Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel &...

19
Undocumented Pregnant Women: What does the literature tell us? Kimberly Munro 1 , Catherine Jarvis 2 , Marie Munoz 2,3 , Vinita DSouza 4 , Lisa Graves 2 1 Facultéde médicine, Universitéde Montréal, Montréal, Québec 2 Department of Family Medicine, McGill University, Montréal, Québec 3 Centre de recherche et de formation, CSSS de la Montagne, Montréal, Québec 4 Herzl Family Practice Centre, Jewish General Hospital, Montréal, Québec

Transcript of Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel &...

Page 1: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Undocumented Pregnant Women:

What does the literature tell us?

Kimberly Munro1, Catherine Jarvis2, Marie Munoz2,3, Vinita

D’Souza4, Lisa Graves2

1 Facultéde médicine, Universitéde Montréal, Montréal, Québec2 Department of Family Medicine, McGill University, Montréal, Québec

3 Centre de recherche et de formation, CSSS de la Montagne, Montréal, Québec4Herzl Family Practice Centre, Jewish General Hospital, Montréal, Québec

Page 2: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Outline

Background

Objectives

Methods

Synthesis

Conclusions

Page 3: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Background

There are no Canadian studies on undocumented pregnant women

Undocumented pregnant women are a particularly vulnerable group Status limits access to prenatal and delivery services

Prenatal care favours healthy maternal and infant outcomes

Issue of individual and public health

Page 4: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Objective

To provide a synthesis of the existing literature on the topic of undocumented pregnant women, regardless of research design

Page 5: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Methods

Literature review January 1967 to August 2009

PubMed, Medline, CINAHL and EMBASE databases + relevant grey literature

Keywords: pregnancy, medically uninsured, medical indigency, uncompensated care, insurance, health, refugee, undocumented, no status, clandestine, sans papiers, Canada, Canadian.

Inclusion criteria: pregnancy-related issues with respect to undocumented migrant women

Page 6: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis

Initial search retrieved 204 articles

95 articles following application of inclusion criteria

Each reviewed by primary reviewer

Classified into “include”, “exclude”, “unsure”

Consensus on “unsure”

Final sample of 22 articles

Page 7: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (1): Documenting the issue

Very little information exists

Demographics vary by host country

Ex. US=Mexico, Switzerland=SA, France=SSA

Some consistent features between populations

Young, single, low-income domestic employment, lack of health insurance

Page 8: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (2): Prenatal care

Less access (Chavez et al., 1986; Barlow et al., 1994)

Status cited as a reason for not seeking care (Blondel & Marshall, 1996; Higgins & Burton, 1996)

Delayed/Inadequate (Chavez et al., 1986; Reed et

al., 2005; Caulford & Vali, 2006; Wolff et al., 2008)

Page 9: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (3): Prenatal care

Lack of prenatal care associated with less favourable birth outcomes

Low birth-weight infants (Lu et al., 2000)

More costs to system later

STI-related adverse birth outcomes (Kuiper et al., 1999;

Wolff et al. 2008b)

Costs to system

Public health

Page 10: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (4): Delivery

Conflicting evidence

Study site (PNC vs. no PNC, tertiary care, etc.)

Number of participants (complications are rare)

Admitted at later stage, less epidural, shorter hospital stay (Barlow et al., 1994)

More complications (Reed et al. 2005)

Similar rates of complications (Wolff et al. 2008)

Page 11: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (5): Birth outcomes

Conflicting evidence

Less favourable (Lejeune 1998; Barlow et al., 1994)

No difference (Kelaher & Jessop, 2002; Wolff et al., 2008)

More favourable (Reed et al., 2005)

Lower rates preterm delivery & LBW infants, despite higher rates of pregnancy-related risk factors

«Healthy Migrant Effect»

Page 12: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (6): Programs

Few policies specific to the needs of undocumented populations (Wolff et al. 2000)

Few publications on programs targeting undocumented women

Programs developed on an ad-hoc basis

“Patchwork” programming leads to confusion/reticence in care seeking behaviours (Castañeda, 2008)

Page 13: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (7): Programs

Dar a Luz (Carillo, Pust, & Borbon, 1986)

Initiated in September 1980 in Tucson, Arizona Free community clinic

274 clients registered in first three years

Prenatal care for pregnant Hispanic women

Trained patient advocates assigned to each woman

Childbirth education during weekly clinics

Informed local hospitals of program Women presented at emergency room with prenatal

records

No formal agreement

Page 14: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Synthesis (8): Programs

Unité mobile de soins communautaires(UMSCO) (Durieux-Paillard et al., 1999; Wolff, 2004)

Opened in January 1997 as a result of partnership between hospital and city

> 95% patients are undocumented migrants

Mobile clinic

Spanish-speaking staff

2002 agreement between UMSCO and University Hospital facilitated access to care for pregnant undocumented women

Page 15: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Conclusions

Information

Better documentation is needed

Programs

Stakeholders must be informed on policies and available resources

Political participation can help mobilize resources

Organization of services must take into account the unique aspects of each population

Public health

Advocacy tool

Page 16: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

Thank you

Page 17: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

ReferencesBarlow, P., Haumont, D., & Degueldre, M. (1994). Devenir obstérical et

périnatal des patientes sans couverture sociale. Rev Méd Brux, 15, 366-370.

Blondel, B., & Marshall, B. (1996). Les femmes peu ou pas suivies pendant la grossesse: Résultats d'une étude dans 20 départements. J Gynécol Obstet Biol Reprod, 25, 729-736.

Carrillo, J. M., Pust, R. E., & Borbon, J. (1986). Dar a Luz: A Perinatal Care Program for Hispanic Women on the US-Mexico Border. American Journal of Preventive Medicine, 2(1), 26-29.

Castañeda, H. (2008). Paternity for Sale: Anxieties over "Demographic Theft" and Undocumented Reproduction in Germany. Medical Anthropology Quarterly, 22(4), 340-359.

Caulford, P., & Vali, Y. (2006). Providing healthcare to medically uninsured immigrants and refugees. CMAJ, 174(9), 1253-1254.

Chavez, L. R., Cornelius, W. A., & Williams Jones, O. (1986). Utilization of Health Services by Mexican Immigrant Women in San Diego. Women and Health, 11(2), 3-20.

Durieux-Paillard, S., Figueras, G., Tuosto-Aeschliman, R., Rollier, V., Maso, P., & Stalder, H. (1999). Précarité et accès aux soins: À Genève, l'hôpital sort de ses murs. Med Hyg, 57(2270), 1825-1829.

Page 18: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

References (1)Higgins, P. G., & Burton, M. (1996). New Mexico Women With No Prenatal

Care: Reasons, Outcomes and Nursing Implications. Health Care for Women International, 17, 255-269.

Kelaher, M., & Jessop, D. J. (2002). Differences in low-birthweight among documented and undocumented foreign-born and US-born Latinas. Social Science and Medicine, 55, 2171-2175.

Kuiper, H., Richwald, G. A., Rotblatt, H., & Asch, S. (1999). The communicable disease impact of eliminating publicly funded prenatal care for undocumented migrants. Maternal and Child Health Journal, 3(1), 39-51.

Lejeune, C., Fontaine, A., Crenn-Hebert, C., Paolotti, V., Foureau, V., & Lebert, A. (1998). Recherche-action sur la prise en charge médico-sociale des femmes enceintes sans couverture sociale. J Gynécol Obstet Biol Reprod, 27, 772-781.

Lu, M. C., Lin, Y. G., Prietto, N. M., & Garite, T. J. (2000). Elimination of public funding of prenatal care for undocumented immigrants in California: A cost-benefit analysis. American Journal of Obstetrics and Gynecology, 182(1), 233-239.

Page 19: Undocumented Pregnant Women - Wellesley Institute · Undocumented Pregnant Women: ... (Blondel & Marshall, ... (Chavez et al., 1986; Reed et al., 2005; Caulford & Vali, 2006; Wolff

References (2)

Reed, M. M., Westfall, J. M., Bublitz, C., Battaglia, C., & Fickenscher, A. (2005). Birth outcomes in Colorado's undocumented immigrant population. BMC Public Health, 5(100).

Wolff, H., Durieux-Paillard, S., Meynard, A., & Stalder, H. (2000). Précarité et accès aux soins: “Mieux vaut être riche et en bonne santé que pauvre et malade…”. Med Hyg, 58, 1927-1930.

Wolff, H., Epiney, M., Lourenço, A. P., Costanza, M. C., Delieutraz-Marchand, J., Andreoli, N., et al. (2008). Undocumented migrants lack access to pregnancy care and prevention. BMC Public Health, 8(93).

Wolff, H., Laurenço, A., Bodenmann, P., Epiney, M., Uny, M., Andreoli, N., et al. (2008b). Chlamydia trachomatis prevalence in undocumented migrants undergoing voluntary termination of pregnancy: a prospective cohort study. BMC Public Health, 8(391)