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Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews

Lookup NU author(s): Dr Nicola Heslehurst, Dr Heather Brown, Augustina Pemu, Dr Hayley Coleman, Professor Judith Rankin

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Background: Global migration is at an all-time high with implications for perinatal health. Migrantwomen, especially asylum seekers and refugees, represent a particularly vulnerablegroup. Understanding the impact on the perinatal health of women and offspring is animportant prerequisite to improving care and outcomes. The aim of this systematicreview was to summarise the current evidence-base on perinatal health outcomes andcare among women with asylum seeker or refugee status.Methods:Twelve electronic databases, reference list and citation searches (1 Jan 2007 - July2017) were carried out between June and July 2017. Quantitative and qualitativesystematic reviews, published in the English language were included if they reportedperinatal health outcomes or care and clearly stated that they included asylum seekersor refugees. Screening for eligibility, data extraction, quality appraisal and evidencesynthesis were carried out in duplicate. The results were summarised narratively.Results:Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Onlyone exclusively focussed on asylum seekers; the remaining reviews grouped asylumseekers and refugees with wider migrant populations. Perinatal outcomes werepredominantly worse among migrant women, particularly mental health, maternalmortality, preterm birth and congenital anomalies. Access and use of care wasobstructed by structural, organisational, social, personal and cultural barriers. Migrantwomen's experiences of care included negative communication, discrimination, poorrelationships with health professionals, cultural clashes and negative experiences ofclinical intervention. Additional data for asylum seeker and refugees demonstratedcomplex obstetric issues, sexual assault, unwanted pregnancy, poverty, socialisolation, and experiences of racism, prejudice and stereotyping within perinatalhealthcare.Conclusion:This review identified adverse pregnancy outcomes among asylum seeker and refugeewomen, representing a double burden of inequality for one of the most globallyvulnerable groups of women. Improvements in the provision of perinatal healthcarecould reduce inequalities in adverse outcomes and improve women's experiences ofcare. Strategies to overcome barriers to accessing care require immediate attention.The systematic review evidence-base is limited by combining heterogeneous migrant,asylum seeker and refugee populations, inconsistent use of definitions, and limiteddata on some perinatal outcomes and risk factors. Future research needs to overcomethese limitations to improve data quality and address inequalities.


Publication metadata

Author(s): Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J

Publication type: Article

Publication status: Published

Journal: BMC Medicine

Year: 2018

Volume: 16

Print publication date: 01/12/2018

Online publication date: 12/06/2018

Acceptance date: 25/04/2018

ISSN (electronic): 1741-7015

Publisher: BioMed Central Ltd

URL: https://doi.org/10.1186/s12916-018-1064-0

DOI: 10.1186/s12916-018-1064-0


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