The influence of acculturation on the risk of stillbirth in migrant women residing in Western Australia

Abstract

Objective To investigate the influence of acculturation, demonstrated by age on arrival, length of residence, interpreter use and having an Australian-born partner, on disparities observed in the risk of stillbirth between migrant and Australian-born populations in Western Australia (WA). Methods A retrospective cohort study using linked administrative health data for all non-Indigenous births in WA from 2005-2013 was performed. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Adjusted odds ratios (aOR) for stillbirth in migrants from six ethnicities of white, Asian, Indian, African, Māori, and 'other', with different levels of acculturation, were compared with Australian-born women using multivariable logistic regression analysis and marital status, maternal age group, socioeconomic status, parity, plurality, previous stillbirth, any medical conditions, any pregnancy complications, sex of baby, and smoking during pregnancy as the covariates. Results From all births studied, 172,571 (66%) were to Australian-born women and 88,395 (34%) to migrant women. Women from African, Indian and Asian backgrounds who gave birth in the first two years after arrival in Australia experienced the highest risk of stillbirth (aOR 3.32; 95% CI 1.70-6.47, aOR 2.71; 95% CI 1.58-4.65, aOR 1.93; 95% CI 1.21-3.05 respectively) compared with Australian-born women. This association attenuated with an increase in the length of residence in Asian and Indian women, but the risk of stillbirth remained elevated in African women after five years of residence (aOR 1.96 [1.10-3.49]). Interpreter use and an Australian-born partner were associated with 56% and 20% lower odds of stillbirth in migrants (p<0.05), respectively.

Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study

“…A foreign-born father was associated with increased odds of very preterm birth, SGA, stillbirth, and low Apgar score at 5 minutes in births to migrant women. Our results related to very preterm birth support previous findings from 1 Swedish [ 9 ] and 1 Canadian [ 10 ] study, the increased odds of SGA is consistent with findings from 1 Swedish study [ 3 ], and the increased odds of stillbirth is consistent with findings from 1 Canadian [ 8 ] and 1 Australian study [ 11 ]. In addition, 1 Swedish study reports an increased risk of low Apgar score in migrant women, irrespective of paternal origin [ 3 ].…”

“…A partner from the host population might ease the integration process by providing the woman with increased wealth and social capital less likely to be available to couples in which both parents are foreign-born [ 3 , 11 ]. He may further facilitate communication between the woman and caregivers and better guide her through the healthcare system [ 6 , 11 , 42 ]. It is also possible that a migrant woman may be less prone to experience discrimination or disrespectful care from caregivers [ 43 ] if the father is from the host population.…”

“…Both parents’ origins seem to influence pregnancy outcomes [ 3 , 6 , 8 – 11 ]. However, the number of studies investigating paternal origin is limited, and the methodological differences between studies and the complexity of migration all make the findings difficult to interpret [ 3 , 6 , 8 – 11 ].…”

Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power

“…It is essential to provide effective communication training to health professionals [ 40 ]. When professionals offer direct and honest information, the asymmetry in their relationships with patients is reduced [ 29 ]. Nurses should be trained in person-centered intercultural communication so that (a) they can improve their overall communication skills, (b) increase their cultural awareness to avoid prejudice, and (c) include immigrant patients in the decision-making process.…”

“…Obviously, the amount of time spent in the host country influences not only the language proficiency of immigrants but also their health status, relationships with healthcare professionals, and access to and use of the healthcare system and prevention services [ 27 , 28 ]. For example, in the case of pregnant immigrant women, the acculturation process reduces the risk of miscarriage and improves communication with and access to healthcare services [ 29 ].…”