Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 12;16(1):89.
doi: 10.1186/s12916-018-1064-0.

Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews

Nicola Heslehurst  1 , Heather Brown  2 , Augustina Pemu  2 , Hayley Coleman  2 , Judith Rankin  2
Affiliations

Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews

Nicola Heslehurst et al. BMC Med. .

Abstract

Background: Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status.

Methods: Twelve electronic database, reference list and citation searches (1 January 2007-July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively.

Results: Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women's experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare.

Conclusions: This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women's experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities.

Systematic registration: Systematic review registration number: PROSPERO CRD42017073315 .

Keywords: Access to care; Asylum seeker; Migrant health; Perinatal health; Pregnancy; Refugee; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of searches, screening, and inclusion and exclusion of studies
See this image and copyright information in PMC

References

    1. United Nations High Commission for Refugees . Global trends: forced displacement in 2016. Geneva: United Nations High Commissioner for Refugees; 2017.
    1. Cheng IH, Drillich A, Schattner P. Refugee experiences of general practice in countries of resettlement: a literature review. Br J Gen Pract. 2015;65(632):e171–e176. doi: 10.3399/bjgp15X683977. - DOI - PMC - PubMed
    1. Khanlou N, Haque N, Skinner A, Mantini A, Kurtz Landy C: Scoping review on maternal health among immigrant and refugee women in Canada: prenatal, intrapartum, and postnatal care. J Pregnancy 2017, Article ID 8783294. https://doi.org/10.1155/2017/8783294. - PMC - PubMed
    1. Chauvin P, Simonnot N, Douay C, Vanbiervliet F. Access to healthcare for the most vulnerable in a Europe in social crisis. 2015.
    1. Anderson FM, Hatch SL, Comacchio C, Howard LM. Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis. Archives Women's Mental Health. 2017;20(3):449–462. doi: 10.1007/s00737-017-0723-z. - DOI - PMC - PubMed

Publication types