Skip to main content
SpringerLink
Log in

Cesarean section rate differences by migration indicators

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators?

Methods

Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed.

Results

Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8–27.3). Cesarean section rates of African women were consistently high (31–33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %).

Conclusion

Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mackenbach JP, Bakker MJ (2003) European network on interventions and policies to reduce inequalities in health tackling socioeconomic inequalities in health: analysis of European experiences. Lancet 362(9393):1409–1414

    Article  PubMed  Google Scholar 

  2. World Health Organization (2010) Health of migrants—the way forward: report of a global consultation, Madrid, Spain, 3–5 March 2010. World Health Organization Press, Geneva

    Google Scholar 

  3. Beiser M, Stewart M (2005) Reducing health disparities: a priority for Canada. Can J Public Health 96(Suppl 2):S4–S5

    Google Scholar 

  4. Zelkowitz P, Schinazi J, Katofsky L, Saucier JF, Valenzuela M, Westreich R, Dayan J (2004) Factors associated with depression in pregnant immigrant women. Transcult Psychiatry 41(4):445–464

    Article  PubMed  Google Scholar 

  5. Diani F, Zanconato G, Foschi F, Turinetto A, Franchi M (2003) Management of the pregnant immigrant woman in the decade 1992–2001. J Obstet Gynaecol 23(6):615–617

    Article  PubMed  CAS  Google Scholar 

  6. Rizzo N, Ciardelli V, Gandolfi-Colleoni G, Bonavita B, Parisio C, Farina A, Bovicelli L (2004) Delivery and immigration: the experience of an Italian hospital. Eur J Obstet Gynecol Reprod Biol 116(2):170–172

    Article  PubMed  Google Scholar 

  7. Vangen S, Stoltenberg C, Holan S, Moe N, Magnus P, Harris JR, Stray-Pedersen B (2003) Outcome of pregnancy among immigrant women with diabetes. Diabetes Care 26(2):327–332

    Article  PubMed  Google Scholar 

  8. Dejin-Karlsson E, Ostergren PO (2004) Country of origin, social support and the risk of small for gestational age birth. Scand J Public Health 32:442–449

    Article  PubMed  Google Scholar 

  9. Essen B, Bodker B, Sjoberg NO, Langhoff-Roos J, Greisen G, Gudmundsson S, Ostergren PO (2002) Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG Int J Obstet Gynaecol 109(6):677–682

    Google Scholar 

  10. Ibison JM (2005) Ethnicity and mode of delivery in ‘low risk’ first-time mothers, East London, 1988–1997. Eur J Obstet Gynecol Reprod Biol 118(2):199–205

    Article  PubMed  Google Scholar 

  11. Paranjothy S, Frost C, Thomas J (2005) How much variation in CS rates can be explained by case mix differences? BJOG Int J Obstet Gynaecol 112(5):658–666

    Article  CAS  Google Scholar 

  12. Yoong W, Wagley A, Fong C, Chukwuma C, Nauta M (2004) Obstetric performance of ethnic Kosovo Albanian asylum seekers in London: a case-control study. J Obstet Gynaecol 24(5):510–512

    Article  PubMed  CAS  Google Scholar 

  13. Johnson EB, Reed SD, Hitti J, Batra M (2005) Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state. Am J Obstet Gynecol 193(2):475–482

    Article  PubMed  Google Scholar 

  14. Merten S, Wyss C, Ackermann-Liebrich U (2007) Caesarean sections and breastfeeding initiation among migrants in Switzerland. Int J Public Health 52(4):210–222

    Article  PubMed  Google Scholar 

  15. Rio I, Castelló A, Barona C, Jané M, Más R, Rebagliato M, Bosch S, Martínez E, Bolúmar F (2010) Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery. Eur J Public Health 20(5):524–529

    Article  PubMed  Google Scholar 

  16. Shah RR, Ray JG, Taback N (2011) Adverse pregnancy outcomes among foreign-born Canadians. J Obstet Gynaecol Can 33(3):207–215

    PubMed  Google Scholar 

  17. David M, Pachaly J, Vetter K (2006) Perinatal outcome in Berlin (Germany) among immigrants from Turkey. Arch Gynecol Obstet 274(5):271–278

    Article  PubMed  Google Scholar 

  18. Ismail KI, Marchocki Z, Brennan DJ, O’Donoghue K (2011) Intrapartum caesarean rates differ significantly between ethnic groups–relationship to induction. European J Obstet Gynecol Reprod Biol 158(2):214–219

    Google Scholar 

  19. St-Cyr I, Gagnon AJ, Blondel B, Glazier R, Ng E, Small R, Stewart D, Stray-Pedersen B, Zimbeck M (2008) Migration and cesarean birth [poster] CPHA 2008 annual conference, Halifax, NS. http://resources.cpha.ca/CPHA/Conf/Code/PresentationsAbstract.php?r=0&Year=2008&ID=A08-278&l=E. Accessed 1 Nov 2012

  20. Small R, Gagnon AJ, Gissler M, Zeitlin J, Bennis M, Glazier R, Haelterman E, Martens G, McDermott S, Urquia M, Vangen S (2008) Somali women and their pregnancy outcomes postmigration: data from six receiving countries. BJOG 115:1630–1640

    Article  PubMed  CAS  Google Scholar 

  21. Gagnon AJ, Zimbeck M, Zeitlin J (2009) Migration to western industrialized countries and perinatal Health: a systematic review. Soc Sci Med 69(6):934–946

    Article  PubMed  CAS  Google Scholar 

  22. Gagnon AJ, Zimbeck M, Zeitlin J (2010) Migration and perinatal health surveillance: an international Delphi survey. Eur J Obstet Gynecol Reprod Biol 149(1):37–43

    Article  PubMed  Google Scholar 

  23. Gagnon AJ, Dougherty G, Platt RW, Wahoush O, George A, Stanger E, Oxman-Martinez J, Saucier JF, Merry L, Stewart DE (2007) Refugee and refugee-claimant women and infants post-birth: migration histories as a predictor of Canadian health system response to needs. Can J Public Health 98(4):287–291

    PubMed  Google Scholar 

  24. United Nations High Commissioner for Refugees (UNHCR) (2007) Convention and protocol relating to the status of refugees. UNHCR, Geneva

    Google Scholar 

  25. United Nations Statistics Division (2010) Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. http://unstats.un.org/unsd/methods/m49/m49regin.htm. Accessed September 2012

  26. Malin M, Gissler M (2009) Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health 9(1):84

    Article  PubMed  Google Scholar 

  27. Von Katterfeld B, Li J, McNamara B, Langridge AT (2011) Obstetric profiles of foreign-born women in Western Australia using data linkage, 1998–2006. Aust N Z J Obstet Gynaecol 51(3):225–232

    Article  Google Scholar 

  28. LeRay C, Carayol M, Zeitlin J, Breart G, Goffinet F, Group PS (2006) Level of perinatal care of the maternity unit and rate of cesarean in low-risk nulliparas. Obstet Gynecol 107(6):1269–1277

    Article  CAS  Google Scholar 

  29. Panagopoulos P, Tsoukalos G, Economou A, Zikopoulos M, Koutras I, Petrakos G, Pachakis M (2005) Delivery and immigration: the experience of a Greek Hospital. Clin Exp Obstet Gynecol 32(1):55–57

    Article  PubMed  CAS  Google Scholar 

  30. Vangen S, Stoltenberg C, Skrondal A, Magnus P, Stray-Pedersen B (2000) Cesarean section among immigrants in Norway. Acta Obstet Gynecol Scand 79(7):553–558

    Article  PubMed  CAS  Google Scholar 

  31. Braveman P, Egerter S, Edmonston F, Verdon M (1995) Racial/ethnic differences in the likelihood of cesarean delivery, California. Am J Public Health 85(5):625–630

    Article  PubMed  CAS  Google Scholar 

  32. Gayral-Taminh M, Arnaud C, Parant O, Fournie A, Reme JM, Grandjean H (1999) Pregnancy and labor of women born in Maghreb and Black Africa followed to delivery at the maternity hospital of Toulouse. (French). J Gynecol Obstet Biol Reprod 28(5):462–471

    CAS  Google Scholar 

  33. Vangen S, Stoltenberg C, Johansen RE, Sundby J, Stray-Pedersen B (2002) Perinatal complications among ethnic Somalis in Norway. Acta Obstet Gynecol Scand 81(4):317–322

    Article  PubMed  Google Scholar 

  34. Newbold KB, Danforth J (2003) Health status and Canada’s immigrant population. Soc Sci Med 57(10):1981–1995

    Article  PubMed  Google Scholar 

  35. Citizenship and Immigration Canada (2008) Application for permanent residence: Federal skilled worker class (IMM 7000). http://www.cic.gc.ca/english/information/applications/guides/EG7TOC.asp. Accessed September 2012

  36. Canadian Institute for Health Information (2006) Health indicators 2006. Canadian Institute for Health Information, Statistics Canada

    Google Scholar 

  37. Migrant Friendly Hospitals (2004) The Amsterdam declaration: towards migrant friendly hospitals in an ethno-culturally diverse Europe. Ludwig Boltzmann Institute for the Sociology of Health and Medicine, WHO Collaborating Centre for Health Promotion in Hospitals and Health Care, Vienna

  38. US Department of Health and Human Services- Office of Minority Health (2001) National standards for culturally and linguistically appropriate services (CLAS) in health care. IQ Solutions, Inc., Washington DC

Download references

Acknowledgments

The NORMAPERS study was funded by the Canadian Institutes of Health Services and Policy Research and of Gender and Health Research (CIHR # 95355), le Réseau de recherche en santé des populations, and Immigration et métropoles. We would also like to acknowledge Drs. Geoffrey Dougherty, Robert W. Platt, and Jacqueline Oxman-Martinez with their assistance in the conception, design, and implementation of the NORMAPERS study.

Conflict of interest

We declare that we have no conflict of interest. We do not have a financial relationship with the organization that sponsored the research and we have had full control of all primary data and agree to allow the Journal to review this data if requested.

Author information

Authors and Affiliations

  1. Ingram School of Nursing and Department of Obstetrics and Gynecology, McGill University, Montreal, Canada

    Anita J. Gagnon

  2. Women’s Health Mission, McGill University Health Center, 2155 Guy St, Suite 400-7, Montreal, QC, H3H 2R9, Canada

    Anita J. Gagnon

  3. Ingram School of Nursing, McGill University, Montreal, Canada

    Lisa Merry

  4. Université de Montréal, Montreal, Canada

    Andrea Van Hulst

  5. University of British Columbia, Prince George, Canada

    Anne George

  6. Centre Hospitalier universitaire de mère enfant, L’Hôpital Sainte-Justine, Montreal, Canada

    Jean-François Saucier

  7. Vancouver Coastal Health, Vancouver, Canada

    Elizabeth Stanger

  8. McMaster University, Hamilton, Canada

    Olive Wahoush

  9. University Health Network, Toronto, Canada

    Donna E. Stewart

  10. University of Toronto, Toronto, Canada

    Donna E. Stewart

Authors
  1. Anita J. Gagnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Van Hulst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Merry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne George
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-François Saucier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elizabeth Stanger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olive Wahoush
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Donna E. Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anita J. Gagnon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gagnon, A.J., Van Hulst, A., Merry, L. et al. Cesarean section rate differences by migration indicators. Arch Gynecol Obstet 287, 633–639 (2013). https://doi.org/10.1007/s00404-012-2609-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-012-2609-7

Keywords

Search

Navigation