Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services?

Abstract

Objective To test the hypothesis that suboptimal factors in perinatal care services resulting in perinatal deaths were more common among immigrant mothers from the Horn of Africa, when compared with Swedish mothers. Design A perinatal audit, comparing cases of perinatal deaths among children of African immigrants residing in Sweden, with a stratified sample of cases among native Swedish women. Population and setting Sixty‐three cases of perinatal deaths among immigrant east African women delivered in Swedish hospitals in 1990–1996, and 126 cases of perinatal deaths among native Swedish women. Time of death and type of hospital were stratified. Main outcome measures Suboptimal factors in perinatal care services, categorised as maternal, medical care and communication. Results The rate of suboptimal factors likely to result in potentially avoidable perinatal death was significantly higher among African immigrants. In the group of antenatal deaths, the odds ratio (OR) was 6.2 (95% CI 1.9–20); the OR for intrapartal deaths was 13 (95% CI 1.1–166); and the OR for neonatal deaths was 18 (95% CI 3.3–100), when compared with Swedish mothers. The most common factors were delay in seeking health care, mothers refusing caesarean sections, insufficient surveillance of intrauterine growth restriction (IUGR), inadequate medication, misinterpretation of cardiotocography (CTG) and interpersonal miscommunication. Conclusions Suboptimal factors in perinatal care likely to result in perinatal death were significantly more common among east African than native Swedish mothers, affording insight into socio‐cultural differences in pregnancy strategies, but also the suboptimal performance of certain health care routines in the Swedish perinatal care system.

Ethnic variations in mortality in pre-school children in Denmark, 1973–2004

“…An increased risk of suboptimal pregnancy care in ethnic minority groups has been found in previous studies. 24,25 Almost all health care services in Denmark are free of charge for all residents, and all women irrespective of ethnic origin should have free access to prenatal care at any hospital. Despite this, a recent Danish study 26 found lower attendance rates at free preventive child care examinations among immigrant children, an unfortunate trend that may also be present in the use of antenatal care among immigrant women.…”

No association between female circumcision and prolonged labour: a case control study of immigrant women giving birth in Sweden

“…Sub-optimal factors in obstetric care were often likely to result in perinatal death in this immigrant group [15]. However, circumcision per se was not found to be directly related to perinatal death [16].…”

Misclassified Maternal Deaths among East African Immigrants in Sweden

“…Tuberculosis and hepatic failure (Cases 1 and 4) are potential causes of deaths that European doctors are not trained to recognise, raising the issues of suboptimal care and miscommunication. 11 In Sweden, deaths in pregnancy related to tuberculosis have not occurred for the last 50 years. The embolism-related death (Case 8) was mentioned in a recent study of maternal death and pulmonary embolism: ''Two women were immigrants from sub-Saharan Africa; there was a delay in seeking health care in one case, and verbal miscommunication might have contributed in both cases. ''…”

“…[7][8][9][10][11] A recent confidential enquiry into maternal deaths in the UK studied deaths among disadvantaged women, including black African women, and found they were more likely to die during pregnancy, childbirth or the puerperium than their white counterparts. 12 To our knowledge, there is a lack of similar studies of maternal mortality and ethnicity in Sweden.…”