Elsevier

Midwifery

Volume 26, Issue 4, August 2010, Pages 407-414
Midwifery

Pregnancy health status of sub-Saharan refugee women who have resettled in developed countries: a review of the literature

https://doi.org/10.1016/j.midw.2008.11.002Get rights and content

Abstract

Objective

to present the literature relating to health status and pregnancy complications among sub-Saharan African women.

Background

sub-Saharan refugee women constitute a new and growing group of maternity service users in developed countries today. These women are perceived to be at high risk of pregnancy complication, based on concurrent disease and unusual medical conditions. As a result of these concerns, midwives may feel ill equipped to provide their pregnancy care.

Method

searches were conducted of CINAHL, Maternity and Infant Care, MEDLINE and PsychINFO databases using the search terms ‘migrants’, ‘Africa’, ‘sub-Saharan’, ‘pregnancy’, ‘refugees’ and ‘women’. Additional articles were located by pursuing references identified in key papers.

Findings

pregnant sub-Saharan women present as an at-risk population related to poor prior health, co-existing disease and cultural practices such as female genital mutilation. Nonetheless, principal pregnancy complications for this population include anaemia and high parity, rather than exotic disease. Higher rates of infant mortality and morbidity appear to persist following resettlement, and are not explained by maternal risk factors alone. Limited access to care is of concern.

Key conclusions

further research is warranted into the impediments to care uptake among sub-Saharan African women. It is hoped that such research will inform the development of culturally appropriate and acceptable services for African refugees.

Implications for practice

it is important that midwives are aware of common health problems among sub-Saharan women. Midwives also need to act to promote access to health services among this group. Social disadvantage and late access to care may impact on neonatal outcomes and thus warrant investigation.

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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