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Public health
Research
Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study
  1. Susitha Wanigaratne1,2,
  2. Yogendra Shakya3,4,
  3. Anita J Gagnon5,
  4. Donald C Cole4,
  5. Meb Rashid6,
  6. Jennifer Blake7,
  7. Parisa Dastoori1,3,
  8. Rahim Moineddin8,
  9. Joel G Ray2,9,10,11,
  10. Marcelo L Urquia1,2,4,12
  1. 1 Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
  2. 2 Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  3. 3 Access Alliance Multicultural Health and Community Services, Toronto, Canada
  4. 4 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5 Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
  6. 6 Crossroads Medical Clinic, Women’s College Hospital, Toronto, Ontario, Canada
  7. 7 Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
  8. 8 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9 Keenan Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
  10. 10 Department of Medicine, University of Toronto, Toronto, Canada
  11. 11 Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
  12. 12 Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Susitha Wanigaratne; wanigaratnes{at}smh.ca

Abstract

Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes.

Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data.

Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.

Primary outcomes Numerous adverse maternal and perinatal health outcomes.

Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers.

Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.

  • epidemiology
  • maternal medicine
  • perinatology
  • public health
  • social medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-018979

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    Footnotes

    • Contributors SW conceived the research questions, designed the study, conducted statistical analysis, interpreted the results and wrote the first and subsequent drafts of the manuscript. RM, JGR and MLU contributed to the research design and data analysis. YS, AG, DCC, MR, JB, PD, RM, JGR and MLU contributed to data interpretation and revisions of the manuscript. MLU and JGR obtained funding. All authors approved the final version of the submitted manuscript.

    • Funding This study was funded by a grant from the Canadian Institutes of Health Research (CIHR) (MOP 137110). SW is supported by a postdoctoral fellowship funded from this grant. MLU holds a Canada Research Chair in Applied Population Health. JGR holds a CIHR Chair in Reproductive, Child and Youth Health Services and Policy Research.

    • Disclaimer Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was approved by the Institutional Review Board at Sunnybrook Health Sciences Centre, and the Ethics Review Board of St. Michael’s Hospital, Toronto, Canada.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data available from this study.