Maternal and Child Health Journal

, Volume 17, Issue 8, pp 1346–1354 | Cite as

Maternal Healthcare in Migrants: A Systematic Review

  • Lígia Moreira AlmeidaEmail author
  • José Caldas
  • Diogo Ayres-de-Campos
  • Dora Salcedo-Barrientos
  • Sónia Dias
Notes from the Field


Pregnancy is a period of increased vulnerability for migrant women, and access to healthcare, use and quality of care provided during this period are important aspects to characterize the support provided to this population. A systematic review of the scientific literature contained in the MEDLINE and SCOPUS databases was carried out, searching for population based studies published between 1990 and 2012 and reporting on maternal healthcare in immigrant populations. A total of 854 articles were retrieved and 30 publications met the inclusion criteria, being included in the final evaluation. The majority of studies point to a higher health risk profile in immigrants, with an increased incidence of co-morbidity in some populations, reduced access to health facilities particularly in illegal immigrants, poor communication between women and caregivers, a lower rate of obstetrical interventions, a higher incidence of stillbirth and early neonatal death, an increased risk of maternal death, and a higher incidence of postpartum depression. Incidences vary widely among different population groups. Some migrant populations are at a higher risk of serious complications during pregnancy, for reasons that include reduced access and use of healthcare facilities, as well as less optimal care, resulting in a higher incidence of adverse outcomes. Tackling these problems and achieving equality of care for all is a challenging aim for public healthcare services.


Migrants Access, Utilization and quality of care Maternal and child health 



This research was funded by FCT, Fundação para a Ciência e Tecnologia, under the scope of the research project “Health and Citizenship: Gaps and needs in intercultural health care to immigrant mothers”. The authors would like to thank the authors that provided their papers: John Eastwood, Andrea Thurman, Sonja Merten, Anita Gagnon and Lisa Merry, Anita Stewart, Heide Castaneda, Cecilia Ékeus, Elena Fuentes-Afflick, Annunziata Lapolla, Jane Bray, Cheryl Beck, Simone Buechi, Pilar Serrano Gallardo, Ann Treacy, Rebecca Bixby and Phyllis A. Nsiah-Kumi.


  1. 1.
    Fernandes, A., & Miguel, J. (2009). Health and migration in the European Union: Better health for all in an Inclusive Society. Lisboa: Instituto Nacional de Saúde Doutor Ricardo Jorge.Google Scholar
  2. 2.
    Bunevicius, R., Kusminskas, L., Bunevicius, A., Nadisauskiene, R., Jureniene, K., & Pop, V. (2009). Psychosocial risk factors for depression during pregnancy. Acta Obstetricia et Gynecologica, 88, 599–605.CrossRefGoogle Scholar
  3. 3.
    Schetter, C. D. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558.CrossRefGoogle Scholar
  4. 4.
    Rumbold, A., Bailie, R., Si, D., Dowden, M., Kennedy, C., et al. (2011). Delivery of maternal health care in Indigenous primary care services: Baseline data for an ongoing quality improvement initiative. BMC Pregnancy & Childbirth, 11, 16.Google Scholar
  5. 5.
    Eastwood, J. G., Phung, H., & Barnett, B. (2011). Postnatal depression and socio-demographic risk: Factors associated with Edinburgh Depression Scale scores in a metropolitan area of New South Wales, Australia. Australian and New Zealand Journal of Psychiatry, 45, 1040–1046.CrossRefPubMedGoogle Scholar
  6. 6.
    Dias, S., Gama, A., Cortes, M., & de Sousa, B. (2011). Healthcare-seeking patterns among immigrants in Portugal. Health and Social Care in the Community, 19, 514–521.CrossRefPubMedGoogle Scholar
  7. 7.
    Dias, S., Severo, M., & Barros, H. (2008). Determinants of health care utilization by immigrants in Portugal. BMC Health Services Research, 8, 207.Google Scholar
  8. 8.
    Dias, S., Gama, A., & Rocha, C. (2010). Immigrant women’s perceptions and experiences of health care services: Insights from a focus group study. Journal of Public Health, 18, 489–496.CrossRefGoogle Scholar
  9. 9.
    Dias, S., Gama, A., & Rocha, C. (2010). Perspectives of African and Brazilian immigrant women on sexual and reproductive health. The European Journal of Contraception and Reproductive Health Care, 15, 255–263.CrossRefPubMedGoogle Scholar
  10. 10.
    Merry, L., Gagnon, A. J., Hemlin, I., Clarke, H., & Hickey, J. (2011). Cross-border movement and women’s health: How to capture the data. International Journal for Equity in Health, 10, 56.Google Scholar
  11. 11.
    Merry, L. A., Gagnon, A. J., Kalim, N., & Bouris, S. S. (2011). Refugee claimant women and barriers to health and social services post-birth. Canadian Journal of Public Health, 102, 286–290.PubMedGoogle Scholar
  12. 12.
    Ganann, R., Sword, W., Black, M., & Carpio, B. (2011). Influence of maternal birthplace on postpartum health and health services use. Journal of Immigrant and Minority Health, 14(2), 223–229.CrossRefGoogle Scholar
  13. 13.
    Bollini, P., Stotzer, U., & Wanner, P. (2007). Pregnancy outcomes and migration in Switzerland: Results from a focus group study. International Journal of Public Health, 52, 78–86.CrossRefPubMedGoogle Scholar
  14. 14.
    Chote, A. A., Koopmans, G. T., Redekop, W. K., de Groot, C. J., Hoefman, R. J., et al. (2011). Explaining ethnic differences in late antenatal care entry by predisposing, enabling and need factors in The Netherlands. The Generation R Study. Maternal and Child Health Journal, 15, 689–699.CrossRefPubMedGoogle Scholar
  15. 15.
    Sosta, E., Tomasoni, L. R., Frusca, T., Triglia, M., Pirali, F., et al. (2008). Preterm delivery risk in migrants in Italy: An observational prospective study. Journal of Travel Medicine, 15, 243–247.CrossRefPubMedGoogle Scholar
  16. 16.
    Sword, W., Watt, S., & Krueger, P. (2006). Postpartum health, service needs, and access to care experiences of immigrant and Canadian-born women. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35, 717–727.CrossRefPubMedGoogle Scholar
  17. 17.
    Bray, J. K., Gorman, D. R., Dundas, K., & Sim, J. (2010). Obstetric care of new European migrants in Scotland: An audit of antenatal care, obstetric outcomes and communication. Scottish Medical Journal, 55, 26–31.CrossRefPubMedGoogle Scholar
  18. 18.
    David, M., Pachaly, J., & Vetter, K. (2006). Perinatal outcome in Berlin (Germany) among immigrants from Turkey. Archives of Gynecology and Obstetrics, 274, 271–278.CrossRefPubMedGoogle Scholar
  19. 19.
    van Roosmalen, J., Schuitemaker, N. W., Brand, R., van Dongen, P. W., & Bennebroek Gravenhorst, J. (2002). Substandard care in immigrant versus indigenous maternal deaths in The Netherlands. BJOG, 109, 212–213.CrossRefPubMedGoogle Scholar
  20. 20.
    Schutte, J. M., Steegers, E. A., Schuitemaker, N. W., Santema, J. G., de Boer, K., et al. (2010). Rise in maternal mortality in the Netherlands. BJOG, 117, 399–406.CrossRefPubMedGoogle Scholar
  21. 21.
    Reeske, A., Kutschmann, M., Razum, O., & Spallek, J. (2011). Stillbirth differences according to regions of origin: An analysis of the German perinatal database, 2004–2007. BMC Pregnancy Childbirth, 11, 63.CrossRefPubMedGoogle Scholar
  22. 22.
    Fedeli, U., Alba, N., Lisiero, M., Zambon, F., Avossa, F., & Spolaore, P. (2010). Obstetric hospitalizations among Italian women, regular and irregular immigrants in North-Eastern Italy. Acta Obstetricia et Gynecologica Scandinavica, 89, 1432–1437.CrossRefPubMedGoogle Scholar
  23. 23.
    Geltman, P. L., & Meyers, A. F. (1999). Immigration legal status and use of public programs and prenatal care. Journal of Immigrant Health, 1, 91–97.CrossRefPubMedGoogle Scholar
  24. 24.
    Reed, M. M., Westfall, J. M., Bublitz, C., Battaglia, C., & Fickenscher, A. (2005). Birth outcomes in Colorado’s undocumented immigrant population. BMC Public Health, 5, 100.CrossRefPubMedGoogle Scholar
  25. 25.
    Thurman, A. R., Harvey, D., & Shain, R. N. (2009). Unfulfilled postpartum sterilization requests. Journal of Reproductive Medicine, 54, 467–472.PubMedGoogle Scholar
  26. 26.
    Thurman, A. R., & Janecek, T. (2010). One-year follow-up of women with unfulfilled postpartum sterilization requests. Obstetrics and Gynecology, 116, 1071–1077.CrossRefPubMedGoogle Scholar
  27. 27.
    Jonkers, M., Richters, A., Zwart, J., Ory, F., & van Roosmalen, J. (2011). Severe maternal morbidity among immigrant women in the Netherlands: Patients’ perspectives. Reproductive Health Matters, 19, 144–153.CrossRefPubMedGoogle Scholar
  28. 28.
    Janevic, T., Savitz, D. A., & Janevic, M. (2011). Maternal education and adverse birth outcomes among immigrant women to the United States from Eastern Europe: A test of the healthy migrant hypothesis. Social Science & Medicine, 73, 429–435.CrossRefGoogle Scholar
  29. 29.
    Ravelli, A. C. J., Tromp, M., Eskes, M., Droog, J. C., van der Post, J. A. M., et al. (2011). Ethnic differences in stillbirth and early neonatal mortality in The Netherlands. Journal of Epidemiology and Community Health, 65, 696–701.CrossRefPubMedGoogle Scholar
  30. 30.
    Malin, M., & Gissler, M. (2009). Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health, 9, 84.CrossRefPubMedGoogle Scholar
  31. 31.
    Philibert, M., Deneux-Tharaux, C., & Bouvier-Colle, M. H. (2008). Can excess maternal mortality among women of foreign nationality be explained by suboptimal obstetric care? BJOG, 115, 1411–1418.CrossRefPubMedGoogle Scholar
  32. 32.
    Stewart, D. E., Gagnon, A., Saucier, J. F., Wahoush, O., & Dougherty, G. (2008). Postpartum depression symptoms in newcomers. Canadian Journal of Psychiatry, 53, 121–124.Google Scholar
  33. 33.
    Lansakara, N., Brown, S. J., & Gartland, D. (2010). Birth outcomes, postpartum health and primary care contacts of immigrant mothers in an Australian nulliparous pregnancy cohort study. Maternal and Child Health Journal, 14, 807–816.CrossRefPubMedGoogle Scholar
  34. 34.
    Gould, J. B., Madan, A., Qin, C., & Chavez, G. (2003). Perinatal outcomes in two dissimilar immigrant populations in the United States: A dual epidemiologic paradox. Pediatrics, 111, e676–e682.CrossRefPubMedGoogle Scholar
  35. 35.
    El Reda, D. K., Grigorescu, V., Posner, S. F., & Davis-Harrier, A. (2007). Lower rates of preterm birth in women of Arab ancestry: An epidemiologic paradox–Michigan, 1993–2002. Maternal and Child Health Journal, 11, 622–627.CrossRefPubMedGoogle Scholar
  36. 36.
    Reichman, N. E., Hamilton, E. R., Hummer, R. A., & Padilla, Y. C. (2008). Racial and ethnic disparities in low birthweight among urban unmarried mothers. Maternal and Child Health Journal, 12, 204–215.CrossRefPubMedGoogle Scholar
  37. 37.
    Johnelle Sparks, P. (2009). One size does not fit all: An examination of low birthweight disparities among a diverse set of racial/ethnic groups. Maternal and Child Health Journal, 13, 769–779.CrossRefPubMedGoogle Scholar
  38. 38.
    McDonald, J. A., Suellentrop, K., Paulozzi, L. J., & Morrow, B. (2008). Reproductive health of the rapidly growing Hispanic population: Data from the Pregnancy Risk Assessment Monitoring System, 2002. Maternal and Child Health Journal, 12, 342–356.CrossRefPubMedGoogle Scholar
  39. 39.
    Puig Sola, C., Zarzoso Palomero, A., Garcia-Algar, O., Cots Reguant, F., Buron Pust, A., et al. (2008). Hospital admission in newborns according to ethnicity and parents’ country of origin in an urban area of Barcelona [Spain]. Gaceta Sanitaria, 22, 555–564.CrossRefPubMedGoogle Scholar
  40. 40.
    Ekeus, C., Cnattingius, S., & Hjern, A. (2010). Epidural analgesia during labor among immigrant women in Sweden. Acta Obstetricia et Gynecologica Scandinavica, 89, 243–249.CrossRefPubMedGoogle Scholar
  41. 41.
    Essen, B., Bodker, B., Sjoberg, N. O., Langhoff-Roos, J., Greisen, G., et al. (2002). Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? British Journal of Obstetrics and Gynaecology, 109, 677–682.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Lígia Moreira Almeida
    • 1
    • 2
    • 3
    Email author
  • José Caldas
    • 2
    • 3
  • Diogo Ayres-de-Campos
    • 4
  • Dora Salcedo-Barrientos
    • 5
  • Sónia Dias
    • 6
  1. 1.Faculty of Medicine, Institute of Public HealthUniversity of Porto (ISPUP/FMUP)PortoPortugal
  2. 2.Faculty of Psychology and Educational Sciences, Centre for Research and Intervention in EducationUniversity of PortoPortoPortugal
  3. 3.Iberoamerican Observatory of Health and Citizenship (IOHC)PortoPortugal
  4. 4.Department of Obstetrics and GynaecologyMedical School-University of Porto and S. Joao HospitalPortoPortugal
  5. 5.School of Art, Science and HumanitiesUniversity of São Paulo (EACH-USP)São PauloBrazil
  6. 6.CMDT, Instituto de Higiene e Medicina Tropical (IHMT-UNL)LisbonPortugal

Personalised recommendations