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
. 2023 Apr;63(2):134-145.
doi: 10.1111/ajo.13632. Epub 2022 Dec 8.

The associations between women who are immigrants, refugees, or asylum seekers, access to universal healthcare, and the timely uptake of antenatal care: A systematic review

Samantha L Saunders  1   2 , Kerry L Sutcliffe  1 , Nathan S McOrist  1   2 , Kate M Levett  1   3
Affiliations

The associations between women who are immigrants, refugees, or asylum seekers, access to universal healthcare, and the timely uptake of antenatal care: A systematic review

Samantha L Saunders et al. Aust N Z J Obstet Gynaecol. 2023 Apr.

Abstract

Background: The World Health Organization (WHO) recommends that antenatal care (ANC) commence before 12 weeks' gestation to reduce the risk of obstetric and perinatal complications. Immigrants, refugees, and asylum seekers are at higher risk for late or non-initiation of ANC, and exclusion from universal healthcare (UHC) may be a contributing factor.

Aims: The aims were to synthesise evidence regarding uptake of ANC and to examine if this is associated with inadequate access to UHC and to evaluate the link between ANC and the risk of pregnancy outcomes in the immigrant, refugee and asylum seeker population.

Methods: The review was performed according to meta-analysis of observational studies in epidemiology (MOOSE) guidelines. Five databases were systematically searched. Abstracts were screened against inclusion criteria, and eligible papers underwent data extraction by two independent reviewers per paper. The ROBINS-I tool was used to assess risk of bias.

Results: Twelve studies were included in the final review. All studies reported that ANC was delayed for women who were classified as immigrants, refugees, and asylum seekers as per the WHO recommendations, and this was statistically significant compared to controls in 11 of 12 studies (P < 0.05). Findings regarding ANC uptake and pregnancy complications were too heterogeneous to conclusively report an association.

Conclusion: Immigrants, refugees and asylum seekers who are excluded from UHC present significantly later to ANC than receiving-country-born women with full access to UHC. The link between delayed ANC due to inadequate UHC access and pregnancy complications remains unclear due to the heterogeneous nature of the studies.

Keywords: antenatal care; immigrant; maternal health; refugee; universal healthcare.

PubMed Disclaimer

References

REFERENCES

    1. WHO. New guidelines on antenatal care for a positive pregnancy experience: The World Health Organisation; 2016. [Accessed 07/01/21 2021.] Available from: https://www.who.int/news/item/07‐11‐2016‐new‐guidelines‐on‐antenatal‐car....
    1. Mozooni M, Pennell CE, Preen DB. Healthcare factors associated with the risk of antepartum and intrapartum stillbirth in migrants in Western Australia (2005‐2013): A retrospective cohort study. PLoS Med 2020; 17(3): e1003061. https://doi.org/10.1371/journal.pmed.1003061.
    1. Hayes I, Enohumah K, McCaul C. Care of the migrant obstetric population. Int J Obstet Anesth 2011; 20(4): 321–329. https://doi.org/10.1016/j.ijoa.2011.06.008.
    1. Higginbottom GMA, Evans C, Morgan M et al. Experience of and access to maternity care in the UK by immigrant women: A narrative synthesis systematic review. BMJ Open 2019; 9(12): e029478. https://doi.org/10.1136/bmjopen‐2019‐029478.
    1. United Nations T. Refugees and Migrants 2022. Available from: https://refugeesmigrants.un.org/definitions.

Publication types

MeSH terms