Improving maternity care and obstetric outcomes for immigrant women

Rhonda Small in collaboration with the Victorian Perinatal Data Collection Unit and the NSW Midwives’ Data Collection
Around 15 per cent of births in Australia are to immigrant women born in countries where English is not the principal language spoken (NES-countries). Considerable variation in outcomes (eg obstetric interventions, mode of delivery) by maternal country of birth occurs but the reasons remain unknown.  Is the variation in outcomes by maternal country of birth explained by social and obstetric differences between the groups or by a more subtle interplay of non-medical and contextual factors, such as communication difficulties adversely affecting care? 
This project is addressing already identified problems of public health importance in relation to obstetric outcomes and experiences of maternity care for immigrant women of non-English speaking backgrounds in Australia. These include a range of unexplained variations in obstetric outcomes by maternal country of birth; evidence for higher standardised perinatal mortality ratios among well grown term infants of women born in NES-countries (suggesting possible cause for concern about the role of communication difficulties in decision-making during labour and birth in these poorer outcomes); and consistently poorer ratings of maternity care by immigrant women from NES-countries giving birth in Victoria, over the period 1989-2000.
The project aims to provide a more comprehensive understanding of immigrant women’s obstetric outcomes. In 2007 the focus has been on outcomes for women from recent refugee communities, particularly Somalia; and on variations in caesarean section by maternal country of birth.

FUNDING: NHMRC Career Development Award (2005-2009)
STATUS: Ongoing; two papers in preparation

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The experience of maternity care and depression after birth among women from Iran and Afghanistan in Melbourne

Touran Shafiei and Rhonda Small in collaboration with Helen McLachlan, Division of Nursing and Midwifery, La Trobe University
This study aims to explore the experience of childbirth and views of maternity care of immigrant women from Iran and Afghanistan; to investigate women’s emotional well-being and experience of depression after birth; and to compare the findings with previous Victorian studies of Australian-born women and of other groups of immigrant women.
Iranian and Afghan women (n=47) were recruited from four Melbourne hospitals (Monash Medical Centre, Dandenong Hospital, the Mercy Hospital for Women and The Royal Women’s Hospital). Data collection has included a brief hospital visit or telephone call at home after the birth, main telephone interview 4 months after birth, and face-to-face in-depth interviews with up to 15 women exploring in more detail their experiences of their maternity care and of depression, support and use of services after the birth.

FUNDING: La Trobe University Postgraduate Research scholarship (2008-2009); Diamond Consortium Seed and Capacity Building Grant (2006-2007)
STATUS: Telephone interviews completed, analysis in progress, face-to-face interviews commenced

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Collaborative work

Reproductive Outcomes And Migration (ROAM): an international collaboration

Rhonda Small in collaboration with Anita Gagnon, McGill University, Canada; Sophie Alexander, Université libre de Bruxelles, Belgium; Béatrice Blondell, INSERM, France; Simone Buitendijk and Dineke Korfker, TNO Institute, Prevention and Health, The Netherlands; Marie Desmeules, Public Health Agency of Canada; Dominico DiLallo, Agency for Public Health of Rome, Italy; Mika Gissler, STAKES, Finland; Richard Glazier, Institute for Clinical Evaluative Sciences, Canada; Maureen Heaman, University of Manitoba, Canada; Alison Macfarlane, City University of London, UK; Edward Ng, Statistics Canada; Carolyn Roth, University of Keele, UK; Donna Stewart, University Health Network of Toronto, Canada; Babill Stray-Pederson and Siri Vangen, University of Oslo, Norway; Marcelo Urquia, University of Toronto, Canada; Jennifer Zeitlin and Meg Zimbeck, INSERM, France and EURO-PERISTAT
The collaboration aims to undertake comparative work on migrant, refugee and asylum-seeking women’s reproductive health outcomes and their views of maternity care in Europe, North America and Australia.  The collaboration began with an initial grant awarded from the Canadian Institutes of Health Research (CIHR) International Opportunity Development Grant Scheme to establish research links between Canada and Australia for comparing reproductive health outcomes of immigrant and refugee women. The first meeting of a wider collaborative network with researchers from the UK, Italy, France, Belgium, and Finland was held at the European Congress of Epidemiology in Porto, Portugal in September 2004. Since then collaborators from Norway and the Netherlands have also joined the collaborative network. In 2006 a further grant was awarded by CIHR to support the collaboration. 
A two-day ROAM collaborators’ meeting was held in Paris in May 2007, at which work completed was presented. This included: a systematic review of migration and perinatal outcomes; data on birth outcomes for Somali women across six receiving countries; and a Delphi study for identifying key migration indicators for improving research on migration and reproductive outcomes.

FUNDING: Canadian Institutes of Health Research International Collaboration grant
STATUS: One paper submitted; several in preparation

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