Mosley Elizabeth A, Pratt Michelle, Besera Ghenet, Clarke Lasha S, Miller Heidi, Noland Tracy, Whaley Bridget, Cochran Jennifer, Mack Amber, Higgins Melinda
Georgia State University School of Public Health, Atlanta, GA, United States.
Emory University Rollins School of Public Health, Atlanta, GA, United States.
Front Glob Womens Health. 2021 Jun 17;2:655409. doi: 10.3389/fgwh.2021.655409. eCollection 2021.
Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records ( = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants ( = 113) and a comparison group of women from the same community and racial/ethnic backgrounds ( = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, = 0.411), higher full-term gestational age (OR = 1.49, = 0.329), and reduced low birthweight (OR = 0.77, = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.
与美国出生的女性和其他移民女性相比，难民女性在获得性健康和生殖健康护理方面面临着众多独特的障碍，并且可能经历更糟糕的妊娠相关结局。像“接纳难民生育支持”这样基于社区、符合文化特点的项目可能会改善难民获得医疗保健的机会和健康结局，但需要实证研究来评估项目的益处。这项社区参与式研究由佐治亚州导乐服务准入工作组牵头，包括学术研究人员、埃默里迪凯特医院护士和“接纳”组织之间的合作。我们分析了2016年至2018年的医院临床记录（n = 9136），以评估“接纳”项目参与者（n = 113）以及来自相同社区和种族/族裔背景的女性对照组（n = 9023）的妊娠相关结局。我们控制了种族、语言、产妇年龄、产次、保险状况、先兆子痫和糖尿病等因素。参与“接纳”项目与引产几率降低48%（OR = 0.52，P = 0.025）以及纯母乳喂养意愿几率提高65%（OR = 1.65，P = 0.028）显著相关。“接纳”项目在降低剖宫产率（OR = 0.83，P = 0.411）、提高足月妊娠率（OR = 1.49，P = 0.329）和降低低出生体重率（OR = 0.77，P = 0.55）方面呈现出积极但不显著的趋势。我们得出结论，像“接纳”这样基于社区、符合文化特点的妊娠支持项目可以满足难民女性的复杂需求。此外，社区参与式的跨部门研究方法可以确保在研究设计、实施和传播过程中纳入社区和临床两方面的观点。
