European Journal of Obstetrics & Gynecology and Reproductive Biology
Migration and perinatal health surveillance: An international Delphi survey
Introduction
Extensive international migration to industrialized countries [1] has been accompanied by health disparities between migrants and receiving-country nationals [2], [3], [4], [5] which make this issue a priority for research and action [6], [7]. Examples of differences in perinatal health outcomes and care between migrant and native-born women include: a 50% greater perinatal mortality risk for migrant women living in Sweden compared to their Swedish counterparts [adjusted odds ratio (ORadj) 1.5; 95% CI (1.04, 2.17)] [8] and a near doubling of preterm birth rates for migrants in France [ORadj 1.9; 95% CI (1.18, 3.05)] [9]. However, this portrait of migrant health varies between studies and migrant outcomes are sometimes comparable or better than their receiving counterparts. For instance, migrant women had a 19% lower risk for perinatal mortality than US-born women in one study [ORadj 0.81 (0.72, 0.91)] [10] and equivalent risks of low birth weight were reported in migrants in lower Saxony [ORadj 1.01 (0.92, 1.10)] [11].
One of the difficulties in interpreting the literature on migration and perinatal health is inconsistency in the definition and measurement of migration. Variables used to describe migration include: country of birth/national origin, regional origin, nationality, ethnicity, race, language, skin colour, ethnic majority/minority, parents’ country of birth, religion, length of time in country, and generation immigrant (i.e., 1st, 2nd, etc.). Contradictory study findings may result from differences in migrant definitions or in migrant groups themselves, which cannot be distinguished given the labels used. For instance, ‘foreign-born’ could include individuals from many world regions who arrived months or years ago. Heterogeneity in the definition of migrant groups has limited attempts to synthesize results from the many studies that have been carried out on this subject.
In order to reduce this heterogeneity, international consensus on migrant definitions is needed.
The Reproductive Outcomes and Migration (ROAM) international research collaboration was created to study the relationship between migration and reproductive health outcomes, with an initial objective to obtain consensus on migration indicators to be used internationally for perinatal indicator sets and routine population-based perinatal surveys. Toward this end, and in collaboration with the EURO-PERISTAT project [12], an international Delphi consensus process was conducted.
Section snippets
Materials and methods
We began by undertaking a review of 10 years of literature on migration and perinatal health, resulting in a database of 133 published studies [13]. One purpose was to inventory the definitions of ‘migrant’ that had been used, and to form an exhaustive list of potential migration indicators.
To achieve consensus on indicators of migration, a modified Delphi process was used. Delphi is a formalised consensus method whereby participants respond to a successive series of questionnaires with the aim
Results
Of the 49 people contacted, 38 agreed to participate in the Delphi panel, including 18 EURO-PERISTAT members, 14 ROAM members, and 6 other experts. Of the respondents, 4 were from Australia, 8 from Canada and 26 from Europe (see appendix).
Table 1 presents the results of the classification of migration indicators inventoried in the literature by importance and feasibility. Items ranked most highly pertained to country of birth, the time that the migrant has been in the country (recent immigrant,
Discussion
A panel of international experts was able to reach consensus on a set of indicators for measuring migration considered acceptable and feasible in a wide range of countries and contexts. These recommendations provide guidelines for surveillance and research, and have the capacity, if applied broadly, to improve the comparability of data over time and across countries.
The entire panel considered the core indicator mother's country of birth to be essential or important, and 69% judged it to be
Acknowledgements
This study was funded by the Canadian Institutes of Health Research (CIHR) under their International Opportunities Program (#157033) with start-up support from Immigration et métropoles (Center of Excellence in Immigration Studies - Montreal). Le fonds de la recherche en santé du Québec (FRSQ) provided career support and l’INSERM a visiting scientist scholarship to AJG. EURO-PERISTAT is funded by the Directorate General for Health and Consumers and the Executive Agency for Health and Consumers
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