Unmet family planning needs among female refugees and asylum seekers in Germany – is free access to family planning services enough? Results of a cross-sectional study

Inci, Melisa Guelhan; Kutschke, Nadja; Nasser, Sara; Alavi, Seyed Ali; Abels, Ingar; Kurmeyer, Christine; Sehouli, Jalid

doi:10.1186/s12978-020-00962-3

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…According to the United Nations Population Fund (UNFPA), one billion people – one in every seven – are migrants. 1 , 2 About 250 million people are international migrants, and nearly half of them are women. 1 Globally, women are migrating to new countries, bringing with them their perspectives and knowledge about sexual and reproductive health and rights (SRHR) and contraceptives.…”

Section: Introductionmentioning

confidence: 99%

Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study

Kolak

Löfgren-Mårtenson

Hansson

et al. 2022

Sexual and Reproductive Health Matters

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Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women’s health at both individual and societal levels. This study explored immigrant women’s perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife’s professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.

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Section: Introductionmentioning

confidence: 99%

Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study

Kolak

Löfgren-Mårtenson

Hansson

et al. 2022

Sexual and Reproductive Health Matters

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“…Another study by our working group showed, in addition, that only 53 % of refugee women who wished to avoid pregnancy used contraceptive methods. 34 % of them used the unreliable method of coitus interruptus [12]. This could help to explain the younger maternal age and the frequent pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…Eine andere Studie unserer Arbeitsgruppe hat zudem gezeigt, dass nur 53 % der geflüchteten Frauen, die sich keine Schwangerschaft wünschten, kontrazeptive Methoden verwendeten. 34 % davon verhüteten mit der unsicheren Methode des Coitus interruptus [12]. Das könnte ein Erklärungsansatz für das jüngere maternale Alter sowie für die häufigen Schwangerschaften sein.…”

Section: Diskussionunclassified

Perinatal Data of Refugee Women from the Gynaecology Department of Charité University Hospital Berlin Compared with German Federal Analysis

Ammoura

Sehouli

Kurmeyer

et al. 2021

Geburtshilfe Frauenheilkd

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Introduction The aim of this study was to record the perinatal data of refugee women at Charité Hospital, Berlin, and to evaluate possible differences in pre-, peri- and postnatal outcomes compared with indigenous women. Material and Methods All pregnant women who gave birth in the period from 1 January 2014 to 30 September 2017 and were registered at least once in the hospital as “refugee” were included in the analysis. The data recorded from the refugee women were compared with the perinatal data of the German Federal obstetric analysis for the year 2016, which was published by the IQTIG (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen [Institute for Quality Assurance and Transparency in Healthcare]). Results The analysis comprised 907 refugee women and 928 infants (21 twin pregnancies). Pregnant refugee women were significantly younger than the pregnant women from the Federal analysis (birth before the age of 30: 66 vs. 41%, p < 0.001, RR: 1.6, 95% CI: 62.9 – 69.2). They had a history both of more pregnancies (≥ 3 pregnancies: 29.4 vs. 13.4%, p < 0.001, RR: 2.2, 95% CI: 26.4 – 32.5) and of more miscarriages (> 2 miscarriages: 9.7 vs. 5.9%, p < 0.001, RR: 1.6, 95% CI: 7.9 – 11.8) and more often had a history of suffering from psychological stress (11.1 vs. 4.1%, p < 0.001, RR: 2.70, 95% CI: 9.2 – 13.4). There were more premature births (10.3 vs. 3.0%, p < 0.001, RR: 3.36, 95% CI: 8.4 – 12.4), post-term pregnancies (8.5 vs. 0.5%, p < 0.001, RR: 15.4, 95% CI: 6.7 – 10.5), and cases of postpartum anaemia (28.7 vs. 22.0%, p < 0.001, RR: 1.30, 95% CI: 25.7 – 31.7) and puerperal endometritis (1 vs. 0.2%, p = 0.006, RR: 4.3, 95% CI: 0.5 – 1.9) compared with the Federal analysis. The neonatal outcome showed an increased rate of hypotrophy (11 vs. 7%, p < 0.001, RR: 1.6, 95% CI: 9.1 – 13.2), more stillbirths (0.7 vs. 0.2%, p = 0.006, RR: 3, 95% CI: 0.2 – 1.4) and increased congenital malformations (2.8 vs. 0.4%, p < 0.001, RR: 3, 95% CI: 0.2 – 1.4). Conclusion Both refugee women and their infants showed significant differences. Despite the average younger age of the pregnant refugee women, the rates of premature birth and stillbirth and congenital malformations were significantly more frequent. More intensive antenatal screening with differentiated foetal organ diagnostics including psychosomatic care could contribute to early identification and prompt diagnosis. As regards the postpartum anaemia and puerperal endometritis, which occur more often in refugee women, midwife engagement and an improvement in the living situation in homes and accommodation facilities could be of great importance.

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“…The relatively high birthrate among asylum seekers in this study was likely related to limited access to and availability of sexual and reproductive health services throughout the process of forced migration [ 24 , 25 , 26 , 27 ]. In absolute numbers, most children in this study were born to mothers from the Middle East/North Africa, a region which includes common countries of origin among asylum seekers such as Syria and Iraq [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study

Tankink

Verschuuren

Postma

et al. 2021

IJERPH

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This five-year cross-sectional study mapped the prevalence of several known risk factors for adverse perinatal outcomes in asylum-seeking women in The Netherlands. Characteristics of 2831 registered childbirths among residents of asylum seekers centers (ASCs) in The Netherlands from 2016 to 2020 were included. Results showed a high general and teenage birthrate (2.15 and 6.77 times higher compared to the Dutch, respectively). Most mothers were pregnant upon arrival, and the number of births was highest in the second month of stay in ASCs. Another peak in births between 9 and 12 months after arrival suggested that many women became pregnant shortly after arrival in The Netherlands. Furthermore, 69.5 percent of all asylum-seeking women were relocated between ASCs at least once during pregnancy, which compromises continuity of care. The high prevalence of these risk factors in our study population might explain the increased rate of adverse pregnancy outcomes in asylum seekers compared to native women found in earlier studies. Incorporating migration-related indicators in perinatal health registration is key to support future interventions, policies, and research. Ultimately, our findings call for tailored and timely reproductive and perinatal healthcare for refugee women who simultaneously face the challenges of resettlement and pregnancy.

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Unmet family planning needs among female refugees and asylum seekers in Germany – is free access to family planning services enough? Results of a cross-sectional study

Cited by 14 publications

References 18 publications

Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study

Immigrant women’s perspectives on contraceptive counselling provided by midwives in Sweden – a qualitative study

Perinatal Data of Refugee Women from the Gynaecology Department of Charité University Hospital Berlin Compared with German Federal Analysis

Childbirths and the Prevalence of Potential Risk Factors for Adverse Perinatal Outcomes among Asylum Seekers in The Netherlands: A Five-Year Cross-Sectional Study

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