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Medical and social characteristics according to mothers' immigrant and naturalization status
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Background: Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities
are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship
status. Methods: This was a population-based study using 2008 data from the Belgian birth regi...
Context in source publication
Context 1
... malformation rate was 1.3% for both naturalized and non-naturalized mothers (P = 0.95), and 1.2% for non-immigrants (P-value for non-immigrants vs. immigrants = 0.09). Table 2 summarizes the distribution of medical and socio-demographic differences according to naturalization status. Non-naturalized immigrants had lower parity and were more likely to be <20-year old than their naturalized counterparts. ...
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Citations
... The classical conceptualization of migration as a binary link between the country of origin and the destination disregards the complexity of the phenomenon (Ahrens et al., 2016;de Hoon et al., 2019) by not considering, among others, key aspects such as return and/or onward migration (Borjas and Bratsberg, 1996;Cassarino, 2004). Within this simplistic framework, studies on naturalization have focused primarily on its consequences in terms of access to the labour market (DeVoretz and Pivnenko, 2005; for Switzerland, Fibbi et al., 2007;Bevelander and Pendakur, 2012), political participation (Just and Anderson, 2012), health (Minsart et al., 2013), social integration (Bloemraad et al., 2008;Hainmueller et al., 2017), and discrimination, with relatively few and only recent studies examining the relation between naturalization and subsequent international migration (Ahrens et al., 2016;Ramos et al., 2018;de Hoon et al., 2019). In the European case, this relationship is particularly relevant both in demographic and political terms given the asymmetry of intra-European mobility rights between citizens of UE/EFTA 1 countries and third-country nationals (non-EU/EFTA). ...
The notion of residential settlement associated with the acquisition of new citizenship has been recently challenged by a number of studies highlighting its instrumentality as a subsequent mobility factor. The long and diverse history of Switzerland as a country of immigration and the availability of rich data on naturalization and international migration that allow individuals to be followed over time make this country a valuable case for investigating the impact of naturalization on international (return or onward) migration. Using longitudinal data, we follow 88,900 immigrants who entered the country between 1998 and 2000 over a period of 84 months between January 2011 and December 2017, documenting changes in naturalization status and in migratory movements and their direction. Using different implementations of a Cox proportional hazards model, we examine whether and under what conditions the international migration behaviour of naturalized persons differs from that of non-naturalized persons. Our results show that the population accessing naturalization tends to be less mobile, but also that among third-country nationals, naturalization can trigger further international mobility, in particular among those with poor economic performance and with no family ties in Switzerland.
... Muslim women from other origins and women who gave birth at home were excluded, as well as un-documented immigrants since their status can be linked to very specific healthcare problems. [9,39] At first, we also excluded women who were not able to speak Dutch fluently due to extra sensitivities and risk of bias when interviewing with an interpreter. ...
Objectives
To reach nuanced understanding of the perinatal experiences of ethnic minority women from Turkish and Moroccan descent giving birth in maternity wards in Belgium thereby gaining insight into the underlying challenges of providing intercultural care for ethnic minority persons in a hospital setting.
Methods
A qualitative study design was used by conducting In-depth interviews with 24 women from Turkish and Moroccan descent who gave birth during the past three years in maternity wards in Flanders, Belgium. The interviews were analysed using a Grounded Theory Approach.
Results
This study shows that the women’s care experiences were shaped by the care interactions with their caregivers, more specifically on the attention that was given by the caregivers towards two essential dimensions of the care relationship, viz. Ereignis (attention to what happens) and Erlebnis (attention to how it happens). These two dimensions were interrelated in four different ways, which defined the women’s care experiences as being either ‘uncaring’, ‘protocolized’, ‘embraced’ or ‘ambiguous’. Moreover, these experiences were fundamentally embedded within the women’s cultural context, which has to be understood as a relational process in which an emotional and moral meaning was given to the women’s care expectations, interactions and interpretations of care.
Conclusions
The findings reveal that the quality of intercultural care depends on the nature and quality of care interactions between ethnic minority patients and caregivers much more than on the way in which cultural questions and tensions are being handled or dealt with in a practical way. As such, the importance of establishing a meaningful care relationship should be the priority when providing intercultural care. In this, a shift in perspective on ‘culture’ from being an ‘individual culture-in-isolation’ towards an understanding of culture as being inter-relational and emerging from within these care relationships is necessary.
... Un estudio parece utilizar el país de nacionalidad de ambos progenitores (parents citizenship), aunque no se define claramente si ambos o cualquiera de los dos deben tener nacionalidad extranjera 62 . Además, dos estudios utilizan tanto el país de nacionalidad de la madre como el del padre, pero de forma independiente 54,57 . ...
... Por otro lado, la consideración de ambos progenitores o solo de uno de ellos para la transmisión del estatus migratorio no parece seguir un patrón en la literatura. Mientras algunos estudios utilizaron el origen migratorio de ambos progenitores a la vez 25,[35][36][37][38][39] , lo más frecuente fue considerar como migrante al descendiente de al menos un progenitor migrante, ya fuera solo la madre [18][19][20][21][22][23][24]52,[54][55][56][57][58][59][60][61] , especialmente en los estudios de salud perinatal, o bien cualquiera de los dos [25][26][27][28][29][30][31][32][33][34]54,57 . La mayoría de los estudios no justifican el uso de la variable elegida, explican escasamente su elección y no reflexionan sobre la idoneidad de esta o su posible impacto en los resultados, seguramente por la imposibilidad de elegir entre más de una variable dada la limitada disponibilidad de información diversa sobre el estatus migratorio en las bases de datos. ...
... Por otro lado, la consideración de ambos progenitores o solo de uno de ellos para la transmisión del estatus migratorio no parece seguir un patrón en la literatura. Mientras algunos estudios utilizaron el origen migratorio de ambos progenitores a la vez 25,[35][36][37][38][39] , lo más frecuente fue considerar como migrante al descendiente de al menos un progenitor migrante, ya fuera solo la madre [18][19][20][21][22][23][24]52,[54][55][56][57][58][59][60][61] , especialmente en los estudios de salud perinatal, o bien cualquiera de los dos [25][26][27][28][29][30][31][32][33][34]54,57 . La mayoría de los estudios no justifican el uso de la variable elegida, explican escasamente su elección y no reflexionan sobre la idoneidad de esta o su posible impacto en los resultados, seguramente por la imposibilidad de elegir entre más de una variable dada la limitada disponibilidad de información diversa sobre el estatus migratorio en las bases de datos. ...
Objective:
To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe.
Method:
A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described.
Results:
50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained.
Conclusions:
There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.
... The few studies on the link between health and naturalisation produced mixed results. In line with the view that naturalisation is an important step towards integration, Minsart et al. (2012) showed that the acquisition of the Belgian citizenship is protective of perinatal mortality. Minsart et al. sustained that naturalised immigrant mothers are significantly less affected by perinatal death in a country with a very liberal naturalization policy, such as in Belgium, where access to health care is universal. ...
... Naturalisation acts as an instrument of integration which ensures better health (cf. Minsart et al., 2012), the younger an immigrant is upon arrival. On the other hand, the acquisition of the U.S. citizenship may occur more frequently in case of poor health, because it lifts restricted access to health care programmes. ...
... In the limited literature on the link between naturalisation and health (e.g. Minsart et al., 2012;Gubernskaya et al., 2013;Riosmena et al., 2015), the acquisition of the host-country citizenship is often regarded as an important step towards integration which ensures better health. This argument is consistent with the evidence of Bollini et al. (2009) who show a lower risk of perinatal mortality in countries with a strong integration policy measured by an easier access to naturalisation. ...
Naturalised migrants are found to have a higher human capital endowment as they are more educated, more likely to be employed or have higher earnings than non-naturalised migrants. But little is known about how naturalisation affects health. Since 2007, Germany has recognised dual citizenship, while Austria still does not grant this right to their citizens. In the present paper, we exploit this policy change as a source of exogenous variation to identify the causal impact of dual citizenship on health and labour market outcomes. Based on panel data from the Swiss Labour Force Survey for the years 2003-2009, we first show that German migrants (who were granted the right of dual citizenship) are more likely to acquire the Swiss nationality compared to Austrian migrants (for whom the law has remained unaltered). Overall, the effects of dual citizenship rights on health and labour market outcomes are not significant. Behind this general picture, however, there are heterogeneous effects of the policy change, in particular in terms of health outcome. For instance, the legalisation of dual citizenship improves health for young foreign-born or Swiss-born Germans relative to their Austrian peers. A direct policy implication of these results would be that naturalisation should be facilitated at younger ages in order to enhance young migrants’ health and thus avoid any negative financial repercussions on the health system.
... The study population includes recent immigrants and families living often in poor socio-economic conditions. In Belgium, as in most part of the world, childhood mortality is associated with family income [39]. The role of these factors in the susceptibility of HEU infants to infections could not be evaluated in our study because socio-economic indicators were not available retrospectively. ...
Background:
Several studies indicate that HIV-exposed uninfected (HEU) children have a high infectious morbidity. We previously reported an increased incidence of group B streptococcus (GBS) infections in HEU infants born in Belgium.
Methods:
This study was undertaken to evaluate the incidence and risk factors of all cause severe infections in HEU infants born in Belgium between 1985 and 2006, including the pre-antiretroviral (ARV) prophylaxis era (1985 to 1994). The medical charts of 537 HEU infants followed in a single center were reviewed.
Results:
The incidence rate of severe infections during the first year of life was 16.8/100 HEU infant-years. The rates of invasive S. pneumoniae (0.62/100 infant-years) and GBS infections (1.05/100 infant-years) were, respectively, 4 and 13-fold higher in HEU infants than in the general infant population. Preterm birth was a risk factor for severe infections in the neonatal period (aOR = 21.34, 95%CI:7.12-63.93) and post-neonatal period (aHR = 3.00, 95%CI:1.53-5.88). As compared to the pre-ARV prophylaxis era, infants born in the ARV prophylaxis era (i.e., after April 1994) had a greater risk of severe infections (aHR = 2.93; 95%CI:1.07-8.05). This risk excess was present in those who received ARV prophylaxis (aHR 2.01, 95%CI 0.72-5.65) and also in those born in the ARV prophylaxis era who did not benefit from ARV prophylaxis as a result of poor access to antenatal care or lack of compliance (aHR 3.06, 95%CI 0.88-10.66).
Conclusions:
In HEU infants born in an industrialized country, preterm birth and being born during the ARV prophylaxis era were risk factors of severe infections throughout the first year of life. These observations have important implications for the clinical management of HIV-infected mothers and their infants.
... Un ejemplo particularmente grave de desigualdades en salud es el que afecta a mujeres embarazadas, madres, recién nacidos y niños, como grupos de particular vulnerabilidad. Investigaciones realizadas en diversos países europeos como Holanda (Zwart et al., 2010), Bélgica (Minsart, Englert & Buekens, 2012), España (Luque, Bueno & de Mateo, 2010;Luque, Gutiérrez & Bueno, 2010) el Reino Unido (Lewis, 2007) y Portugal (Machado et al., 2007), entre otros, han mostrado que las mujeres inmigrantes tienden a sufrir mayores tasas de mortalidad y morbilidad infantil y materna, y suelen mostrar peores indicadores de salud materno-infantil, tales como menor peso del bebé al nacer, mayor número de partos prematuros, mayores tasas de depresión postparto, o mayor frecuencia de complicaciones durante el embarazo y el parto, con severas implicaciones sobre la salud y el desarrollo infantil. ...
The main aim of this paper is to critically examine the adequacy of cultural competence as a strategy to reduce health inequalities in contexts of migration-driven diversity. After a brief historical overview of the emergence and evolution of this concept, cultural competence policies and practices are severely criticized due to their inability to transform the conditions leading to inequalities in health and healthcare in contexts of diversity, particularly in current times of crisis and austerity.
... In contexts of migration-driven diversity, the impact of the financial crisis may be even more pernicious, taking into consideration wide empirical evidence showing that immigrants and ethnic minorities tend to have worse health and more limited access to quality healthcare when compared to the broader general population (Ingleby, Chiarenza, Devillé, & Kotsioni, 2012;Ingleby, Krasnik, Lorant, & Razum, 2012; World Health Organization [WHO] Regional Office for Europe, 2010). In the particular case of maternal-child health, research conducted in a variety of European countries has shown that immigrant women tend to suffer higher infant and maternal morbidity and mortality rates, increased premature births, higher rates of postpartum depression, and more frequent complications during pregnancy and childbirth (Almeida, Caldas, Ayres-de-Campos, Salcedo-Barrientos, & Dias, 2013;Luque, Bueno, & de Mateo, 2010;Luque, Gutiérrez, & Bueno, 2010;Minsart, Englert, & Buekens, 2012;Zwart et al., 2010). The same pattern has been observed in the specific case of Portugal, where immigrant women tend to have increased premature childbirths, more health problems during pregnancy, and higher rates of fetal and neonatal mortality (Machado, 2008;Machado et al., 2007). ...
Adoptando una aproximación psico-sociopolítica, en el presente trabajo se describen los resultados de una evaluación de necesidades percibidas por las mujeres en edad reproductiva como usuarias de cuidados de salud primarios en contextos de diversidad asociada a la inmigración y vulnerabilidad socio-económica, en el área metropolitana de Lisboa. Se llevaron a cabo 64 entrevistas en profundidad a mujeres, tanto autóctonas como inmigrantes, de los principales países de origen en el contexto analizado (Brasil, Cabo Verde y otros países africanos de lengua oficial portuguesa) y una encuesta en la que participaron 125 mujeres, tanto autóctonas como inmigrantes, procedentes de los mencionados países. El papel central de la metodo-logía cualitativa y la Teoría Fundamentada, en el marco de una investigación multimétodo, permitió comprender cómo las necesidades de las mujeres se insertan en contextos caracterizados por relaciones de poder asimétricas, basadas en el acceso desigual a los recursos y oportunidades, a múltiples niveles ecológicos, interrelacionados entre sí (personal, relacional, organizacional, comunitario, socioeconómico, sistema/políticas de salud, cultura/migración). Las necesidades prioritarias identificadas se relacionan principalmente con la situación de desventaja socio-económica en la que se encuentran las mujeres, agravada en el actual contexto de crisis, y con factores a nivel de sistema de salud, tales como el acceso desigual al médico de familia, las elevadas listas de espera, o los costes cada vez mayores de la atención sanitaria. En este sentido, los resultados obtenidos permiten cuestionar la adecuación de la competencia cultural como estrategia para reducir las desigualdades en salud materno-infantil en el contexto objeto de estudio, mostrando el valor de la metodología cualitativa y la teoría fundamentada en la investigación sobre justicia social y salud en contextos de diversidad y dinámicas de poder asimétricas.
... • Le milieu socio-économique de cette population d'enfant est souvent bas, ce qui a une répercussion sur la morbidité infectieuse comme le montre les rapports de l'observatoire de la santé de Bruxelles [160]. En Belgique, il apparaît aussi que la population d'immigrants récents (non naturalisés) présente une mortalité périnatale plus grande comme l'a montré une étude récente du CEPIP [161]. ...
... [9] has shown that the risk of perinatal mortality is significantly reduced 329 in countries with a strong integration policy including Belgium. By com-330 paring perinatal mortality rates among immigrant mothers according to 331 citizenship status, a recent study in Belgium [21] revealed that the nat-332 uralization status of immigrants was associated with a decreased risk of 333 perinatal mortality. Naturalized immigrant mothers had a lower inci-334 dence of perinatal mortality (6.1‰) compared with their non-335 naturalized counterparts (10.3‰) with an adjusted OR of 2.2 (95% CI, 336 1.1-4.5). ...
To compare fetal and infant mortality between immigrant and native-born mothers in Flanders, Belgium.
In a population-based study, data from 326 166 neonatal deliveries, collected by the Study Center for Perinatal Epidemiology and the Belgian Civil Birth Registration system between January 2004 and December 2008, were analyzed. Immigrant mothers were defined as women born in any country other than Belgium, and were grouped by country of origin according to the World Bank Atlas definition of low-, middle-, and high-income countries. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between immigration and fetal/infant outcome.
In univariate analysis, fetal and infant mortality rates were significantly higher among immigrants than among native-born mothers (fetal: crude OR, 1.50; 95% CI, 1.29-1.75; infant: crude OR, 1.47; 95% CI, 1.29-1.67). Fetal/infant death rates were highest among mothers originating from low-income countries. In multivariate analysis, however, most differences became non-significant: only the early neonatal death rate remained significantly higher (adjusted OR, 1.30; 95% CI, 1.06-1.60), whereas the fetal death rate appeared lower (adjusted OR, 0.67; 95% CI, 0.57-0.80), among immigrant mothers.
After adjustment for relevant characteristics, fetal/infant mortality was comparable between immigrant women and native-born women in Flanders.
... It would be of interest in future studies to compare perinatal morbidity and mortality and circumstances of delivery in each immigrant subgroup. Women from sub-Saharan Africa have high perinatal mortality rates despite their high CS rate (7,20,21). Several factors may play an important role in this difference, such as language fluency and broader aspects of communication, intercurrent diseases and prenatal care (7). An English study has found an increased risk of CS in women from sub-Saharan Africa compared with native mothers despite adjusting for the number of prenatal visits and language fluency (9), and in Belgium, sub-Saharan African women come mostly from French-speaking countries. ...
Objective:
To provide insight into the differential effect of immigration on cesarean section (CS) rates, using the Robson classification.
Design:
A population-based study using birth certificates from the birth registry of 2009.
Setting:
All births in two of the three Belgian regions excluding Flanders.
Population:
37 628 deliveries from Belgian and immigrant mothers from sub-Saharan Africa, Maghreb and Eastern Europe.
Methods:
Multivariate analyses using CS as the dependent variable and immigration status as the primary independent variable. Several multivariate logistic regression models were built including medical, anthropometric, socio-economic characteristics, and medical interventions. The impact of analyzing all delivery sites together was tested using mixed-effect analyses.
Main outcome measures:
CSs of immigrant subgroups compared with Belgian women.
Results:
CS rates varied according to immigrant subgroups. Mothers from sub-Saharan Africa had an adjusted odds ratio of 2.06 (1.62-2.63) for CS compared with Belgian natives. Increased risk for mothers from sub-Saharan Africa compared with Belgian natives was found among nulliparous and multiparous women without previous CS, and a term, singleton fetus in cephalic position. In comparison, nulliparous East European mothers with a term singleton fetus in cephalic position in spontaneous labor had an adjusted odds ratio of 0.29 (0.08-0.99) for CS.
Conclusions:
CS rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from sub-Saharan Africa with a term, singleton infant in cephalic position, without previous CS, appear to carry the highest burden.
