The impact of African ethnicity and migration on pregnancy in women living with HIV in the UK: design and methods

Abstract

BackgroundThe number of reported pregnancies in women with diagnosed HIV in the UK increased from 80 in 1990 to over 1400 in 2010; the majority were among women born in sub-Saharan Africa. There is a paucity of research on how social adversity impacts upon pregnancy in HIV positive women in the UK; furthermore, little is known about important outcomes such as treatment uptake and return for follow-up after pregnancy. The aim of this study was to examine pregnancy in African women living with HIV in the UK.Methods and designThis was a two phase mixed methods study. The first phase involved analysis of data on approximately 12,000 pregnancies occurring between 2000 and 2010 reported to the UK’s National Study of HIV in Pregnancy and Childhood (NSHPC). The second phase was based in London and comprised: (i) semi-structured interviews with 23 pregnant African women living with HIV, 4 health care professionals and 2 voluntary sector workers; (ii) approximately 90 hours of ethnographic fieldwork in an HIV charity; and (iii) approximately 40 hours of ethnographic fieldwork in a Pentecostal church.DiscussionWe have developed an innovative methodology utilising epidemiological and anthropological methods to explore pregnancy in African women living with HIV in the UK. The data collected in this mixed methods study are currently being analysed and will facilitate the development of appropriate services for this group.

Using mixed methods in health research

“…(qualitative)We conducted analyses of national surveillance data followed by semi-structured interviews with pregnant African women living with HIV and their health care providers. 7 We supplemented interview data with ethnographic research in a charity supporting people living with HIV and an African Pentecostal church in London. Each type of data was analysed separately with findings from one analysis informing the other.…”

A concept analysis of the term migrant women in the context of pregnancy

“…They use a range of methodological approaches, addressing a variety of relevant issues, most commonly access to and use of maternity care by migrant women (Kilner, ; Munro, Jarvis, Munoz, D'Souza, & Graves, ; Binder, Johnsdotter, & Essén, ; Wolff, Epiney, et al, ; Bray et al, ; Karl‐Trummer, Krajic, Novak‐Zezula, & Pelikan, ). However other issues include maternal and infant outcomes for migrant women (David, Pachaly, & Vetter, ; Merten, Wyss, & Ackermann‐Liebrich, ; Perez Ramirez, Garcia‐Garcia, & Peralta‐Ramirez, ; Reeske, Kutschmann, Razum, & Spallek, ); migrant women's experiences of perinatal care in their host country (Almeida, Casanova, Caldas, Ayres‐de‐Campos, & Dias, ; Balaam et al, ; Velemínský et al, ); reproductive health including HIV, Chlamydia, and Toxoplasmosis (Tariq, Pillen, Tookey, Brown, & Elford, ; Wolff, Epiney, et al, ; Ramos et al, ); the health status of migrant women (Carolan, ; Wolff et al, ); decision‐making in pregnancy (Mantovani & Thomas, ); and identity and settlement (Vaiou & Stratigaki, ).…”

“…Other work considers the idea of secure and insecure status; “Secure immigration status is defined as being a UK citizen, a recognized refugee or having exceptional or indefinite leave to remain. Anyone not in these categories is defined as having insecure immigration status” (Tariq et al, , p. 6), as well as documented and undocumented migrants (Wolff et al, ; Wolff, Epiney, et al, ). Other articles acknowledge, but rarely consider in any depth, that migrant women can be “economic migrants” (Balaam et al, ; Vaiou & Stratigaki, ; Wolff et al, ) and “educational migrants” (Mantovani & Thomas, ), “undocumented … uninsured migrants and refugee claimants” (Munro et al, ) and “A8 migrant population” (Bray et al, ).…”

“…The 21 included articles covered a broad European perspective; an explicitly cross national perspective (n = 3), United Kingdom (n = 6), Switzerland (n = 4), Germany (n = 2), Spain (n = 2), Portugal (n = 1), Greece (n = 1) Czech Republic (n = 1), and Austria (n = 1). (Tariq, Pillen, Tookey, Brown, & Elford, 2012;Ramos et al, 2011); the health status of migrant women (Carolan, 2010;Wolff et al, 2005); decision-making in pregnancy (Mantovani & Thomas, 2014); and identity and settlement (Vaiou & Stratigaki, 2008).…”

“…Other research clusters countries of origin into broader geographical areas or regions; eg, "54 immigrant African women from sub Saharan Africa" (Binder et al, 2012(Binder et al, , p. 2030, "Migrants from A8 countries" (Binder et al, 2012;Bray, Gorman, Dundas, & Sim, 2010;Merten et al, 2007;Munro et al, 2012;Vaiou & Stratigaki, 2008;Wolff et al, 2005;Wolff, Lourenço, et al, 2008). In other articles, the country of birth (Ramos et al, 2011;Almeida et al, 2014;Bray et al, 2010), region of birth (Tariq et al, 2012), or nationality (Reeske et al, 2011;Wolff, Lourenço, et al, 2008) is more specifically identified. One article develops the idea of place of origin further by using an additional economic category, making a distinction between high-income and low-income countries (Binder et al, 2012).…”