Host‐country language proficiency and migrant‐native disparities in prenatal care utilization: A nationwide study in Portugal

Abstract

Background: Migrant-native disparities in perinatal health and care utilization are well-established, yet most evidence comes from countries without universal health coverage. Migrant-specific factors potentially contributing to such disparities are seldom examined. We investigated the association between migration and host-country language proficiency and inadequate utilization of prenatal care (PNC) in Portugal. Methods:We used robust Poisson regression to analyze data from 1419 migrant and 2477 native women enrolled in the Portuguese Bambino cohort study who had given birth at a Portuguese public hospital between 2017 and 2019. Migrant women's language proficiency was self-rated for understanding, speaking, reading, and writing skills. PNC utilization inadequacy was assessed using three dimensions: initiation, number of visits, and the modified Adequacy of Prenatal Care Utilization (mAPNCU) Index score. Results: Migrant women were overall more likely to initiate PNC late and have inadequate/intermediate mAPNCU scores than natives. Migrant-native disparities in the number of PNC visits were only observed among recent migrants (≤5 years in Portugal). Full, intermediate, and limited Portuguese skills were associated with increasingly higher risks of late PNC initiation (aRR 1.34 [95%CI 1.20-1.50]); (aRR 1.52 [95%CI 1.28-1.80]); (aRR 1.91 [95%CI 1.52-2.40]), inadequate number of PNC visits (aRR 1.

Migrant-Native Disparities in Obstetric Neuraxial Analgesia Use: The Role of Host-Country Language Proficiency

“…This means that all women should theoretically have similar access to analgesia-related knowledge. However, previous studies of ours on the same data indicated that limited language skills were associated with inadequate care utilization 16 and suboptimal perceived quality of communication with prenatal care providers. 32 Additionally, prenatal classes are usually offered in Portuguese and our study indicated a lower attendance of prenatal classes and perceived insufficiency of labor/birth and analgesia information among pregnant women with limited Portuguese command.…”

“…This was a secondary analysis of data collected throughout baMBINO (Perinatal Health in Migrant-Barriers, Incentives, and Outcomes)-a prospective cohort study aiming to compare maternity experiences of migrant and native women giving birth in Portuguese public hospitals. [16][17][18] baMBINO was conducted according to Helsinki Declaration guidelines and was approved by the Ethics Committee of the Institute of Public Health of the University of Porto (CE14013), the National Committee of Data Protection (13585/2016), and ethical committees of all collaborating hospitals. All participants provided written informed consent.…”

“…HDI is a United Nations composite index of 3 dimensions of countries’ development: longevity, education, and living standard. 24 We also studied obstetric characteristics, including parity, previous cesareans, complications during pregnancy (high blood pressure, preeclampsia, gestational diabetes, acute pyelonephritis, placenta praevia, placental abruption, and other rare complications), prenatal care utilization index score, 16 labor induction, instrumental delivery, neonatal birth weight, preterm birth, maternity unit, being asked about pain management preferences during labor, main information sources about pregnancy and childbirth, attending prenatal classes, and perceived sufficiency of predelivery information about labor/birth process and nonpharmacological pain relief methods. Most obstetric data were extracted from women’s medical records.…”

Migrant and native women’s perceptions of prenatal care communication quality: the role of host-country language proficiency

“…Our findings are particularly relevant given that previous studies on the role of language proficiency in perinatal healthcare and outcomes have also revealed a link between limited language skills and several adverse outcomes, including inadequate prenatal care utilization, obstetric trauma, and postpartum depressive symptoms [ 16 , 23 , 46 ]. Taken together, our findings, along with those of previous studies, would lay the groundwork for future research into the pathways linking language proficiency to perinatal health outcomes and pave the way for potential intervention studies.…”

“…Obstetric characteristics included: parity (primiparous, multiparous), smoking during the index pregnancy (yes, no), any complications during the index pregnancy (yes, no), and adequacy of prenatal care utilization (adequate, intermediate/inadequate [Initiation of prenatal care after 12 gestational weeks or less than 80% of the recommended number of visits according to gestational age]) [ 23 ].…”