Health care policies for antenatal and postpartum migrant, asylum-seeking and refugee women: a systematic review

Abstract

Abstract Background: The healthcare policies for migrant mothers is multidimensional and complex issue. Women in perinatal period are vulnerable and need special care, especially migrant pregnant women, since are associated with insufficient prenatal care, financial difficulties, and higher stillbirths or infant death rates. Pregnant women seeking asylum, refugees, or irregular migrants face many barriers to accessing health care, including maternity. Timely access to perinatal care and other barriers needs to be addressed by the health policies. Healthcare policies aimed at supporting antenatal and postpartum refugee women are crucial for ensuring their well-being and the health of their babies. These policies should address the unique needs and challenges faced by refugee women during pregnancy, childbirth, and the postpartum period. It is important to note that healthcare policies should be flexible, responsive, and regularly evaluated to address the evolving needs and challenges faced by antenatal and postpartum refugee women. Aims: The purpose of this systematic review was to analyze both the barriers which asylum-seeking, migrant and refugee women face during antenatal and postpartum period, and the necessity of healthcare policies to that population. Methods: Based on The Preferred Reporting Items for Systematic Reviews and Meta Analyses reporting guidelines (PRISMA, a systematic literature review was conducted from 2009 until 2022 using the following databases: PubMed, MEDLINE, and Scopus. Google Scholar is used to find relevant studies. Titles, abstracts and keywords of studies identified in the search strategies were screened for inclusion criteria. Results: A total of 16 articles were selected for inclusion. According to the literature, several factors lead to refugee women delaying their search for medical services. Among these factors are instances of racism encountered by refugees from healthcare providers, linguistic barriers, difficulties in integrating into mainstream society, and stress about adapting to host countries. Socioeconomic factors, cultural influences, family status, language, and the quality of social networks can synergistically impact both refugee women's health experiences and their maternal health. In the same time, refugee crisis drives the governments to embrace austerity policies, which effect refugee women’s health condition significantly. Moreover, healthcare policies intersect with laws for migrants and refugees, implying that the health of undocumented women depends on immigration policies. Here are some key healthcare policies that can be implemented: • Accessible and Culturally Competent Care: Ensure that antenatal and postpartum healthcare services are accessible to refugee women. This includes providing interpretation services, culturally competent care, and addressing language barriers to facilitate effective communication between healthcare providers and refugee women. • Comprehensive Antenatal Care: Implement policies that promote early and regular antenatal care for refugee women. This should include routine prenatal check-ups, screenings, immunizations, and access to essential prenatal vitamins and medications. Refugee women should be informed about the importance of antenatal care and the available services. • Mental Health Support: Recognize the increased risk of mental health issues among refugee women during pregnancy and postpartum. Develop policies that integrate mental health screenings, counselling services, and trauma informed care into antenatal and postpartum healthcare. Collaborate with mental health professionals and community organizations to provide necessary support. • Health Education and Literacy: Develop policies that prioritize health education for refugee women, including information on pregnancy, childbirth, breastfeeding, nutrition, and infant care. This should be provided in a culturally sensitive and language-appropriate manner, ensuring that refugee women have access to accurate and understandable health information. • Collaboration and Coordination: Encourage collaboration and coordination between healthcare providers, refugee support organizations, and government agencies to ensure a holistic approach to healthcare for antenatal and postpartum refugee women. Conclusions: Pregnant female migrants, asylum seekers, or irregular migrants face more difficulties than the local population. Poor living conditions and nutrition, difficult access to health facilities, and the lack of translators that make communication with medical personnel more difficult affect the health of the pregnant woman during pregnancy, increasing the complications and risks in pregnancy as well as maternal or newborn mortality. These factors also affect the health of the mother and newborn after delivery, increasing the risk of postpartum depression and complications. The above barriers show how important healthcare policies are for migrant, asylum-seeking and refugee women and the quality of taken health care.