Pregnancy health status of sub-Saharan refugee women who have resettled in developed countries: a review of the literature
Introduction
Worldwide trends of refugee resettlement mean that societies in developed countries are becoming more culturally diverse. For more than a decade, much of this increase has related to sub-Saharan1 African populations, displaced as a result of war and/or famine [Adams et al., 2004; Hampshire et al., 2004]. In Australia, for example, approximately 12,000 refugees holding humanitarian visas are accepted annually [Australian Government Department of Immigration and Multicultural Affairs, 2004, Australian Government Department of Immigration and Multicultural Affairs, 2005], and approximately 70% come from countries in sub-Saharan Africa. Most are from Eritrea, Somalia, Sudan, Ethiopia and Kenya (DIMIA, 2005; Harris and Zwar, 2006; Smith, 2006). Similar patterns of African refugee resettlement are reported in the USA, the UK and selected European countries (DIMIA, 2005). Globally, this increasing trend gives rise to a number of concerns for midwives, and there is a general perception among health-care professionals that sub-Saharan refugees are at risk for serious pregnancy complications based on pre-existing health issues and diseases, such as malaria, which are common in Africa but unusual in developed countries. Moreover, the real risks for African refugee women giving birth in developed countries are, as yet, unclear. These women constitute a relatively new maternity client group, and currently there is little literature available that explores their prior health status or pregnancy complications following resettlement. Therefore, midwives may be called upon to provide pregnancy care for sub-Saharan refugees without a clear understanding of concurrent health issues. This paper aims to review the current literature around health status and pregnancy complications for sub-Saharan African refugee women. The principal purpose of the review is to raise awareness among midwives of health issues experienced by this group of women.
Section snippets
Search methods
The literature search was conducted using the following electronic databases: CINAHL, Maternity and Infant Care, MEDLINE and PsychINFO. Search terms included: ‘migrants’, ‘women’, ‘refugees’ and ‘asylum seekers’ in combination with ‘pregnancy’, ‘Africa’ and ‘sub-Saharan’. Search parameters included publications within the past 10 years (1997–2007), and this time span was chosen as pertinent to the current wave of African refugee resettlement. In total, 238 papers were initially located and were
Findings
At the start of this review, it was hoped to consider papers, from host countries, which focused on the health status and pregnancy dilemmas of sub-Saharan refugee women. However, as the search progressed, it became clear that this pool of literature was very limited, so a decision was made to expand the search to include papers based on studies conducted in sub-Saharan Africa, from where most current refugees originate. The rationale for this expanded search was the likelihood of uncovering
Discussion
This review aimed to examine health status and likely pregnancy complications among sub-Saharan refugees attending maternity services in host countries. Literature came from two disparate sources: sub-Saharan Africa and developed countries receiving African migrants. However, whilst informative, the focus of the literature varied considerably and this is a limitation of the review. However, it is also a strength in that the broader literature has highlighted both pregnancy issues and likely
Conclusion
Language difficulties, cultural factors and health concerns present challenges to midwives everywhere who provide care for refugee women. Nonetheless, midwives are well placed to provide information for these vulnerable groups and, indeed, often provide the bulk of maternity services. Thus, they are potentially in a position to significantly influence refugee health behaviours. In order to prepare for this important role, midwives themselves need information and support. Such information may
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