Perinatal outcomes of uninsured immigrant, refugee and migrant mothers and newborns living in Toronto, Canada

Abstract

Canadian healthcare insurance is not universal for all newcomer populations. New immigrant, refugee claimant, and migrant women face various barriers to healthcare due to the lack of public health insurance coverage. This retrospective study explored the relationships between insurance status and various perinatal outcomes. Researchers examined and compared perinatal outcomes for 453 uninsured and provincially insured women who delivered at two general hospitals in the Greater Toronto Area between 2007 and 2010. Data on key perinatal health indicators were collected via chart review of hospital medical records. Comparisons were made with regional statistics and professional guidelines where available. Four-in-five uninsured pregnant women received less-than-adequate prenatal care. More than half of them received clearly inadequate prenatal care, and 6.5% received no prenatal care at all. Insurance status was also related to the type of health care provider, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced a higher percentage of caesarian sections due to abnormal fetal heart rates and required more neonatal resuscitations. No significant difference was found for low birth weight, preterm birth, NCIU admissions, postpartum hemorrhage, breast feeding, or intrapartum care provided.

Figure 1

Ethnic background by insurance status (n = 453).

Figure 2

Prenatal healthcare provider type by insurance status (n = 453).

Figure 3

Number of Prenatal Visits by Insurance Status (n = 453) Adequate means ≥9–12 visits beginning by the 4th month (based upon SOGC Guidelines).

Figure 4

Rates of medical interventions by insurance status (n = 453) and in general population.

Figure 5

Mean length of hospital stay by insurance status (n = 453).