Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany

David, Matthias; Borde, Theda; Brenne, Silke; Henrich, Wolfgang; Breckenkamp, Jürgen; Razum, Oliver

doi:10.1371/journal.pone.0127489

Cited by 27 publications

(18 citation statements)

References 27 publications

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“…We found no differences in emergency caesarean section rates across groups of women with and without migration background in the BaBi birth cohort study. This is in line with the Berlin perinatal study [15,20]. It is important to note, though, that the BaBi participants with a migration background do not necessarily represent the diversity of migration biographies in Germany.…”

Section: Implications Of the Resultssupporting

confidence: 82%

“…Although Germany is a diverse country and one of the main reception countries for migrants in Europe, there has been little systematic investigation regarding differences in emergency caesarean section rates by migration status and socioeconomic status. In a recent prospective study conducted in Berlin, emergency caesarean section rates did not differ depending on migration status and level of education [15]. Income, however, was not included in the analysis.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

Miani

Ludwig

Breckenkamp

et al. 2020

BMC Pregnancy Childbirth

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Background: Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. Methods: In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. Results: Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1. and aOR: 2.36, respectively) to undergo an emergency caesarean section than women in the higher income groups. Conclusions: Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.

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Section: Implications Of the Resultssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

Miani

Ludwig

Breckenkamp

et al. 2020

BMC Pregnancy Childbirth

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“…We observed no differences in terms of labour induction or caesarean section rates between RIs and LTRs, whereas inconsistent results have been published by other authors, some reporting higher and others reporting lower rates of caesarean sections in RI populations 22 23 29 30. A certain number of obstetrical complications such as failure to progress labour, inflammatory syndrome during labour, fetal distress and severe perineal lacerations were more prevalent among RIs.…”

Section: Discussioncontrasting

confidence: 74%

Do recent immigrants have similar obstetrical care and perinatal complications as long-term residents? A retrospective exploratory cohort study in Brussels

et al. 2020

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PurposeRecent immigrants (RIs) face various barriers affecting quality of care. The main research question assessed whether perinatal complications (during pregnancy, labour, delivery and neonatal period) were similar in RIs to those in long-term residents (LTRs). The secondary question assessed whether prenatal and perinatal care was similar in the two groups.MethodsThis is a monocentric observational study, carried out in Brussels between November 2016 and March 2017 (n=1365). We surveyed 892 pregnant women during prenatal consultations and immediate postpartum period in order to identify RIs of less than 3 years (n=230, 25%) and compared them with LTRs (n=662). Sociodemographic data, baseline health status, prenatal care, obstetrical and neonatal complications were compared between these two groups. Multivariable binary logistic regression was conducted to examine the occurrence of perinatal complications (during pregnancy, labour and delivery, and neonatal period) between RIs and LTRs after adjustment for potential confounders.ResultsRIs were living more frequently in precarious conditions. RIs were younger (p<0.001) and had a lower body mass index (p<0.001) than LTRs. Prenatal care was often delayed in RIs, resulting in fewer evaluations during the first trimester (p<0.001). They had a lower prevalence of gestational diabetes mellitus (p<0.05) and less complications during the pregnancy even after adjustment for confounding factors. Similar obstetrical care during labour and delivery occurred. After adjustment for confounding factors, no differences in labour and delivery complications were observed. Although RIs’ newborns had a lower umbilical cord blood pH (<0.05), a lower 1 min of life Apgar score (p<0.01) and more frequently required respiratory assistance (p<0.05), no differences in the composite endpoint of neonatal complications were observed. No increase in complications in the RI group was detected whatever the considered period.ConclusionRIs had less optimal prenatal care but this did not result in more obstetrical and perinatal complications.

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“…For instance, one study showed a lower probability of utilization especially among 1st generation migrants (odds ratio (OR): 0.58; confidence interval (CI): 0.40–0.83) [ 23 ]. Inpatient care was assessed by the number of hospitalizations and elective surgeries (mostly caesarean section) [ 17 , 18 , 23 , 25 , 26 , 29 , 30 , 37 – 39 ]. The 10 studies revealed an inconsistent pattern in terms of ethnical disparities.…”

Section: Resultsmentioning

confidence: 99%

Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review

Klein

Knesebeck

2018

Int J Equity Health

122

102

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BackgroundDespite the growing number of people with migrant background in Germany, a systematic review about their utilization of health care and differences to the non-migrant population is lacking. By covering various sectors of health care and migrant populations, the review aimed at giving a general overview and identifying special areas of potential intervention.MethodsA systematic review was conducted in PubMed database including records that were published until 1st of June 2017. Further criteria for eligibility were a publication in a peer-reviewed journal written in English or German language. The studies have to report quantitative and original data of a population residing in Germany. The appropriateness of the studies was judged by both authors. Studies were excluded if native controls were not originated from the same sample. Moreover, indicators of health care utilization have to assess individual behaviour like consultation or participation rates. 63 studies met the inclusion criteria for a qualitative synthesis of the findings.ResultsThe overall findings indicate a lower utilization among migrants, although the results vary in terms of health care sector, indicator of health care utilization and migrant population. For specialist care, medication use, therapist consultations and counselling, rehabilitation as well as disease prevention (early cancer detection, prevention programs for children and oral health check-ups) a lower utilization among people with migrant background was found. The lower usage was particularly shown for migrants of the 1st generation, people with two-sided migrant background, children/adolescents and women. Due to the methodological heterogeneity a meta-analysis was not feasible. As most of the studies were cross-sectional, no causal interpretations could be drawn.ConclusionsThe inequalities in utilization could not substantially be explained by differences in the socioeconomic status. Other reasons of lower utilization could be due to differences in need, preferences, information, language and formal access barriers (e.g. charges, waiting times, travel distances or lost wages). Different migrant-specific and migrant-sensitive strategies are relevant to address the problem for certain health care sectors and migrant populations.Trial registrationThe review protocol was registered on PROSPERO (CRD42014015162).Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0876-z) contains supplementary material, which is available to authorized users.

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Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany

Cited by 27 publications

References 27 publications

Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

Do recent immigrants have similar obstetrical care and perinatal complications as long-term residents? A retrospective exploratory cohort study in Brussels

Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review

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