampsia. The incidence of preeclampsia in Switzerland is in line with frequencies observed elsewhere in the world. Extrapolation to a national level indicates that about 1,911 (range 1,340-2,713) preeclampsia cases per year can be expected to occur in Switzerland.

Reduced Bone Strength and Muscle Force in Women 27 Years After Anorexia Nervosa.

A substantial body of research findings indicate that muscle mass and bone mass are reduced in populations of anorexic females, even in such populations whose anorexia nervosa had been in remission for longer periods. This study aimed to investigate whether the bone of an anorexia nervosa recovery cohort is adapted to maximal muscle forces and whether there are alterations in the structure of the tibia in this population, as compared with a control group. This was a cross-sectional study of 22 women in Switzerland who have remained in stable recovery from anorexia nervosa for an average of 27 years. The measurements were compared with those of an age- and gender-matched control group (n = 73). There were no interventions. Bone characteristics of the tibia and maximal voluntary ground reaction force (Fm1LH) were measured. The variability in volumetric bone mineral content (vBMC) at the 14% site was explained by 54.7% on the grounds of Fm1LH (P < .001). Formerly anorexic women had an 11.6% lower Fm1LH (P = .001), a significantly lower vBMC at 4% and 14% of tibia length, and an 11.9% (P = .001) lower body mass than the age- and gender-matched control population. Present body mass of the anorexia group correlated positively with vBMC at the 14% site (P < .001). Despite the fact that findings reflected an adaptation of bone to the acting forces, most results indicated that the test cohort generally suffered from a secondary bone defect. In addition, maximal muscle force was also impaired in the formerly anorexic women.

Feasibility of at-home self-sampling for HPV testing as an appropriate screening strategy for nonparticipants in Switzerland: preliminary results of the DEPIST study.

Nonattendees to cervical cancer screening are at a higher risk of developing cervical cancer. This study assessed women's willingness to perform a home-based self-sampling for human papillomavirus testing (Self-HPV) and explored the feasibility of establishing a home-based Self-HPV screening strategy in Switzerland. Underscreened women (n = 158) who had not underwent a Pap test in the preceding 3 years were recruited between September 2011 and September 2013. Participants completed 2 questionnaires evaluating reasons for non-attendance at a screening program, sociodemographic issues, and satisfaction with and acceptability of the Self-HPV. Descriptive data and multivariate logistic regression were used to identify variables associated with women's willingness to perform at-home self-sampling for HPV testing. Lack of time because of work or childcare was the most common reason for nonattendance at a screening program. One hundred six women (82%) preferred the Self-HPV because it is easy to perform, convenient, comfortable, and private. Women were more likely to accept the Self-HPV as a future screening strategy if they had missed cervical cancer screening in the past because of lack of time (odds ratio [OR] = 6.2, 95% confidence interval [CI] = 1.6-23.6; p < .01). Twenty-six women felt pain during self-sampling. Previous negative experiences with screening and stress during sampling were associated with higher risk for pain (OR = 7.14, 95% CI = 2.0-25.3, p < .01 and OR = 4.73, 95% CI = 1.5-14.5, p < .01, respectively). The Self-HPV was accepted by nonattendees of cervical cancer screening programs. Self-sampling may promote screening among the unscreened and underscreened population of women in Switzerland while overcoming some practical barriers.

Breast cancer in younger women in Switzerland 1996–2009: A longitudinal population-based study

BackgroundBreast cancer (BC) is the most commonly diagnosed cancer and a leading cause of death in younger women. MethodsWe analysed incidence, mortality and relative survival (RS) in women with BC aged 20–49 years at diagnosis, between 1996 and 2009 in Switzerland. Trends are reported as estimated annual percentage changes (EAPC). ResultsOur findings confirm a slight increase in the incidence of BC in younger Swiss women during the period 1996–2009. The increase was largest in women aged 20–39 years (EAPC 1.8%). Mortality decreased in both age groups with similar EAPCs. Survival was lowest among women 20–39 years (10-year RS 73.4%). We observed no notable differences in stage of disease at diagnosis that might explain these differences. ConclusionsThe increased incidence and lower survival in younger women diagnosed with BC in Switzerland indicates possible differences in risk factors, tumour biology and treatment characteristics that require additional examination.

Life satisfaction trajectories of elderly women living in Switzerland: an age–period–cohort analysis

ABSTRACTOld age is a priori a vulnerable stage of the lifecourse. Quality of life can be expected to decline in older age due to loss, isolation, and declining cognitive and physical abilities. The purpose of this study was to investigate the distribution, prevalence and trajectory of life satisfaction (LS) as a measure of quality of life among Swiss elderly women. We also assessed the impact of different social determinants on LS within the age categories of the ‘young old’ and the ‘old old’ across different cohorts. Using the Swiss Household Panel survey data, analyses of LS distribution and trajectories were conducted for 1,402 women aged 65–84 years. About 50 per cent of elderly women in Switzerland were very satisfied with their lives. The mean LS score and the prevalence of satisfied women were lower in more recent cohorts of identical ages. However, their LS remained more stable over ageing than was the case in former cohorts. High education, satisfaction with income, social support, living with a partner and good self-perceived health were all positive and significant predictors of LS. Longitudinal analyses allowed the ageing process net of cohort and period effects to be disentangled and the assessment of the influence of both social determinants and within-individual psychological traits on the self-evaluation of LS.

The Border of Reproductive Control: Undocumented Immigration as a Risk Factor for Unintended Pregnancy in Switzerland

Unintended pregnancies reflect an unmet need for family planning, and are part of health disparities. Using the only database to inquire about pregnancy intention among women in Switzerland, this study examined the relationship between immigrant documentation and unintended pregnancy (UP). Among pregnant women presenting to a Swiss hospital, we compared pregnancy intention between documented and undocumented women. We used logistic regression to examine whether undocumented status was associated with UP after adjusting for other significant predictors. Undocumented women had more unintended pregnancies (75.2 vs. 20.6%, p = 0.00). Undocumented status was associated with UP after adjustment (OR 6.23, 95% CI 1.83-21.2), as was a history of psychological problems (OR 4.09, 95% CI 1.32-12.7). Contraception non-use was notably associated with lower odds of UP (OR 0.01, 95% CI 0.004-0.04). Undocumented status was significantly associated with UP, even after adjusting for well-recognized risk factors. This highlights the tremendous risk of undocumented status on UP among women in Switzerland.

Temporal trends in treatment of ST-elevation myocardial infarction among men and women in Switzerland between 1997 and 2011

Few data are available concerning the impact of gender on temporal trends in patients with acute ST-segment elevation myocardial infarction (STEMI). All STEMI patients consecutively enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project from 1997-2011 were included. Temporal trends in presentation, treatment and outcomes were analyzed using multiple logistic regressions with generalized estimations. Of 21,620 STEMI patients, 5786 were women and 15,834 men from 78 Swiss hospitals. Women were 8.6 years older, presented 48 minutes later with less pain, but more dyspnea, and more frequently had atrial fibrillation (5.5 vs. 3.9%, p<0.001), heart failure (Killip class >2) (9.7 vs. 7.3%, p<0.001), and moderate or severe comorbidities (24.8 vs. 18.2%, p<0.001). Women were less likely to undergo primary reperfusion treatment after adjustment for baseline characteristics and admission year (OR 0.80, 95% CI 0.71-0.90, p<0.001) or receive early and discharge drugs, such as thienopyridines, angiotensin-converting-enzyme inhibitors, angiotensin II receptor antagonists, and statins. In 1997, thrombolysis was performed in 51% of male and 39% of female patients; its use rapidly decreased during the 1990s and has now become negligible. Primary percutaneous coronary intervention increased from under 10% in both genders in 1997 to over 70% in females and over 80% in males since 2006. Patients admitted in cardiogenic shock increased by 8% per year in both genders. The incidence of both reinfarction and cardiogenic shock developing during hospitalization decreased significantly over 15 years while in-hospital mortality decreased from 10 to 5% in men and from 18 to 7% in women. This corresponds to a relative reduction of 5% per year for males (OR 0.95, 95% CI 0.92-0.99, p=0.006) and 6% per year for female STEMI patients (OR 0.94, 95% CI 0.91-0.97, p<0.001). Despite higher crude in-hospital mortality, female gender per se was not an independent predictor of in-hospital mortality (OR 1.07, 95% CI 0.84-1.35, p=0.59). Substantial changes have occurred in presentation, treatment, and outcome of men and women with STEMI in Switzerland over the past 15 years. Although parallel trends were seen in both groups, ongoing disparities in certain treatments remain. However, these did not translate into worse risk-adjusted in-hospital mortality, suggesting that the gender gap in STEMI care may be closing.

Abstract 283: Temporal Trends in Treatment of ST-Elevation Myocardial Infarction Among Men and Women in Switzerland from 1997 through 2010

Introduction: Few data describe temporal trends in presentation, treatment and outcome in men and women with acute ST-segment elevation myocardial infarction (STEMI). Methods: Swiss STEMI patients enrolled in the AMIS Plus registry from1997-2010 were analyzed using multivariate logistic regression. Results: From 20,363 STEMI patients, 5458 were women and 14,905 men. Women were 8.6 years older, had more co-morbidities (Charlson Index ≥2 16.9% vs 12.8%; P&lt;0.001), diabetes mellitus (22.6% vs 17.3%; P&lt;0.001) and hypertension (64.9% vs 50.6%; P2 (10.6% vs 7.2%; P&lt;0.001) and atrial fibrillation (5.6% vs 3.9%; P&lt;0.001). Men had more often dyslipidemia (54.1% vs 50.3%; P&lt;0.001), resuscitation prior admission (6.3% vs 5.2%; P=0.003) and were more often current smokers (46.3% vs 29.9%; P&lt;0.001). Women were less likely to undergo primary reperfusion (61.6% vs 75.4%; OR 0.52; 95%CI 0.49-0.58; P&lt;0.001) even after adjusting for baseline characteristics and admission year (OR 0.80; 95%CI 0.71-0.89; P&lt;0.001), or to receive early and discharge drugs such as thienopyridines, ACE inhibitors, AT antagonists or statins. In 1997, thrombolysis was performed in 51% of male and 39% of female patients. Now, thrombolysis is negligible. Use of primary PCI increased from below 10% in both genders in 1997 to over 70% in females and over 80% in males. Early thienopyridine therapy steadily increased to 90% of all patients in 2010. Statin use rapidly increased until 2002, peaking at 72% in women and 82% in men in 2005/6. Early statin use since decreased but thienopyridine and statin therapies at discharge increased and were prescribed to over 90% of patients in 2010. From 1997-2010, annual in-hospital mortality decreased by 5% in men (OR 0.95; 95%CI 0.94-0.97; &lt;0.001) and 6% in women (OR 0.94; 95%CI 0.92-0.96; P&lt;0.001). Despite higher crude in-hospital mortality, female gender was not an independent predictor of in-hospital mortality (OR 1.10; 95%CI 0.90-1.35; P=0.37). Conclusion: Therapy of STEMI patients has changed greatly during the past 14 years in Switzerland, largely in accordance with guideline recommendations.

A Soiled Password: Democracy, the Word and Democracy, the Thing

The word‘democracy’ to be distinguished from the thing‘democracy.’ Removal by the Italian parliament of a corrupt and scandalous Premier for a respected, honest technician and a form of civil service government does not infringe the second category. Referendums give strength to a handful of already overmighty rich men controlling media outlets. Witness Fox Radio and TV and the poison of Glen Beck, also the virulent nationalism of the Murdoch and Desmond papers. Note the fifty plus year lag in enfranchising women in Switzerland, a self‐evident democratic advance held back by ‘the voice of the people’ in successive referendums. Government should be free from populism and be run by educated, intelligent people both in parliament and the Civil Service. ‘Yes Minister,’ however amusing, has done us a disservice. I would trust a senior civil servant above a press lord any day of the week. Witness the good sense of the Upper House in its current informed and experienced composition. The Lords blocked Tony Blair's plans to by‐pass Habeas Gorpus, refusing authoritarian government to an elected Premier with no sense of the rule of law or constitutional principle.

Seroepidemiology of herpes simplex virus type 1 and 2 in pregnant women in Switzerland: an obstetric clinic based study

Objective To assess the seroprevalence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) IgG antibodies and the seroincidence of HSV-1 and HSV-2 infections in pregnant women attending the maternity clinic of the University Hospital Lausanne. Study design Blood samples from 1030 women were taken at the usual pregnancy visit in the first trimester to assess the prevalence rate of IgG antibodies against HSV-1 and HSV-2 using a type-specific assay. A second blood sample was taken 6–8 weeks postpartum from returning women who were seronegative for HSV-2 or HSV-1 to assess the incidence of seroconversion (primary infection). Results The seroprevalence rates were 79.4% (95% CI: 76.9–81.9) for HSV-1 and 21.2% (18.7–23.7) for HSV-2 in women 14–46 years old. Type-specific serostatus patterns were as follows: 17.3% HSV-1/-2: +/+, 62.1% HSV-1/-2: +/−, 3.9% HSV-1/-2: −/+, 16.7% HSV-1/-2: −/−. Two hundred and sixty five women (59 of the 212 seronegative for HSV-1 (27.8%) and 265 of the 812 seronegative for HSV-2 (32.6%)) returned to the outpatient clinic for the post-delivery check and a second blood sample was obtained. One HSV-1 seroconversion was detected (HSV-1 seroconversion rate 2.4%/100 patient × year (95% CI: 0.06–13.4)) in a patient who had symptoms compatible with primary genital herpes. No HSV-2 seroconversion was detected (HSV-2 seroconversion rate: 0/100 patient × year (97.5% one-sided CI: 0–2)). Conclusion Compared to a previous population-based study, our study results suggest a rise in the prevalence of HSV-2 among pregnant women in Switzerland. The low incidence of seroconversion detected during pregnancy is consistent with the very low reported incidence of neonatal herpes in Switzerland. Condensation This study in a public hospital in Western Switzerland suggests an increasing prevalence of HSV-2, but a low incidence of primary infections in women of childbearing age.

Drawing New Boundaries of Participation: Experiences and Strategies of Economic Citizenship among Skilled Migrant Women in Switzerland

The concept of citizenship, originally coined by Marshall, and synonymous with social rights and equality, is pivotal in understanding and overcoming the social injustices that many migrants experience. Marshall's notion of social rights, however, does not elaborate on economic rights. Feminist authors argue that women's equal access to sources of income outside family relations is key to their citizenship. Access to spaces of paid work is a significant aspect of migrant women's citizenship because their residence status and naturalization is often contingent on their employment. The author thus argues that economic rights should be central to debates on migration and citizenship. The proposed term ‘economic citizenship’ is used to examine experiences and strategies of fifty-seven skilled migrant women from Latin America, the Middle East, and South East Europe when trying to access positions in the Swiss labour market corresponding to their professional qualifications. The feminist and postcolonial perspectives of ‘intersectionality’ and participatory research are used to understand how and why inequalities in the labour market occur. It is found that traditional ideas about gender roles, discourses about ethnic difference, and discriminatory migration policies intersect to create boundaries for skilled migrant women in accessing upper segments of the Swiss labour market. Migration, therefore, does not always imply empowerment and emancipation, but also generates new forms of social inequality.

Pregnancy and delivery outcomes of HIV infected women in Switzerland 2003–2008

Rates of vertical HIV transmission between mother and child are low, allowing many HIV positive women to have children with near impunity. In this study, data from the Swiss Mother and Child HIV Cohort Study were used to describe maternal characteristics and their association with pregnancy outcomes in HIV positive women. HIV positive women were followed prospectively during their pregnancies and deliveries by anonymous questionnaires between January 2003 and October 2008. Adverse pregnancy outcomes included preterm delivery, preeclampsia and gestational diabetes mellitus. This study included 266 HIV positive women, of which 67 (25.2%) were first diagnosed with HIV during pregnancy. Thirty percent (n=80) of the women had pregnancy complications after 24 weeks of gestation. Preterm delivery was noted in 72 (27%) patients. Other complications included preeclampsia (n=7; 2.6%) and gestational diabetes (n=7; 2.6%). Older maternal age was the only risk factor associated with adverse pregnancy outcomes (adjusted odds ratio: 1.06, 95% confidence interval 1.01-1.12, P=0.02). HIV positive women, especially with advanced maternal age, have high-risk pregnancies and should be monitored as in an interdisciplinary setting. The preponderance of initial HIV diagnosis during pregnancy confirms the importance of HIV screening in pregnant women.

Uptake of breast cancer screening measures among immigrant and Swiss women in Switzerland.

Early detection of breast cancer plays a crucial role in survival, and in most developed countries immigrant women present for treatment at a later stage of the disease. Compared to the indigenous population, immigrant women have a lower uptake of breast cancer prevention services. The situation for immigrant women in Switzerland is compounded by the fact that all women living in Switzerland are at major risk of developing breast cancer during their lifetime. Our study aimed to detect disparities in uptake of preventive methods such as mammography, clinical breast examination (CBE) and breast self-examination (BSE) among women from the four major immigrant groups Italy, Spain, former Yugoslavia and Portugal, compared to the native population in Switzerland. This study is a secondary analysis of data from the 2002 Swiss Health Survey, a nationwide cross-sectional telephone survey. The self-reported questionnaires addressed immigrant and Swiss women of age 20 and over (n = 9,790). Descriptive statistics were used to describe the demographic characteristics of the sample. The dichotomous variables of interest, mammography, CBE and BSE were adjusted for nationality and further sociodemographic factors using logistic regression, with Swiss women serving as the comparison group. Main predictors for mammography uptake were higher income and older age. For the use of CBE, lower age, higher income and nationality were the strongest predictors. Women from former Yugoslavia (OR = 2.6) and Portugal (OR = 2.8) more frequently stated that they did not receive CBE compared to Swiss females (p = .011). BSE is linked to a higher socioprofessional status and to nationality. Women from Italy (OR = 1.62) and former Yugoslavia (OR = 2.6) perform BSE significantly less often than Swiss women (p = .0001). Differences exist in the use of mammography, CBE and BSE among the four major foreign nationality groups living in Switzerland compared to Swiss nationals. Immigrant and low-income women might draw benefit from a systematic and culturally adapted breast cancer screening programme to overcome disparities in access to screening.

Uptake of breast cancer screening measures among immigrant and Swiss women in Switzerland.

Early detection of breast cancer plays a crucial role in survival, and in most developed countries immigrant women present for treatment at a later stage of the disease. Compared to the indigenous population, immigrant women have a lower uptake of breast cancer prevention services. The situation for immigrant women in Switzerland is compounded by the fact that all women living in Switzerland are at major risk of developing breast cancer during their lifetime. Our study aimed to detect disparities in uptake of preventive methods such as mammography, clinical breast examination (CBE) and breast self-examination (BSE) among women from the four major immigrant groups Italy, Spain, former Yugoslavia and Portugal, compared to the native population in Switzerland. This study is a secondary analysis of data from the 2002 Swiss Health Survey, a nationwide cross-sectional telephone survey. The self-reported questionnaires addressed immigrant and Swiss women of age 20 and over (n = 9,790). Descriptive statistics were used to describe the demographic characteristics of the sample. The dichotomous variables of interest, mammography, CBE and BSE were adjusted for nationality and further sociodemographic factors using logistic regression, with Swiss women serving as the comparison group. Main predictors for mammography uptake were higher income and older age. For the use of CBE, lower age, higher income and nationality were the strongest predictors. Women from former Yugoslavia (OR = 2.6) and Portugal (OR = 2.8) more frequently stated that they did not receive CBE compared to Swiss females (p = .011). BSE is linked to a higher socioprofessional status and to nationality. Women from Italy (OR = 1.62) and former Yugoslavia (OR = 2.6) perform BSE significantly less often than Swiss women (p = .0001). Differences exist in the use of mammography, CBE and BSE among the four major foreign nationality groups living in Switzerland compared to Swiss nationals. Immigrant and low-income women might draw benefit from a systematic and culturally adapted breast cancer screening programme to overcome disparities in access to screening.

Endocrine Disruptors and Breast Cancer

Breast cancer strikes one out of eight women in Switzerland. The increase in breast cancer incidence over the past 70 years parallels an enormous increase of man-made, persistent chemicals in our environment; some of which have endocrine-disrupting properties in wildlife and/or in animal models. Epidemiological evidence is strong that a woman's risk to get breast cancer is linked to her reproductive history and with that to the changes in her hormonal milieu. Exogenous hormones have also been shown to increase breast cancer risk, however, a causative link between exposure to endocrine disruptors and human disease is difficult establish as many of these compounds are ubiquitous and no unexposed controls exist. The synthetic estrogen, diethylstilbestrol (DES), that was given to pregnant women for three decades, was banned because it was linked to a vaginal carcinoma in their daughters. It has now been shown that not only women who have taken the drug themselves have increased breast cancer risk but also their daughters who were exposed in utero. This indicates that breast cancer risk can be affected by endocrine disruption not only in the adult but already in utero. Evidence from animal models is accumulating that perinatal exposure to environmentally relevant, low doses of a related compound, bisphenol A (BPA), alters breast development and increases breast cancer risk. Given the prevalence of endocrine-disrupting agents they deserve our attention.

Shift work among women—a century-old health issue in occupational health

Shift work among women—a century-old health issue in occupational health

Caesarean sections and breastfeeding initiation among migrants in Switzerland

Twenty-six percent of all women giving birth in Switzerland are of non-Swiss nationality. Differences in reproductive health outcomes such as preterm deliveries, Caesarean sections, and breastfeeding initiation for mother-child pairs of various nationalities are investigated, and the influence of the educational level was assessed. In order to identify trans-national differences, national breastfeeding rates from 22 countries and Caesarean section rates from 24 countries were compared to the rates in Swiss hospitals. Drawing on routinely collected monitoring data, 37332 mother-child pairs from various nationalities, who delivered in Swiss Baby-Friendly hospitals between 2000 and 2002, were included in the study. All nationalities with at least 150 deliveries were coded individually, while the remaining were summarised in regional groups. Sub-Saharan African, Latin American and Asian mothers had higher rates of Caesarean sections compared to Swiss mothers (OR = 1.77, 95% CI 1.49-2.22; OR = 1.80, 1.51-2.17; OR = 1.37, 1.18-1.59). African and Asian children were at an increased risk of being transferred to neonatal care units (OR = 1.48, 95 %CI 1.19-1.83; OR = 1.45, 1.21-1.73;). In addition, infants from Balkan countries, who showed lowest Caesarean section rates, were also more likely to be transferred to an ICU (OR = 1.30, 95% CI 1.12-1.52). Apart from the country or region of origin, the maternal educational level was an important influence and modified the effect of the mother's nationality. Mothers from all regions, apart from Western Europe, were significantly more likely to breastfeed their children after being discharged. Established determinants for breastfeeding duration, including feeding exclusively with breast milk in maternity wards, early initiation of breastfeeding, rooming-in and pacifier use, varied according to nationality. The comparison of Caesarean section and breastfeeding rates with the rates in the mother's country of origin additionally investigates the relation between reproductive health outcomes of migrant women in Switzerland compared to their country of origin. In both cases, a significant rank correlation (Spearman) could be established between the rate in Swiss hospitals and the rate in the mother's country of origin (P < 0.001, P = 0.04). Our data confirms inequalities in reproductive health outcomes and responses to health promotion programmes among migrant women in Switzerland. These differences are dependent on educational level and on the mothers' nationality. The large variation suggests that different trans-national experiences play some role in health-related decision-making and access to health care. This should be considered when planning health promotion programs and the individual counselling of pregnant mothers in Switzerland.

Understanding the Labour Market Participation of Skilled Immigrant Women in Switzerland: The Interplay of Class, Ethnicity, and Gender

Switzerland has recently adopted immigration policies that give preference to skilled migrants, the assumption being that migrants with higher education will integrate easily. Our study of 57 skilled immigrant women from Latin America, the Middle East and Southeastern Europe shows that this assumption is largely unjustified. Most of the women cannot use their social and cultural capital to establish themselves in the upper segments of the labour market. A third are not integrated in the labour market and a quarter occupy positions below their skill-level. A further third work at their skill-level but only irregularly. The differentiated participation of these immigrants in the labour market is well explained by analysing the interplay of class, ethnicity and gender.

Hepatitis C in a sample of pregnant women in Switzerland: seroprevalence and socio-demographic factors.

The aim of this study was to determine the prevalence of hepatitis C (HCV) infection in a sample of pregnant women living in Switzerland in 1990-1991, in order to complement existing data in various populations. Blood samples were collected from women from consecutive births in obstetric wards in public hospitals of 23 Swiss cantons over a one-year period. They were tested, among other things, for the presence of hepatitis C virus antibodies (anti-HCV). Statistical analyses were done to explore the association of demographic variables with anti-HCV. The study included a total of 9,057 women of whom 64 tested positive for anti-HCV, resulting in a crude prevalence of 0.71%. Prevalence varied by age and was highest in the 25-29-year age-group (0.90%). 43/5,685 Swiss women were HCV seropositive (0.76%) compared with 21/3,372 non-Swiss women (0.62%). Stratified analysis showed a significant association between anti-HCV and anti-HBc antibody positivity in Swiss (adjusted OR [aOR] 23, 95% CI 12-43) and non-Swiss nationals (aOR 3.3, 95% CI 1.3-8.3). The prevalence of anti-HCV antibodies in the early 1990s was <1% in this sample of pregnant women in Switzerland and was associated with age, nationality and the presence of anti-HBc antibodies, a marker of exposure to hepatitis B virus. These results are in accordance with those from other published European studies. If an effective intervention to prevent vertical transmission becomes available, information on the current prevalence of HCV in pregnant women would be needed in order to assess how screening recommendations should be modified.