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

Abstract

BACKGROUND: Neuraxial analgesia (NA) is the most effective modality in managing labor pain with widespread availability in high-income countries. Previous research has reported a differential obstetric NA use among migrant and native women, but the contribution of language barriers is not well understood. We aimed to investigate whether host-country language proficiency among migrant women influences NA use and satisfaction with pain management during labor, when compared to natives. METHODS: We conducted a secondary analysis of data collected from 1024 native and 1111 migrant women who had singleton vaginal deliveries between 2017 and 2019 and were enrolled in the nationwide Portuguese baMBINO prospective cohort study. Obstetric NA use, satisfaction with labor pain management, and migrants’ Portuguese language proficiency were self-reported. Data were analyzed using robust multilevel Poisson regression, adjusted for maternal region of birth (characterized by the Human Development Index), age, and education. RESULTS: Overall, 84.4% of native women gave birth with NA, compared to 81.6%, 71.3%, and 56.9% of migrant women with full, intermediate, and limited language proficiency, respectively. Compared to native women, migrants with intermediate (adjusted risk ratio [aRR] = 0.91 [95% confidence interval {CI}, 0.82–0.99]) and limited (aRR = 0.73 [95% CI, 0.56–0.94]) proficiency were less likely to receive NA. However, no significant differences were observed in pain management satisfaction by language proficiency level. CONCLUSIONS: Compared to native women, we observed a differential obstetric NA use across migrant women with different host-country language proficiency levels in Portugal, without affecting satisfaction with labor pain management. Although defining the mechanisms underlying NA use discrepancies requires further research, our findings support systematically evaluating pregnant migrant women’s linguistic skills and ensuring their access to adequate obstetric analgesia-related information and interpretation services.

Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal

“…We used baseline data from the Bambino study, a national, prospective, observational cohort study that aimed to investigate the maternity experiences of migrant and native women giving birth in mainland Portugal [ 15 ]. All 39 Portuguese public maternity units (accounting for 85% of all deliveries in mainland Portugal in 2018) were invited to participate in the project, and 32 (82%) agreed to collaborate.…”

“…Improving migrant maternal health has emerged as a top priority for many stakeholders in highincome countries, due to the large influx of migrant women of reproductive age (in Europe, 21% of babies are born to foreignborn women [4,5]), the importance of adequate maternal care in the health of pregnant women and their offspring, and previously observed migrant-native disparities in perinatal health [1,[6][7][8][9]. Migrant women may have better perinatal health than native women, explained by the healthy migrant effect, or conversely be more vulnerable to maternal and child health problems, due to socioeconomic circumstances, health background and the existence of health inequalities or language barriers [10][11][12][13][14][15][16][17]. Studies comparing migrants with natives often focus on assessing health outcomes.…”

Perinatal Outcomes of Immigrant Mothers and Their Infants Born Very Preterm across Germany

“…For instance, systemic language barriers pose serious challenges to equity and equality of health care [ 21 , 22 ]. Immigrants’ proficiency in a country’s official majority language correlates with health care utilisation [ 23 , 24 , 25 ] and overall health [ 26 , 27 ]. Speakers of other languages experience different levels of barriers depending on the degree of similarity with their mother tongue (L1).…”