A Systematic Review of Refugee Women’s Reproductive Health

Resettling refugee women may be at greater risk than other women for several harmful reproductive health outcomes as a result of their migration experience. The objective of this study was to determine differences in reproductive health status between refugee women in countries of resettlement and non-refugee counterparts. A systematic review of the literature culled from five electronic databases and web searching of international agencies and academic centres focusing on refugees was conducted. Of the forty-one high quality studies identified, fourteen looked at refugees exclusively; only nine of the fourteen focused on the reproductive health of refugees; six of the nine directly compared refugee to non-refugee women’s health. There is a paucity of populationbased data to support or refute claims of greater reproductive health risks for resettling refugee women.Les femmes réfugiées en situation de réétablissement pourraient bien être plus susceptibles que d’autres femmes de souffrir d’un certain nombre de conséquences néfastes en matière de santé génésique suite à l’expérience de lamigration. Le but de cette étude était de cerner les différences entre le niveau de santé génésique des femmes réfugiées dans les pays de réétablissement et leurs congénères non-réfugiées. Pour ce faire, un examen systématique de la littérature provenant de cinq bases de données électroniques a été entrepris, ainsi que des recherches sur le Web d’agences et de centres académiques internationaux. Des 41 études de haut niveau identifiées, seules 9 de ces études se concentraient sur la santé génésique des réfugiées ; 6 de ces 9 études effectuaient une comparaison directe entre la santé des réfugiées et celle des non-réfugiées. Il existe en fait un manque de données démographiques qui permettraient de soutenir ou de rejeter l’affirmation selon laquelle les risques sont accrus en matière de santé génésique chez les femmes réfugiées en cours de réétablissement

Developing population interventions with migrant women for maternal-child health: a focused ethnography

BACKGROUND: Literature describing effective population interventions related to the pregnancy, birth, and post-birth care of international migrants, as defined by them, is scant. Hence, we sought to determine: 1) what processes are used by migrant women to respond to maternal-child health and psychosocial concerns during the early months and years after birth; 2) which of these enhance or impede their resiliency; and 3) which population interventions they suggest best respond to these concerns. METHODS: Sixteen international migrant women living in Montreal or Toronto who had been identified in a previous study as having a high psychosocial-risk profile and subsequently classified as vulnerable or resilient based on indicators of mental health were recruited. Focused ethnography including in-depth interviews and participant observations were conducted. Data were analyzed thematically and as an integrated whole. RESULTS: Migrant women drew on a wide range of coping strategies and resources to respond to maternal-child health and psychosocial concerns. Resilient and vulnerable mothers differed in their use of certain coping strategies. Social inclusion was identified as an overarching factor for enhancing resiliency by all study participants. Social processes and corresponding facilitators relating to social inclusion were identified by participants, with more social processes identified by the vulnerable group. Several interventions related to services were described which varied in type and quality; these were generally found to be effective. Participants identified several categories of interventions which they had used or would have liked to use and recommended improvements for and creation of some programs. The social determinants of health categories within which their suggestions fell included: income and social status, social support network, education, personal health practices and coping skills, healthy child development, and health services. Within each of these, the most common suggestions were related to creating supportive environments and building healthy public policy. CONCLUSIONS: A wealth of data was provided by participants on factors and processes related to the maternal-child health care of international migrants and associated population interventions. Our results offer a challenge to key stakeholders to improve existing interventions and create new ones based on the experiences and views of international migrant women themselves

Problems with Sleep Do Not Predict Self-Reported Driving Factors and Perception in Older Drivers: Evidences from the Candrive II Prospective Cohort

Given that sleep problems and serious motor vehicle collisions are increasingly prevalent in older adults, even minor drowsiness could potentially contribute to driving patterns in older drivers. To date, it is unknown whether less serious problems with sleep influence driving frequency and ability in older adults. We investigated the influence of everyday sleep disturbances on driving practices and driver perceptions in a large cohort of healthy older drivers. Selfreported measures of sleep problems were used to investigate the influence of sleep disturbance on self-reported driving practices and perceived driving abilities. On two measures of self-reported driving outcomes, participants with problems with rated themselves more poorly. However, this relationship disappeared when health and demographic variables were entered prior in hierarchical regression analyses. Our results show that the relationship between sleep problems, driving frequency and perceived abilities is better explained by mediating demographic, health, and cognitive factors

Mothering Here and Mothering There: International Migration and Postbirth Mental Health

Over 125,000 women immigrate to Canada yearly—most in their childbearing years and many having given birth before immigrating. We sought to (1) examine the background characteristics and mental health profile of women separated from their children due to migration and subsequently giving birth in Canada (“dual-country (DC) mothers”) and (2) contrast these with those of “non-dual-country” migrant mothers. Of 514 multiparous migrant women giving birth, one-fifth (18%) reported being separated from their children due to migration. Over one-third of DC mothers were living in poverty (36.0% versus 18.6%, P=0.001), and one in seven was experiencing household food insecurity (16.3% versus 7.6%, P=0.01). Over one-third had no partner (40.2% versus 11.4%, P=0.00), and nearly one-quarter reported no available support (23.1% versus 12.2%, P=0.007). Over three-quarters were asylum seekers or refugees (83.7% versus 51%, P=0.00). More DC than non-DC mothers had symptoms of postpartum depression (28.3% versus 18.6%, P=0.04), symptoms of clinical depression (23.1% versus 13.5%, P=0.02), and anxiety related to trauma (16.5% versus 9.4%, P=0.04). Results suggest that identifying DC mothers is a rapid approach to enable clinicians to target a subgroup of women needing special attention

T cell receptor Vbeta gene usage in Thai children with dengue virus infection

T lymphocyte activation during dengue is thought to contribute to the pathogenesis of dengue hemorrhagic fever (DHF). We examined the T cell receptor Vbeta gene usage by a reverse transcriptase-polymerase chain reaction assay during infection and after recovery in 13 children with DHF and 13 children with dengue fever (DF). There was no deletion of specific Vbeta gene families. We detected significant expansions in usage of single Vbeta families in six subjects with DHF and three subjects with DF over the course of infection, but these did not show an association with clinical diagnosis, viral serotype, or HLA alleles. Differences in Vbeta gene usage between subjects with DHF and subjects with DF were of borderline significance. These data suggest that the differences in T cell activation in DHF and DF are quantitative rather than qualitative and that T cells are activated by conventional antigen(s) and not a viral superantigen

Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process

Background Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. Methods This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. Results A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) – in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth. Conclusions A 4-stage process of questionnaire development with international experts in migrant reproductive health and research resulted in the MFMCQ, a questionnaire measuring key aspects of migrant-sensitive maternity care. The MFMCQ is available for further translation and use to examine and compare care and perceptions of care within and across countries, and by key socio-demographic, migration, and obstetrical characteristics of migrant women

F.A.R.O.G. FORUM, Vol. 6 No. 4

https://digitalcommons.library.umaine.edu/francoamericain_forum/1065/thumbnail.jp

Immigrant and non-immigrant women's experiences of maternity care: A systematic and comparative review of studies in five countries

Background: Understanding immigrant women’s experiences of maternity care is critical if receiving country care systems are to respond appropriately to increasing global migration. This systematic review aimed to compare what we know about immigrant and non-immigrant women’s experiences of maternity care. Methods: Medline, CINAHL, Health Star, Embase and PsychInfo were searched for the period 1989–2012. First, we retrieved population-based studies of women’s experiences of maternity care (n = 12). For countries with identified population studies, studies focused specifically on immigrant women’s experiences of care were also retrieved (n = 22). For all included studies, we extracted available data on experiences of care and undertook a descriptive comparison. Results: What immigrant and non-immigrant women want from maternity care proved similar: safe, high quality, attentive and individualised care, with adequate information and support. Immigrant women were less positive about their care than non-immigrant women. Communication problems and lack of familiarity with care systems impacted negatively on immigrant women’s experiences, as did perceptions of discrimination and care which was not kind or respectful. Conclusion: Few differences were found in what immigrant and non-immigrant women want from maternity care. The challenge for health systems is to address the barriers immigrant women face by improving communication,increasing women’s understanding of care provision and reducing discrimination