Refugee Maternal and Perinatal Health

The key goal of this study was to examine maternal and perinatal health outcomes for mothers with refugee experience compared with other groups including non-refugee immigrant mothers and Canadian-born counterparts.

Our Research Goals and Methods
Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. This retrospective population-based database study included all Ontario hospital childbirth admissions occurring between 1 April 2002 and 31 March 2014. A matched cohort design was used to isolate the excess risk conferred by refugee status beyond that of immigration and COB, while a non-matched cohort design used all available data to compare outcomes of refugee and non-refugee immigrants to Canadian-born mothers. The data included refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.

Our Project Team
The study was a result of a partnership between researchers at St Mike’s (Dr Susitha Wanigaratna, Dr Marcelo Urquia, and Dr Joel Ray) and Access Alliance, with collaboration from Dr Anita J Gagnon, Dr Donald C Cole, Meb Rashid, Dr Jennifer Blake, and Dr Rahim Moineddin. Parisa Dastoori worked as an Immigrant Insight Scholar for this project. This study was supported by the Institute for Clinical Evaluative Sciences (ICES).

What we found
We found modest increased odds of caesarean section and moderate pre-term birth among refugee compared with non-refugee mothers from the same COB. Refugee mothers were 4% more likely to have a caesarean section compared to their non-refugee counterparts. We observed some country specific variations: Afghan and Iraqi refugee mothers were ~30% more likely to experience caesarean section than their same-country non-refugee counterparts. Refugee mothers differed from non-refugee immigrant mothers most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Overall, our findings suggest that refugee status, measured with an administrative definition, is not a strong risk indicator for poor maternal and perinatal health. In addition, we found that refugee and non-refugee mothers experienced a similar magnitude of ORs for almost all outcomes when each group was separately compared with Canadian-born mothers. About one-third of outcomes were significantly worse among refugee and non-refugee immigrant mothers when compared with Canadian-born mothers.

Our study also found that refugee mothers with secondary migration (travelled/lived in a country other than country of origin before coming to Canada) had double the HIV prevalence refugee mothers without secondary migration experience. This highlights the need for more sexual health services and financial and personal security for refugee women in protracted refugee situations. 

Our Knowledge Translation Activities
We have shared study results in relevant conferences and symposiums, and to specific groups of healthcare providers who work closely with immigrant and refugee mothers (for example, midwives).

Our Funder
This study was funded by the Canadian Institutes of Health Research. Dr. Wanigaratne was supported by a postdoctoral fellowship funded from this grant and Parisa Dastori was supported by Immigrant Insight Scholar position funded from this grant.

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