Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
BMC Med. 2018 Jun 12;16(1):89. doi: 10.1186/s12916-018-1064-0.
Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status.
Twelve electronic database, reference list and citation searches (1 January 2007-July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively.
Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women's experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare.
This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women's experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities.
Systematic review registration number: PROSPERO CRD42017073315 .
全球移民达到历史最高水平，这对围产期健康产生了影响。移民妇女，尤其是寻求庇护者和难民，是一个特别脆弱的群体。了解妇女及其后代围产期健康的影响是改善护理和结果的重要前提。本系统评价的目的是总结目前关于寻求庇护者或难民身份的妇女围产期健康结果和护理的证据基础。
2017 年 6 月至 7 月期间，进行了 12 项电子数据库、参考文献列表和引文搜索（2007 年 1 月至 2017 年 7 月）。如果报告了围产期健康结果或护理，并明确表示包括寻求庇护者或难民，则纳入了定量和定性系统评价，这些评价以英文发表。采用双重筛选法进行资格筛选、数据提取、质量评估和证据综合。结果以叙述方式进行总结。
在筛选出的 3415 条记录中，有 29 项系统评价符合纳入标准。只有一项专门针对寻求庇护者；其余的综述将寻求庇护者和难民与更广泛的移民群体归为一类。围产期结局在移民妇女中普遍较差，特别是心理健康、孕产妇死亡率、早产和先天畸形。结构性、组织性、社会性、个人和文化障碍阻碍了护理的获取和利用。移民妇女的护理体验包括沟通不畅、歧视、与卫生专业人员关系不佳、文化冲突以及对临床干预的负面体验。针对寻求庇护者和难民的补充数据表明，他们存在复杂的产科问题、性侵犯、后代死亡、意外怀孕、贫困、社会孤立以及在围产期医疗保健中经历种族主义、偏见和刻板印象。
本综述确定了寻求庇护者和难民妇女的不良妊娠结局，这使她们成为全球最脆弱的妇女群体之一面临不平等的双重负担。改善围产期保健服务的提供可以减少不良结局的不平等，并改善妇女的护理体验。克服获取护理障碍的策略需要立即关注。系统评价证据基础受到限制，因为它将异质的移民、寻求庇护者和难民群体结合在一起，对定义的使用不一致，并且对一些围产期结局和风险因素的数据有限。未来的研究需要克服这些限制，以提高数据质量并解决不平等问题。
系统评价注册号：PROSPERO CRD42017073315。
