Elsevier

Social Science & Medicine

Volume 69, Issue 6, September 2009, Pages 934-946
Social Science & Medicine

Migration to western industrialised countries and perinatal health: A systematic review

https://doi.org/10.1016/j.socscimed.2009.06.027Get rights and content

Abstract

Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in western industrialised countries have consistently poorer perinatal health than receiving-country women. A systematic review of literature from Medline, Health Star, Embase and PsychInfo from 1995 to 2008 included studies of migrant women/infants related to pregnancy or birth. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not western and industrialised. Studies were assessed for quality, analysed descriptively and meta-analysed when possible. We identified 133 reports (>20,000,000 migrants), only 23 of which could be meta-analysed. Migrants were described primarily by geographic origin; other relevant aspects (e.g., time in country, language fluency) were rarely studied. Migrants' results for preterm birth, low birthweight and health-promoting behaviour were as good or better as those for receiving-country women in ≥50% of all studies. Meta-analyses found that Asian, North African and sub-Saharan African migrants were at greater risk of feto-infant mortality than ‘majority’ receiving populations, and Asian and sub-Saharan African migrants at greater risk of preterm birth. The migration literature is extensive, but the heterogeneity of the study designs and definitions of migrants limits the conclusions that can be drawn. Research that uses clear, specific migrant definitions, adjusts for relevant risk factors and includes other aspects of migrant experience is needed to confirm and understand these associations.

Section snippets

Research question

Do migrant women in western industrialised countries have consistently poorer perinatal health outcomes than receiving-country women?

A secondary objective was to describe which migration and perinatal outcome indicators and related factors have been studied and how these studies were conducted.

Results

Table 1 describes the characteristics of the studies reviewed as well as the subset identified for meta-analyses. Nearly all the reports meeting our inclusion criteria were published in English. Eighteen receiving countries were represented in the review, and just over one-third of the studies concerned migrants in the United States. The review incorporated data about 20,152,134 women, with over one-third of the studies including <1000 migrants and just over one-twentieth between 1 and 2

Discussion

Our review identified numerous studies of migration and perinatal health, but heterogeneity in study design and the definitions used to define migrant groups limited the conclusions that could be drawn from them. Being a migrant was not a consistent marker of risk of poorer perinatal health outcomes; migrants did as well as or better than host-county women for all perinatal health outcomes in a large proportion of studies – indeed, for preterm birth, low birthweight and health-promoting

Conclusions

Our systematic review of published studies shows that being a migrant is not a consistent marker for risk of poor perinatal health outcomes. This review also showed, however, that some migrant women fare less well than receiving-country women; Asian, North- and other-African migrants were at greater perinatal health risk than their receiving-country counterparts in the small number of studies that could be included in meta-analyses for each subgroup. Despite the large number of studies of

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    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'Institut national de la santé et de la recherche médicale (INSERM; France), a visiting scientist scholarship to AJG. Thanks to Hilary Elkins and Diane Habbouche for administrative support and to Francoise Maillard for database troubleshooting.

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