TY - JOUR
T1 - Suboptimal care and maternal mortality among foreign-born women in Sweden
T2 - maternal death audit with application of the 'migration three delays' model
AU - Esscher, Annika
AU - Binder-Finnema, Pauline
AU - Bødker, Birgit
AU - Högberg, Ulf
AU - Mulic-Lutvica, Ajlana
AU - Essén, Birgitta
PY - 2014
Y1 - 2014
N2 - BACKGROUND: Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010.METHODS: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context.RESULTS: Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups.CONCLUSIONS: Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.
AB - BACKGROUND: Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010.METHODS: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context.RESULTS: Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups.CONCLUSIONS: Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.
KW - Adult
KW - Death Certificates
KW - Emigrants and Immigrants
KW - Female
KW - Humans
KW - Maternal Death
KW - Maternal Health Services
KW - Maternal Mortality
KW - Middle Aged
KW - Models, Statistical
KW - Pregnancy
KW - Pregnancy Complications
KW - Retrospective Studies
KW - Risk Factors
KW - Socioeconomic Factors
KW - Sweden
KW - Young Adult
U2 - 10.1186/1471-2393-14-141
DO - 10.1186/1471-2393-14-141
M3 - Journal article
C2 - 24725307
SN - 1471-2393
VL - 14
SP - 141
JO - B M C Pregnancy and Childbirth
JF - B M C Pregnancy and Childbirth
ER -