‘Goodbye and good luck’ Midwifery care to pregnant undocumented migrants in Norway: A qualitative study

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Objective: To explore community midwives’ experiences caring for pregnant undocumented migrants seeking prenatal care in Norway. Method: Due to the relatively limited previous research and number of pregnant undocumented migrants we used an explorative approach through qualitative method. Ten community midwives were interviewed after snowball sampling in Oslo, the capital of Norway. The main themes emerged through a qualitative analysis of the transcripts, and meaning units were extracted. Results: Midwives with no prior experience with pregnant undocumented migrants expressed uncertainty regarding the women’s rights. In contrast, those midwives who had had prior experience with this group, developed their own solutions and enacted certain strategies to help them without any guidelines from their employer. All the midwives found it challenging to provide follow-up care to the undocumented migrants during pregnancy and postpartum. They also expressed concerns regarding increasing challenges creating clinical trusting relationships and restrictions and practices at public hospitals. Conclusions: To ensure adequate perinatal care, it is needed to reassure pregnant undocumented migrants free and safe care at all stages in the birth giving process. Community midwives need professional support in establishing trusting clinical relationships with pregnant undocumented migrants to reduce maternal stress and facilitate continuity in perinatal care.publishedVersio

Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this afects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. Methods: In this historic cohort study we included pregnant women aged 18–49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. Results: We identifed 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1–3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion: Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.publishedVersio

Food Intake of Selenium and Sulphur AminoAcids in Tuberculosis Patients and Healthy Adults in Malawi

Background Tuberculosis is a world wide pandemic and a major problem for people in low income countries. The intracellular infection has a bidirectional link with under nutrition, and wasting is a common symptom of the disease. Wasting in tuberculosis patients is associated with the severity of lung disease, low serum level of selenium and higher mortality. Low serum levels may be due to low intake or high body consumption of the components. No assessment of intake of selenium and sulphur amino acids has been done in tuberculosis patients. Objective The main objective is to calculate and compare the intake of selenium and sulphur amino acids in tuberculosis patients and appropriately matched healthy adults. Methodology Participants did a one day interactive 24 hour recall at their home together with a structured questionnaire about socio economic status. Results were compared on group level. Local food was collected and analysed with an inductively coupled plasma mass spectroscopy for selenium content. 7 local samples were collected and analysed for sulphur amino acids and compared to Kenyan and South African food composition tables. The intake was calculated on this basis. Result There was no significant difference in intake of selenium and sulphur amino acids by the two groups. Both TB patients and healthy controls had a low intake of selenium and an adequate intake of sulphur amino acids. Controls ate more staple food but had a lower diversity in the diet than the cases. TB patients had a significant lower body mass index than the healthy controls. Conclusion This study indicates that the deficiencies of selenium and thiols in serum found in earlier studies may not entirely be due to a low intake of selenium and sulphur amino acids

Documenting the undocumented - The use of maternal health care and pregnancy outcomes in undocumented migrant women in Norway.

Research on undocumented (including pregnant) migrants in Norway have mostly been ethnographic (qualitative) studies, or small cross-sectional studies from the voluntary clinics. The situation in other Scandinavian countries is similar, and undocumented migrants’ use of health care services has until recently been a neglected area of research. The aim of the proposed study is to explore longitudinally the utilization of primary health care services at voluntary clinics and emergency clinics by undocumented pregnant women in Oslo and Bergen. In addition, we would like to compare pregnancy outcomes and perinatal health outcomes in undocumented migrants and their children to foreign and Norwegian born residents registered in the Medical Birth Registry

Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway

AbstractObjective To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway.Design A cross-sectional study of consultations at several time points.Setting The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway.Subjects Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions.Main outcome measures Manchester Triage System urgency level at presentation, and hospitalization.Results Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents.Conclusion Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.Key pointsRestricted access to primary care may increase the use of primary care facilities intended for emergency care.A considerable proportion of the consultations with undocumented migrant women at the emergency primary care services are related to pregnancy.Consultations with pregnant undocumented migrants more often contained severe pregnancy-related conditions compared to consultations with pregnant residents of Norway.Interventions to increase access to primary care for pregnant undocumented migrants are urgently needed

Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

Background In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. Methods In this historic cohort study we included pregnant women aged 18–49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. Results We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1–3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them

Decoloniality in global health research:ten tasks for early career researchers

Few articles advocating decolonisation offer actionable strategies within most early career researchers’ (ECRs) sphere of influence. ECRs are uniquely positioned to drive change. Educating ourselves and others, advocacy, critical allyship, advancing beneficiaries’ agendas, strengthening capacity, equitable partnership, diversifying paradigms, upholding ethics, ensuring recognition and pursuing epistemic justice are ten tasks within our reach