Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
BMC Pregnancy Childbirth. 2022 Oct 24;22(1):789. doi: 10.1186/s12884-022-05112-0.
In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway's two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics.
In this historic cohort study we included pregnant women aged 18-49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes.
We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1-3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%.
Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.
2011 年，挪威赋予无证妇女接受产前护理和在医院分娩的权利，但不将她们纳入全科医生和报销计划。作为对医疗保健服务有限获取的回应，非政府组织（NGO）一直在挪威最大的两个城市为无证移民经营健康诊所。为了进一步促进全民健康覆盖，有必要调查无证孕妇如何使用 NGO 诊所，以及这如何影响她们的孕产妇健康。因此，我们调查了这些诊所接受的护理、妊娠相关并发症的发生情况以及妊娠结局。
在这项历史性队列研究中，我们纳入了 2009 年至 2020 年在城市 NGO 诊所就诊的年龄在 18-49 岁的孕妇，并从转诊医院检索了她们的医疗记录。我们根据原籍地区对女性进行了比较，使用对数二项式回归估计不良妊娠结局的相对风险。
在研究期间，我们共确定了 500 名女性中的 582 例妊娠。约一半（46.5%）的女性在妊娠 12 周后开始接受产前护理，25.7%在 22 周后。这些女性在 NGO 诊所接受中位数为 1 次（IQR 1-3）的产前就诊，其中 77.7%的女性被转诊到公共医疗保健。共有 28.4%的女性被转诊进行人工流产。在检索到的 205 例分娩记录中，任何不良妊娠结局的风险为 45.9%。死产的风险为 1.0%，早产为 10.3%，紧急剖宫产为 19.3%。
尽管合并症的发生率较低，但使用 NGO 诊所的无证孕妇接受的产前护理不达标，且妊娠不良结局的风险很高。为了实现全民健康覆盖，应更加关注无证妇女的结构性脆弱性，并确保为她们提供足够的产前护理。
