Skip to main content
SpringerLink
Log in

Obstetric care quality indicators and outcomes based on the degree of acculturation of immigrants—results from a cross-sectional study in Berlin

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

Abstract

Hypothesis

Acculturation is a complex, multidimensional process involving the integration of the traditional norms, values, and lifestyles of a new cultural environment. It is, however, unclear what impact the degree of acculturation has on obstetric outcomes.

Methods

Data collection was performed in 2011 and 2012 at three obstetric tertiary centers in Berlin, Germany. Standardized interviews (20–30 min.) were performed with support of evaluated questionnaires. The primary collected data were then linked to the perinatal data recorded at the individual clinics provided from the obstetric centers which correspond with the routinely centralized data collected for quality assurance throughout Germany. The questionnaire included questions on sociodemographic, health care, and migrant-related aspects. Migrant women and women with a migration background were assessed using the Frankfurt Acculturation Scale, a one-dimensional measurement tool to assess the degree of acculturation (15 items on language and media usage as well as integration into social networks).

Results

In summary, 7100 women were available for the survey (response rate of 89.6%) of which 3765 (53%) had a migration background. The probability of low acculturation is significantly (p < 0.001) associated with a lower level of German knowledge, a shorter period of residence, and lower education. Pregnant women with a low acculturation also had a significantly greater chance of having the first booking visit after 9 weeks of pregnancy and fewer ultrasound examinations during pregnancy. There is no significant difference depending on the degree of acculturation for the frequency of elective and emergency cesarean sections. The results of the logistic regression analyses for the examination of possible relationships between the degree of acculturation and obstetric parameters show no significant differences for prematurity, 5 min.-Apgar values > 7, arterial umbilical cord pH values > 7.00 and admissions to the neonatal unit.

Conclusions

In Berlin, among migrant women a low degree of acculturation may have an unfavorable effect on the utilization of pregnancy care provision. However, there were no relevant differences in obstetric outcome parameters in relation to the degree of acculturation within the migrant population of Berlin.

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

Similar content being viewed by others

References

  1. Statistisches Bundesamt/Destatis. Bevölkerung mit Migrationshintergrund auf Rekordniveau. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Bevoelkerung/MigrationIntegration/MigrationIntegration.html. Accessed 5 Oct 2016

  2. Berry JW (1990) Psychology of acculturation: understanding individuals moving between cultures. In: Brislin RW (ed) Applied cross-cultural psychology, vol 14. Sage, Newbury Park, pp 232–253

  3. Bourghis RY, Moise LC, Perreault S, Senécal S (1997) Towards an interactive acculturation model: a social psychological approach. Int J Psychol 32:369–386

    Article  Google Scholar 

  4. Ikram UZ, Malmusi D, Juel K, Rey G, Kunst AE (2015) Association between integration policies and immigrants’ mortality: an explorative study across three european countries. PLoS ONE 10(6):e0129916. doi:10.1371/journal.pone.0129916

    Article  PubMed  PubMed Central  Google Scholar 

  5. Malmusi D (2015) Immigrants’ health and health inequality by type of integration policies in European countries. Eur J Pub Health 25:293–299

    Article  Google Scholar 

  6. Gissler M, Alexander S, MacFarlane A, Small R, Stray-Pedersen B, Zeitlin J, Zimbeck M, Gagnon A (2009) Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand 88:134–148

    Article  PubMed  Google Scholar 

  7. Bollini P, Pampallona S, Wanner P, Kupelnick B (2009) Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature. Soc Sci Med 68:452–461

    Article  PubMed  Google Scholar 

  8. Urquia ML, Frank JW, Moineddin R, Glazier RH (2010) Immigrants’ duration of residence and adverse birth outcomes: a population-based study. BJOG 117:591–601

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Villalonga-Olives E, Kawachi I, von Steinbüchel N (2016) Pregnancy and birth outcomes among immigrant women in the US and Europe: a systematic review. J Immigrant Minority Health 1–19. doi:10.1007/s10903-016-0483-2

  10. Zlot AI, Jackson DJ, Korenbrot C (2005) Association of acculturation with cesarean section among Latinas. Matern Child Health J 9:11–20

    Article  PubMed  Google Scholar 

  11. Ruiz RJ, Saade GR, Brown CEL, Nelson-Becker C, Tan AL, Bishop S, Bukowki R (2008) The effect of acculturation on progesterone/estriol ratios and preterm birth in Hispanics. Obstet Gynecol 111:309–316

    Article  PubMed  Google Scholar 

  12. Rosenberg TJ, Pagan T, Chiasson MA (2005) A further examination of the “Epidemiologic Paradox”: birth outcomes among Latinas. J Nat Med Assoc 97:550–556

    Google Scholar 

  13. Kang SM (2006) Measurement of acculturation, scale formats, and language competence. Their implications for adjustment. J Cross-Cultural Psychol 37:669–693

  14. van Dick R, Wagner U, Adams C, Petzel T (2014) Einstellungen zur Akkulturation. Zusammenstellung sozialwissenschaftlicher Items und Skalen. doi:10.6102/zis155

    Google Scholar 

  15. Bongard S, Pogge SF, Arslaner H, Rohrmann S, Hodapp V (2002) Acculturation and cardiovascular reactivity of second-generation—Turkish migrants in Germany. J Psychosom Res 53:795–803

    Article  PubMed  Google Scholar 

  16. Bongard S, Arslaner H, Pogge SF (2000) FRAKK-Fragebogeninstrument, o. O

  17. Schenk L, Bau AM, Borde T, Butler J, Lampert T, Neuhauser H, Razum O, Weilandt C (2006) Mindestindikatorensatz zur Erfassung des Migrationsstatus. Empfehlungen für die epidemiologische Praxis. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 49:853–860

    Article  CAS  PubMed  Google Scholar 

  18. Statistics Netherlands. Den Haag/Heerlen. Population; sex, age, origin and generation. http://statline.cbs.nl/statweb/publication/?vw=t&dm=slen&pa=37325eng&d1=a&d2=0&d3=0&d4=0&d5=0-4,139,145,216,231&d6=0,4,9,14,(l-1),l&hd=160114-1625&hdr=g2,g1,g3,t&stb=g4,g5. Accessed 13 Jun 2017

  19. Essén B, Bödker B, Sjöberg NO, Langhoff-Roos J, Greisen G, Gudmundsson S, Östergren PO (2002) Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG 109:677–682

    Article  PubMed  Google Scholar 

  20. Alderliesten ME, Vrijkotte TGM, Van der Wal MF, Bonsel GJ (2007) Late start of antenatal care among ethnic minorities in a large cohort of pregnant women. BJOG 114:1232–1239

    Article  CAS  PubMed  Google Scholar 

  21. Ny P, Dykes AK, Molin J, Dejin-Karlsson E (2007) Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden. Acta Obstet Gynecol Scand 86:805–813

    Article  PubMed  Google Scholar 

  22. Oberaigner W, Leitner H, Oberaigner K, Marth C, Pinzger G, Concin H, Steiner H, Hofmann H, Wagner T, Mörtl M, Ramoni A (2013) Migrants and obstetrics in Austria—applying a new questionnaire shows differences in obstetric care and outcome. Wien Klin Wochenschr 125:34–40

    Article  PubMed  Google Scholar 

  23. Flynn PM, Foster EM, Brost BC (2011) Indicators of acculturation related to Somali refugee women’s birth outcomes in Minnesota. J Immigrant Minority Health 13:224–231

    Article  Google Scholar 

  24. Merry L, Small R, Blondel B, Gagnon AJ (2013) International migration and caesarean birth: a systematic review and meta-analysis. BMC Pregnancy Childbirth 13:27. doi:10.1186/1471-2393-13-27

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sørbye IK, Daltveit AK, Sundby J, Stoltenberg C, Vangen S (2015) Caesarean section by immigrants’ length of residence in Norway: a population-based study. Eur J Public Health 25:78–84

    Article  PubMed  Google Scholar 

  26. Perez MJ, Chung JH, Campos B, Sorkin D (2016) Effects of US acculturation and obesity on birth outcomes in Latina women [291]. Obstet Gynecol. doi:10.1097/01.AOG.0000483733.27092.4c

    Google Scholar 

  27. Miller LS, Robinson JA, Cibula DA (2016) Healthy immigrant effect: preterm births among immigrants and refugees in Syracuse, NY. Matern Child Health J 20:484–493

    Article  PubMed  Google Scholar 

  28. Bakken K, Skjeldalet OA, Stray Pedersen B (2017) Obstetric outcomes of first- and second-generation Pakistani immigrants: a comparison study at a low-risk maternity ward in Norway. J Immigrant Minority Health. doi:10.1007/s10903-015-0329-3

    Google Scholar 

Download references

Funding

This study was funded by German Research Foundation (Deutsche Forschungsgemeinschaft DFG: DA 1199/2-1).

Author information

Authors and Affiliations

  1. Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Gynäkologie, Augustenburger Platz 1, 13353, Berlin, Germany

    Matthias David

  2. Alice Salomon Hochschule, Berlin, Germany

    Theda Borde & Silke Brenne

  3. Vivantes Klinikum Neukölln, Klinik für Geburtsmedizin, Berlin, Germany

    Babett Ramsauer

  4. Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Charité Mitte, Kliniken für Geburtsmedizin, Berlin, Germany

    Larry Hinkson & Wolfgang Henrich

  5. Fakultät für Gesundheitswissenschaften, AG Epidemiologie und International, Universität Bielefeld, Bielefeld, Germany

    Oliver Razum & Jürgen Breckenkamp

Authors
  1. Matthias David
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theda Borde
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silke Brenne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Babett Ramsauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Larry Hinkson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolfgang Henrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oliver Razum
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jürgen Breckenkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M David: Protocol/project development; data management; Manuscript writing/editing. T Borde: Protocol/project development; manuscript writing/editing. S Brenne: Data collection and management; editing. B Ramsauer: Data collection; editing. L Hinkson: Manuscript writing; translation. W Henrich: Data collection; editing. O Razum: Project development, data management and analysis; manuscript writing/editing. J Breckenkamp: Data management and analysis; manuscript writing/editing.

Corresponding author

Correspondence to Matthias David.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

David, M., Borde, T., Brenne, S. et al. Obstetric care quality indicators and outcomes based on the degree of acculturation of immigrants—results from a cross-sectional study in Berlin. Arch Gynecol Obstet 297, 313–322 (2018). https://doi.org/10.1007/s00404-017-4574-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4574-7

Keywords

Search

Navigation