Undocumented migrants lack access to pregnancy care and prevention

Article Article scientifique Article Undocumented migrants lack access to pregnancy care and prevention eng 2008 author Wolff Hans 45574 author Epiney Manuela 850809 Emmanuela Epiney author Lourenco Ana Paula 92693 author Costanza Michael 112187 author Delieutraz-Marchand Jacqueline author Andreoli Nicole author Dubuisson Jean-Bernard 135306 author Gaspoz Jean-Michel 126367 author Irion Olivier 125635 93 10.1186/1471-2458-8-93 18366690 1471-2458 http://www.biomedcentral.com/1471-2458/8/93 BACKGROUND: Illegal migration is an increasing problem worldwide and the so-called undocumented migrants encounter major problems in access to prevention and health care. The objective of the study was to compare the use of preventive measures and pregnancy care of undocumented pregnant migrants with those of women from the general population of Geneva, Switzerland. METHODS: Prospective cohort study including pregnant undocumented migrants presenting to the University hospital from February 2005 to October 2006. The control group consisted of a systematic sample of pregnant women with legal residency permit wishing to deliver at the same public hospital during the same time period. RESULTS: 161 undocumented and 233 control women were included in the study. Mean ages were 29.4 y (SD 5.8) and 31.1 y (SD 4.8) (p < 0.02), respectively. 61% of undocumented women (controls 9%) were unaware of emergency contraception (OR 15.7 (8.8;28.2) and 75% of their pregnancies were unintended (controls 21%; OR 8.0 (4.7;13.5)). Undocumented women consulted for an initial pregnancy visit more than 4 weeks later than controls and only 63% had their first visit during the first trimester (controls 96%, p < 0.001); 18% had never or more than 3 years ago a cervical smear test (controls 2%, OR 5.7 (2.0;16.5)). Lifetime exposure to violence was similar in both groups, but undocumented migrants were more exposed during their pregnancy (11% vs 1%, OR 8.6 (2.4;30.6)). Complications during pregnancy, delivery and post-partum were similar in both groups. CONCLUSION: Compared to women who are legal residents of Geneva, undocumented migrants have more unintended pregnancies and delayed prenatal care, use fewer preventive measures and are exposed to more violence during pregnancy. Not having a legal residency permit therefore suggests a particular vulnerability for pregnant women. This study underscores the need for better access to prenatal care and routine screening for violence exposure during pregnancy for undocumented migrants. Furthermore, health care systems should provide language- and culturally-appropriate education on contraception, family planning and cervical cancer screening. Adult Contraception, Postcoital/utilization Female Health Services Accessibility/statistics & numerical data Hospitals, Public Hospitals, University Humans Maternal Health Services/statistics & numerical data Pregnancy Pregnancy Complications/epidemiology Pregnancy, Unplanned Preventive Health Services/statistics & numerical data Prospective Studies Switzerland Transients and Migrants/legislation & jurisprudence/psychology/statistics & numerical data Violence Dewey 613 Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 66 Institut de santé globale 22A1 false 16 Groupe Jean-Michel Gaspoz 23 213 Martinez De Tejada Begona 272 BMC public health 8 6df6eabf-67ee-4c98-a579-cd42f8059e8d Article (Accepted version) Public Article.pdf 288866 application/pdf CC BY openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de santé globale

Title	Published in	Year	Views	Downloads

Undocumented migrants lack access to pregnancy care and prevention	BMC public health	2008	893	740
In a quasi-simultaneous assessment, imprecise cholesterol monitoring and screening tests were improved	Journal of Clinical Epidemiology	2005	149	0

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Costanza, Michael