The migrant population, although far from being a homogeneous population, is particularly vulnerable. Upon arrival in the destination country, migrants face new cultural and legal environments, language barriers and restrictions on education or access to health care.
Furthermore, disparities in health status have been described, namely in perinatal health, which persist beyond the known effect of the healthy emigrant. The reproductive and perinatal period influences and shapes the future health of the mother and the child and is therefore a particularly important time to intervene.
In Portugal, the proportion of births among women born abroad has been increasing, representing in 2013 almost 10% of all births. Prolonged migration has been associated with old colonial ties, especially until the seventies, and almost 50% of foreign-born residents in Portugal came from Brazil and Portuguese-speaking African countries. Thus, cultural divides or language barriers are less expected for most migrant women.
In addition, immigrants in Portugal have universal and free access to the National Health Service, which offers free prenatal, obstetric, neonatal and pediatric services to all women of reproductive age (national or foreign-born) and their children. Thus, social inequalities in health outcomes, comparing immigrant and native women, must be of a different nature and reflect more complex processes. All of this makes Portugal one of the most appropriate options to study both the etiology of adverse behaviors and outcomes in perinatal health and the subjective perception influences the choices and use of available structures, as well as health outcomes.
In order to understand how perinatal health services are used and viewed by migrant women and how they influence disparities in pre- and postnatal outcomes, we have identified the following specific objectives in three
main domains:
1) Access and content of prenatal care: a) compare the access and use of antenatal services in Portuguese and migrant women and b) assess how the content and quality of care varies between migrants and non-migrants, regardless of individual maternal characteristics;
2) Effect of prenatal care and perinatal services on pregnancy outcomes: a) to assess how prenatal care influences the association between migrant status and the occurrence of adverse outcomes, such as prematurity and restriction
of intrauterine growth, b) estimate how obstetric practices, such as induction of labor, cesarean delivery or episiotomy, differ in migrant and non-migrant women, c) describe how the father’s participation andsatisfaction with perinatal health services influence the perception and use of these services by women;
3) Effect of host country characteristics: assess the effect of cultural and language barriers on access to care and health outcomes.
To respond to the aforementioned objectives, a national cross-sectional study will be carried out, based on 42 public maternity hospitals in Mainland Portugal. Women with a live birth or stillbirth during the study period will be eligible. Migrants will be defined as women who were born in a foreign country and have been resident in Portugal for 10 years or less. Portuguese women will be randomly selected in a factor of 1:1, paired by birth outcome (live or stillbirth) and by day of delivery. We hope to study 7000 women.
The clinical data will be registered by the health professionals of the involved maternity hospitals. Later (up to 3 months after delivery), a structured questionnaire will be carried out, which includes the Portuguese version, previously validated in a pilot study, of the “Migrant Friendly Maternity Care Questionnaire”, developed by the international group ROAM. Information will be obtained through computer-assisted telephone interviews (CATI).
This study of women from different countries giving birth in Portugal will be an ideal opportunity to investigate how socioeconomic factors, cultural heritage and the organization of health care can affect the use of perinatal care and determine health outcomes. Comparison of the perinatal health of Portuguese-speaking migrants living in the country of colonization (Portugal) vs. those giving birth in Canada will provide additional evidence of a quasi-experimental nature to understand the role of language and cultural barriers. As main products, this study will include, in addition to the traditional indicators of scientific production, a “policy brief” to be provided to women and migrant associations.
