Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review

Abstract

Background In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes. Objectives Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies. Review methods An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence. Results We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated. Limitations Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women. Conclusions Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this. Future work Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource. Study registration This study is registered as PROSPERO CRD42015023605. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

Opportunities to Integrate Primary Health Care Digital Innovations in Maternal and Child Health Care Services in Kenya

“…Another systematic review [17] also established that limited access to maternal services is a function of both user and service provider characteristics for instance the stage at which a pregnant woman tries to access health services.…”

A review of the effectiveness and experiences of welfare advice services co-located in health settings: a critical narrative systematic review

“…'Richness' has been described as 'the extent to which study findings provide indepth explanatory insights that are transferable to other settings' (Popay, Roberts et al 2006). The criteria for assessment of 'richness' taken from an approach by Higginbottom et al (2020) are described in Table 2 (Higginbottom, Morgan et al 2013, Higginbottom, Evans et al 2020.…”

“…A textual description of all included and excluded studies was created alongside the quality assessment to generate summary measures that were used to form a cross-study analysis. An example one page systematic textual narrative summary can be found in Appendix X (Popay, Roberts et al 2006, Higginbottom, Evans et al 2020.…”

“…Limited insights provided Lack a clear account of processes Present and underdeveloped and weak interpretation of findings produced Present a weak and underdeveloped interpretation of the analysis based on the data presented Table 2. Criteria for assessment of 'richness' (Higginbottom, Morgan et al 2013, Higginbottom, Evans et al 2020 DATA SYNTHESIS Data extracted from the included studies were analysed using a critical narrative synthesis, adopting an evidence-led framework described by Rodgers et al (Rodgers, Sowden et al 2009). This approach consists of four elements employed in an iterative manner to analyse the included studies: developing a theory of how the intervention works, why and for whom; developing a preliminary synthesis of findings of included studies; exploring relationships in the data; and assessing the robustness of the synthesis.…”

Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID‐19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region

“…Lower utilization of antenatal health care may be a consequence of barriers migrants face in accessing care, 22 including lack of social support, lack of health literacy, language barriers, lack of information, poor experience of care, and discrimination. 21,23 Furthermore, within the process of provision of healthcare services to migrant women, multiple factors associated with poor healthcare experiences have been previously documented, including difficulties related to communication, unfamiliarity with the healthcare system, lack of kind and respectful care, [24][25][26][27] lack of language support, cultural insensitivity, poor interactions with healthcare providers, lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care, 5,28 and outright discrimination. [27][28][29][30] The COVID-19 pandemic has, in addition to the increased burden on health systems, reshaped migration flows, the composition of migrant populations in Europe, and the economic panorama, with important consequences for migrants who are overrepresented in lowskilled professions.…”