Undocumented Pregnant Women:

Transcription

1 Undocumented Pregnant Women: What does the literature tell us? Kimberly Munro 1, Catherine Jarvis 2, Marie Munoz 2,3, Vinita D Souza 4, Lisa Graves 2 1 Facultéde médicine, Universitéde Montréal, Montréal, Québec 2 Department of Family Medicine, McGill University, Montréal, Québec 3 Centre de recherche et de formation, CSSS de la Montagne, Montréal, Québec 4 Herzl Family Practice Centre, Jewish General Hospital, Montréal, Québec

2 Outline Background Objectives Methods Synthesis Conclusions

3 Background There are no Canadian studies on undocumented pregnant women Undocumented pregnant women are a particularly vulnerable group Status limits access to prenatal and delivery services Prenatal care favours healthy maternal and infant outcomes Issue of individual and public health

4 Objective To provide a synthesis of the existing literature on the topic of undocumented pregnant women, regardless of research design

5 Literature review Methods January 1967 to August 2009 PubMed, Medline, CINAHL and EMBASE databases + relevant grey literature Keywords: pregnancy, medically uninsured, medical indigency, uncompensated care, insurance, health, refugee, undocumented, no status, clandestine, sans papiers, Canada, Canadian. Inclusion criteria: pregnancy-related issues with respect to undocumented migrant women

6 Synthesis Initial search retrieved 204 articles 95 articles following application of inclusion criteria Each reviewed by primary reviewer Classified into include, exclude, unsure Consensus on unsure Final sample of 22 articles

7 Synthesis (1): Documenting the issue Very little information exists Demographics vary by host country Ex. US=Mexico, Switzerland=SA, France=SSA Some consistent features between populations Young, single, low-income domestic employment, lack of health insurance

8 Synthesis (2): Prenatal care Less access (Chavez et al., 1986; Barlow et al., 1994) Status cited as a reason for not seeking care (Blondel & Marshall, 1996; Higgins & Burton, 1996) Delayed/Inadequate (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff et al., 2008)

9 Synthesis (3): Prenatal care Lack of prenatal care associated with less favourable birth outcomes Low birth-weight infants (Lu et al., 2000) More costs to system later STI-related adverse birth outcomes (Kuiper et al., 1999; Wolff et al. 2008b) Costs to system Public health

10 Synthesis (4): Delivery Conflicting evidence Study site (PNC vs. no PNC, tertiary care, etc.) Number of participants (complications are rare) Admitted at later stage, less epidural, shorter hospital stay (Barlow et al., 1994) More complications (Reed et al. 2005) Similar rates of complications (Wolff et al. 2008)

11 Synthesis (5): Birth outcomes Conflicting evidence Less favourable (Lejeune 1998; Barlow et al., 1994) No difference (Kelaher & Jessop, 2002; Wolff et al., 2008) More favourable (Reed et al., 2005) Lower rates preterm delivery & LBW infants, despite higher rates of pregnancy-related risk factors «Healthy Migrant Effect»

12 Synthesis (6): Programs Few policies specific to the needs of undocumented populations (Wolff et al. 2000) Few publications on programs targeting undocumented women Programs developed on an ad-hoc basis Patchwork programming leads to confusion/reticence in care seeking behaviours (Castañeda, 2008)

13 Synthesis (7): Programs Dar a Luz (Carillo, Pust, & Borbon, 1986) Initiated in September 1980 in Tucson, Arizona Free community clinic 274 clients registered in first three years Prenatal care for pregnant Hispanic women Trained patient advocates assigned to each woman Childbirth education during weekly clinics Informed local hospitals of program Women presented at emergency room with prenatal records No formal agreement

14 Synthesis (8): Programs Unité mobile de soins communautaires (UMSCO) (Durieux-Paillard et al., 1999; Wolff, 2004) Opened in January 1997 as a result of partnership between hospital and city > 95% patients are undocumented migrants Mobile clinic Spanish-speaking staff 2002 agreement between UMSCO and University Hospital facilitated access to care for pregnant undocumented women

15 Conclusions Information Better documentation is needed Programs Stakeholders must be informed on policies and available resources Political participation can help mobilize resources Organization of services must take into account the unique aspects of each population Public health Advocacy tool

16 Thank you

17 References Barlow, P., Haumont, D., & Degueldre, M. (1994). Devenir obstérical et périnatal des patientes sans couverture sociale. Rev Méd Brux, 15, Blondel, B., & Marshall, B. (1996). Les femmes peu ou pas suivies pendant la grossesse: Résultats d'une étude dans 20 départements. J Gynécol Obstet Biol Reprod, 25, Carrillo, J. M., Pust, R. E., & Borbon, J. (1986). Dar a Luz: A Perinatal Care Program for Hispanic Women on the US-Mexico Border. American Journal of Preventive Medicine, 2(1), Castañeda, H. (2008). Paternity for Sale: Anxieties over "Demographic Theft" and Undocumented Reproduction in Germany. Medical Anthropology Quarterly, 22(4), Caulford, P., & Vali, Y. (2006). Providing healthcare to medically uninsured immigrants and refugees. CMAJ, 174(9), Chavez, L. R., Cornelius, W. A., & Williams Jones, O. (1986). Utilization of Health Services by Mexican Immigrant Women in San Diego. Women and Health, 11(2), Durieux-Paillard, S., Figueras, G., Tuosto-Aeschliman, R., Rollier, V., Maso, P., & Stalder, H. (1999). Précarité et accès aux soins: À Genève, l'hôpital sort de ses murs. Med Hyg, 57(2270),

18 References (1) Higgins, P. G., & Burton, M. (1996). New Mexico Women With No Prenatal Care: Reasons, Outcomes and Nursing Implications. Health Care for Women International, 17, Kelaher, M., & Jessop, D. J. (2002). Differences in low-birthweight among documented and undocumented foreign-born and US-born Latinas. Social Science and Medicine, 55, Kuiper, H., Richwald, G. A., Rotblatt, H., & Asch, S. (1999). The communicable disease impact of eliminating publicly funded prenatal care for undocumented migrants. Maternal and Child Health Journal, 3(1), Lejeune, C., Fontaine, A., Crenn-Hebert, C., Paolotti, V., Foureau, V., & Lebert, A. (1998). Recherche-action sur la prise en charge médicosociale des femmes enceintes sans couverture sociale. J Gynécol Obstet Biol Reprod, 27, Lu, M. C., Lin, Y. G., Prietto, N. M., & Garite, T. J. (2000). Elimination of public funding of prenatal care for undocumented immigrants in California: A cost-benefit analysis. American Journal of Obstetrics and Gynecology, 182(1),

19 References (2) Reed, M. M., Westfall, J. M., Bublitz, C., Battaglia, C., & Fickenscher, A. (2005). Birth outcomes in Colorado's undocumented immigrant population. BMC Public Health, 5(100). Wolff, H., Durieux-Paillard, S., Meynard, A., & Stalder, H. (2000). Précarité et accès aux soins: Mieux vaut être riche et en bonne santé que pauvre et malade. Med Hyg, 58, Wolff, H., Epiney, M., Lourenço, A. P., Costanza, M. C., Delieutraz- Marchand, J., Andreoli, N., et al. (2008). Undocumented migrants lack access to pregnancy care and prevention. BMC Public Health, 8(93). Wolff, H., Laurenço, A., Bodenmann, P., Epiney, M., Uny, M., Andreoli, N., et al. (2008b). Chlamydia trachomatis prevalence in undocumented migrants undergoing voluntary termination of pregnancy: a prospective cohort study. BMC Public Health, 8(391)