The influence of migration on women’s use of different aspects of maternity care in the German health care system: Secondary analysis of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ)

Abstract

Introduction Approximately 21% of Germany's inhabitants or their parents have been born abroad. There is evidence that immigrant women are starting antenatal care later than nonimmigrants. In Berlin, equality in health care access had improved until 2011‐2012, leaving only women with Low German language proficiency and an insecure residence status particularly at risk. With the recent influx of refugees, we analyzed whether access to antenatal and postpartum care differs depending on immigration, residence status, income, and education. Methods At our Berlin tertiary care center, a modified version of the Migrant Friendly Maternity Care Questionnaire was administered to women who delivered in the first half of 2017. Multivariate modeling compared nonimmigrant women, immigrants, and women who are direct descendants of immigrants. Results The study included 184 nonimmigrant women, 214 immigrant women, and 62 direct descendants of immigrants. Germany is relatively good in prenatal care for immigrant women, as most are getting adequate prenatal care. However, 21% of immigrants compared with 11% of nonimmigrant women started pregnancy care after the first trimester (P = .03). Low income was a more powerful predictor than immigration status for starting prenatal care after the first trimester. Immigrant women (23%) were less informed on postpartum care availability than nonimmigrants (3%) and used less postpartum midwifery care. Conclusions When designing health care interventions for immigrant women, not only migration‐specific factors should be considered but also low income as a barrier to access to maternity care.

The associations between women who are immigrants, refugees, or asylum seekers, access to universal healthcare, and the timely uptake of antenatal care: A systematic review

“…Social confounders such as employment, income and education are known independent risk factors for delayed ANC. Despite this, other studies demonstrated that ANC care was still delayed in women without access to UHC, even after confounders were adjusted for 35,37,40,42 …”

“…Despite this, other studies demonstrated that ANC care was still delayed in women without access to UHC, even after confounders were adjusted for. 35,37,40,42…”

“…Each included study reported that women who were immigrants, refugees, or asylum seekers were more likely to present late for ANC compared to receiving-country-born women (see Table 3), and of eight studies which reported a P-value, all reported the outcome to be statistically significant between groups (P < 0.05). [32][33][34][35][36][37][38][39]…”

Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway

“…As we did not compare migrants to non-migrants, we cannot establish if there was a difference in how early the women started antenatal care. Nevertheless, studies from European countries have shown later initiation of antenatal care among migrants compared to non-migrants [ 27 , 28 ], first generation- compared to second generation migrants [ 29 ], minority ethnic groups compared to White women [ 28 , 30 ] and especially profound among recently migrated women [ 31 ]. Although our finding of a high percentage of timely initiation of antenatal care, midwives from the in-depth interviews indicate that subgroups of migrants may be at risk.…”

Some Generalized Estimating Equations Models Based on Causality Tests for Investigation of The Economic Growth of The Country Groups

“…Seidel et al [41] studied on nonimmigrant women, immigrant women, and direct descendants of immigrants to evaluate the influence of migration on maternity care in the German health care system using Cox regression analysis.…”