Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity
Abstract
:1. Introduction
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- Public health considerations relates to the effect of migration on population health. Poor management of migration can lead to lower utilization of healthcare. The reasons for this are mostly associated with the unresolved legal status of the migrant, poor working conditions, and/or insufficient information, etc. Ultimately, this is reflected on public health, e.g., untreated communicable diseases carry the risk of spread, while undiagnosed and untreated chronic conditions may result in ill health and higher costs. One of the most prominent examples is the natural experiment that resulted from a set of policy changes in Germany in the period 1994–2013. The results indicated that it is less costly to allow refugees and asylum-seekers access to healthcare then to exclude them (Bozorgmehr and Razum 2015).
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- Economic contributions: 17% of doctors and 6% of nurses in the Organisation for Economic Co-operation and Development (OECD) countries have been trained abroad. During the COVID-19 pandemic, migrant workers provided an immense contribution by being on the frontline of the crises, with one in four medical doctors, one in six nurses, and more than 30% of key workforce being migrants (OECD 2020; Vearey et al. 2020). An inclusive health system is critical to sustain the health of workers and supporting their participation in the labor market.
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- Social integration and cohesion provides an inclusive healthcare system recognized as one of the policies for social integration of migrants (Ledoux et al. 2018).
2. Methods
2.1. Design
2.2. Search Strategy
2.3. Inclusion and Exclusion Criteria
2.4. Study Selection and Data Extraction
2.5. Quality Appraisal and Data Synthesis
3. Results
3.1. Who Is Being Studied?
3.2. How Is It Being Studied?
3.3. What Is Being Studied?
3.4. Social-Structural Domain
3.5. Sexual Health Domain
3.6. Reproductive Health Domain
3.7. Interventions for Promoting SRH and Gender Equality
4. Discussion
4.1. Strengths and Limitation of the Research
4.2. Recommendations for Research and Action
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- To improve identification of migrants at increased risk for poor SRH outcomes.
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- To implement multi- and inter-sectorial interventions, to fulfil the specific needs of increasingly heterogeneous populations, namely poverty, discrimination, and exclusion.
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- To provide culturally sensitive healthcare that adjusts its provisions to cultural differences.
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- To ensure that the healthcare system is easily accessible to migrants by promoting accessibility on the same terms as the general population.
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- To improve patient-care provider communication that provides interpreting and translation assistance.
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- Provide equitable SRH treatment of migrants by designing programs that offer partnerships between the doctor and the patients, as well as between the healthcare and minority community.
5. Conclusions
Supplementary Materials
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Sample | Men and women in reproductive age (both migrants and natives) |
Phenomenon of interest | Social, cultural, and structural factors influencing sexual and reproductive health |
Design | Systematic literature reviews and meta-analyses of any research type. No publication date restrictions. No restrictions on country and location. No language exclusions |
Evaluation | Any sexual and reproductive health or health inequity outcomes |
Research type | Systematic literature reviews or meta-analyses |
Author, Date | Number of Individual Papers Included in the Review | Year of Publication (Range) | Continents of Destination | Continents of Origin | Methods | Population Included | Search Strategy Conducted in the Paper (Databases and Supplementary Searches) |
---|---|---|---|---|---|---|---|
Anderson et al. 2017 | 53 | 1986–2015 | North America (United States, Canada), and Australia | NR | Quantitative with meta-analysis | Migrant women (including refugees and asylum-seekers versus non-migrant women | PsycINFO, CINAHL, EMBASE, MEDLINE, Maternal and Infant Care and Cochrane Register of Controlled Trials (CENTRAL). Supplementary searches: Backward and forward citation tracking of papers included |
Bollini et al. 2009 | 65 | 1966–2004 | Europe (mostly United Kingdom and France) | NR | Quantitative | Migrant women in European countries versus native women | Medline. Supplementary searches: reference list |
Denize et al. 2018 | 86 | 1963–2018 | North America (mostly United States), Europe, Asia, and Africa | NR | Quantitative with meta-analysis | Pregnant women with different ethnicity/nationality/race/language/immigration status | Ovid MEDLINE; EMBASE; Clinicaltrials.gov; Cochrane Central Register of Controlled Trials; CINAHL; PsycINFO; Sociological Abstracts; Literature Latino-Americana e do Caribe em Ciencias da Saude (LILACS), IBECS; and Cuba Medicina (CUMED). Supplementary searches: Canadian Agency for Drugs and Technologies in Health (CADTH’s) Grey matters and citations of relevant systematic reviews and trials |
Dzomba et al. 2019 | 29 | 2000–2017 | South Africa | NR | Quantitative with meta-analysis | Male and female migrants in South Africa compared to their non-migrant counterparts | PubMed Central, Sage Publications, Google Scholar, Web of Science, and J-STOR. Supplementary searches: contents of specific journals and citing articles |
Gagnon et al. 2009 | 133 | 1995–2008 | North America, Europe and Australia | NR | Quantitative with meta-analysis | International migrant women versus native-born women of the receiving countries | Medline, Health Star, Embase, and PsychInfo. Additional searches: reference list |
Gissler et al. 2009 | 34 | 1983–2002 | North America (United States) and Europe (Italy, Norway, The Netherlands, Serbia, Croatia, Sweden, Belgium, Spain) | Japan, North Africa, Pacific Islands, Mexico, Surinam/Antilles, Republic of Serb Krajina and Serb Republic, Morocco, Turkey, Suriname, Antilles | Quantitative | International migrant or refugee women versus native-born women of the receiving countries | Medline, Health Star, Embase, and PsychInfo. Supplementary searches: reference list |
Heaman et al. 2013 | 29 | 1996–2010 | North America (mostly United States) and Europe | NR | Quantitative | Women who migrated to Western industrialized countries versus non-migrant women | Medline, Embase, and PsychInfo. Supplementary searches: an existing database of the Reproductive Outcomes and Migration international research collaboration, known experts, and reference list |
Merry et al. 2013 | 76 | 1956–2010 | Europe (68%), Australia (11%), the US (11%), Canada (6%), and Israel (4%) | Latin America and Caribbean (39%) ‘origin unspecified’ (11%), and South Asia (7%) | Quantitative with meta-analysis | International migrant women versus native-born women of the receiving countries | Embase, PsycInfo, CINAHL, Medline, Health Star, Sociological Abstracts, Web of Science, Proquest Research Library, Proquest Dissertations and Theses, POPLINE, Global Health, and PAIS. Supplementary searches: reference list, website searches and contact with authors |
Platt et al. 2013 | 26 | 1985–2009 | Europe, Australia, Southeast Asia, Sub-Saharan Africa, Central, and South America | Europe, South America, and Asia | Narrative synthesis | Migrant versus non-migrant female sex workers | Social Science Citation Index, Medline, Embase, Popline, CINAHL, Global Health, African Healthline, Index Medicus for the Eastern European Region, Latin American and Caribbean Centre on Health Sciences Information, Index Medicus of the South-East Asian Region, and Western Pacific Region of the Index Medicus. |
Small et al. 2014 | 34 | 1990–2012 | Australia, North America, and Europe | Asia, America | Mixed methods | Migrant (or refugee) and non-immigrant women | Medline, CINAHL, Health Star, Embase and PsychInfo. Supplementary searches: undefined sources |
Urquia et al. 2010 | 24 | 1996–2006 | North America (United States) and Europe | NR | Quantitative with meta-analysis | International migrant women versus native-born women of the receiving countries | Medline, Health Star, Embase, and PsychInfo. Supplementary searches: reference list and relevant articles referred to the authors |
Villalonga-Olives et al. 2017 | 68 | 1964–2011 | North America (United States) and Europe | NR | Qualitative | Migrant women | Pubmed and Embase. |
Author, Date (Type of Review) | Review Aim | SRH Outcomes | Determinants/PROGRESS-PLUS | Overall Results of the Review | Overall Limitations of the Study | Overall Recommendations of the Study |
---|---|---|---|---|---|---|
Anderson et al. 2017 (MA) | To evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women | Perinatal mental health |
| No evidence for an overall increased risk of antenatal or postnatal depression among migrant women compared to non-migrant women was found. Migrant women in Canada were at increased risk of antenatal and postnatal depression compared to native-born, whereas migrant women in America and Australia were not. | There were no studies conducted in low- and middle-income countries, which reduces generalizability. Only English language papers were included. Lack of high-quality studies, as most studies had risk of selection and measurement bias. |
|
Bollini et al. 2009 (SLR) | To make a synthesis of available evidence on the association between pregnancy outcomes and integration policies | Pregnancy/birth outcomes |
| Migrant women are clearly disadvantaged as compared to native women, their pregnancies ending up significantly more frequently with unfavorable outcomes. In countries where a definite effort to establish strong integration policies has been made, there is a sizeable significant reduction in the gap between native and migrant women. Overall, living in a country with a strong integration policy represented a powerful protective factor for adverse pregnancy outcomes. | Collapsing all migrant groups into a single category of migrants may obscure the differences existing among ethnic groups. |
|
Denize et al. 2018 (MA) | To systematically review the literature and describe the discrepancies in achieving the 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines across cultures. | (1) Inadequate or excessive GWG, as defined by the IOM; (2) maternal-fetal health outcomes (such as large-for-gestational-age, macrosomia, gestational diabetes mellitus, and all pregnancy-induced hypertension disorders). |
| Most women experienced discordant GWG; this was culturally dependent, wherein minority groups such as black, Hispanic and Asian women are more likely to gain below current recommendations, and Caucasian women to exceed them. Studies among Black women indicated they were at risk of both inadequate and excessive GWG. Less acculturated women (mainly to the US), were at a greater risk of inadequate GWG. | 87% of the included articles were carried out in North America (especially the US), most of which compared a small number of racial/ethnic groups (Black, White, Hispanic and Asian).The limited literature present on cultural differences in secondary outcomes did not provide clear trends of which groups are more at risk of pregnancy-related complications than others. |
|
Dzomba et al. 2019 (MA) | To understand the role of migration in HIV risk acquisition and sexual behavior | Risk of HIV acquisition; unprotected sexual intercourse; sex work |
| Mobility is highly associated with increased prevalence of HIV risk behaviors and confers up to 69% increase in the risk of HIV acquisition. Studies included in this review documented increased multiple sexual partnering, unprotected sexual intercourse, visiting sex workers and engaging in sex work in migrants compared to non-migrants. Escalation of this sexual behaviour and risk of HIV acquisition among migrants in comparison to non-migrants calls for increased reliance on the targeted and best-combination HIV prevention strategies. | Several the existing studies examining multiple partnering did not collect data on the characteristics of the sexual partnerships, such as the length of overlaps between and the type of sexual partners. This information is particularly important in determining transmission during concurrent partnerships |
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Gagnon et al. 2009 (MA) | To understand why migrant women have poorer perinatal health outcomes than receiving country women | Perinatal health outcomes (preterm birth, low birthweight and health-promoting behavior) | (1) Place of origin | Being a migrant was not a consistent marker of risk of poorer perinatal health outcomes; migrants did as well as or better than host-county women for all outcomes in a large proportion of studies. However, Asian, North-, and other-African migrants were at greater perinatal health risk than their receiving-country counterparts in the small number of studies that could be included in meta-analyses for each subgroup. | Insufficient data to do a meta-analysis by receiving country. Despite the large number of studies of migration and perinatal health, only limited data were available to shed light on why certain groups of migrants were at higher risk. There is an absence of data on other key notions correlated with migration, such as language ability, length of time in receiving country or immigration status. |
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Gissler et al. 2009 (SLR) | To determine (1) if migrants in western industrialized countries have higher risks of stillbirth, neonatal mortality, or infant mortality, (2) if there are migrant sub-groups at potentially higher risk, and (3) explanations for risk differences found. | Feto-infant mortality including stillbirths, early neonatal deaths (a death occurring 0–6 days after birth), perinatal deaths (stillbirths and early neonatal deaths), neonatal deaths (a death occurring 0–27 days) and infant deaths (a death occurring 0–364 days) |
| Mortality risk among migrant babies born is not consistently higher, but appears to be greatest among refugees, non-European migrants to Europe, and foreign-born blacks in the US. | Limitations in the available data on potentially important risk factors. |
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Heaman et al. 2013 (SLR) | To determine whether migrant women in Western industrialized countries have higher odds of inadequate prenatal care (PNC) compared to receiving-country women | Prenatal care access; health disparities between migrants and non-migrants |
| Migrant women were more likely to receive inadequate PNC than receiving-country women. The odds of inadequate PNC were greater among migrant women younger than 20 years, multiparous, single, with poor or fair language proficiency, less than 5 years of education, unplanned pregnancy, and no health insurance. | Most included studies (70%) were from the US. A consistent definition of inadequate PNC was missing. Another limitation was the comparison groups used in the included studies: most US studies used white receiving-country-born women as the comparison group, while the European studies usually used all country-born women. In addition, studies did not control consistently for potential confounders. |
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Merry et al. 2013 (MA) | To determine if migrants in Western industrialized countries have different rates of caesarean than host-country-born women and to identify associated factors | Caesarean rates disparities between migrants and non-migrants; birth outcomes |
| Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali, and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, gestational diabetes /high BMI, feto-pelvic disproportion, and inadequate prenatal care. | The web searches, although extensive, did not include all the government and professional agency websites from all OECD countries. Most included studies were rated as ‘fair’ quality for not controlling for confounding or due to some ambiguity in their definitions of the study groups. There was heterogeneity for the meta-analysis due to variation in the migrant populations studied or how source countries were grouped to represent regions. |
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Platt et al. 2013 (SLR) | To assess the evidence of differences in the risk of HIV, sexually transmitted infections (STI), and health-related behaviors between migrant and non-migrant female sex workers (FSWs). | HIV, STIs, and risk behavior (practicing of anal sex with clients and accepting of extra money for unprotected sex, vaginal douching with an over the counter medication, undergoing a cervical smear test, termination, and use of contraceptives, use of alcohol or illegal drugs). |
| The lack of consistent differences in risk between migrants and non-migrants highlights the importance of the local context in mediating risk among migrant female sexual workers. The higher prevalence of HIV among some FSWs originating from African countries is likely to be due to infection at home where HIV prevalence is high. | Search was limited to literature written in English. Lack of a standardized definition of sex work. Similarly, inconsistency in the behavioral outcomes and the wide range of STI outcomes reported prevented any meta-analysis. |
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Small et al. 2014 (SLR) | To compare what it is known about migrant and non-migrant women’s experiences of maternity care | Migrant women’s experiences of maternity care (overall expectations regarding maternity care: pregnancy care, intrapartum care, postpartum care) | Migrant women vs. non-migrant women | Migrant and non-migrant women desire similar things from maternity care: safe, high quality, attentive and individualized care, with adequate information and support. Migrant women are less positive about their care than non-migrant women. Lack of familiarity with care systems and communication problems impacted negatively on migrant women’s experiences, as did perceptions of discrimination and disrespectful care. In sum, women want: Q = Quality care that promotes wellbeing for mothers and babies with a focus on individual needs. U = Unrushed caregivers with enough time to give information, explanations and support. I = Involvement in decision-making about care and procedures. C = Continuity of care with caregivers who get to know and understand women’s individual needs and who communicate effectively. K = Kindness and respect. | Globally, relatively few countries have undertaken population-based studies of women’s experiences of their maternity care. Of these, only the Canadian study has used a multi-language strategy in an attempt to address the under-representativeness of migrant women in population studies, and the Australian research involved a companion study of three migrant groups in tandem with one of the three population surveys undertaken there. Recent waves of migration in the European Union and of refugee and asylum-seeking arrivals are not yet well represented. |
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Urquia et al. 2010 (SLR) | To clarify the relation between migration and these birth outcomes by determining the differences in low birth weight (LBW) and preterm birth (PTB) between migrants and non-migrants by migrant subgroups | Birth outcomes disparities between migrants and non-migrants; international disparities of prenatal healthcare |
| The association between foreign-born status and birth outcomes varies according to the migrant subgroup, either defined by a combination of maternal race/ethnicity and migrant status or by the world region of origin and actual destination. Sub-Saharan African and Latin-American and Caribbean migrants were at higher odds of LBW in Europe but not in the USA, and south-central Asians were at higher odds in both continents. | As the social and historical complexity involved in each migrant population was not explored in a meta-analysis, findings should be regarded as global tendencies which may not apply to migrant subgroups settling countries, regions, or cities. Another potential source of bias results from self-reported race/ethnicity and country of birth and nationality in birth certificates. |
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Villalonga-Olives et al. 2017 (SLR) | To review the literature regarding health and migration in US and Europe to observe which features can influence reproductive health outcomes among migrants | Pregnancy outcomes; migrant health disparities between US and Europe |
| The differences in migrant health between the US and Europe could be due to US migrants being typically labor migrants, although this is a changing aspect, while migrants in Europe are more heterogeneous. The social environment of the receiving country is an important factor for health outcomes, but also the migration regime, meaning certain people arriving in migration waves (like refugees) could have poorer health outcomes. | US articles study health related outcomes of Latinos and do not consider the reasons for migration, which makes the comparisons between countries more difficult. | There is a need to understand migration trends and reasons as they heavily contribute to health outcomes. |
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Alarcão, V.; Stefanovska-Petkovska, M.; Virgolino, A.; Santos, O.; Costa, A. Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity. Soc. Sci. 2021, 10, 63. https://doi.org/10.3390/socsci10020063
Alarcão V, Stefanovska-Petkovska M, Virgolino A, Santos O, Costa A. Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity. Social Sciences. 2021; 10(2):63. https://doi.org/10.3390/socsci10020063
Chicago/Turabian StyleAlarcão, Violeta, Miodraga Stefanovska-Petkovska, Ana Virgolino, Osvaldo Santos, and Andreia Costa. 2021. "Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity" Social Sciences 10, no. 2: 63. https://doi.org/10.3390/socsci10020063