Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway

Abstract

Objective To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway. Design A cross-sectional study of consultations at several time points. Setting The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway. Subjects Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions. Main outcome measures Manchester Triage System urgency level at presentation, and hospitalization. Results Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents. Conclusion Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.