女性法律地位对妊娠结局及医疗服务质量的影响:瑞士移民妊娠情况(PROMISES)项目的研究结果
Influence of women's legal status on pregnancy outcomes and quality of care: Findings from the Pregnancy of Migrants in Switzerland (PROMISES) program.
作者信息
de Weck Eugénie, Noble Clara, Sormani Jessica, Naulin Monique Lamuela, Jaksic Cyril, Arsever Sara, de Tejada Begoña Martinez, Schmidt Nicole C, Guyer Anya Levy, Benski Anne-Caroline
机构信息
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Geneva School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland.
出版信息
PLOS Glob Public Health. 2025 Apr 21;5(4):e0004217. doi: 10.1371/journal.pgph.0004217. eCollection 2025.
In 2020, approximately 281 million people lived in a country other than their country of birth. In Geneva, Switzerland, people born in other countries constitute 40.2% of the population. We aimed to describe the population of pregnant women delivering at the University Hospitals of Geneva (HUG) maternity department and to identify associations between legal status, migration status, and economic precarity with quality care and health outcomes. We performed an exploratory cross-sectional retrospective study including all women who delivered in HUG's maternity department in May 2019 (n=339). The group was sub-divided in three ways: by migration status (Swiss (S) or migrant (M)); by legal status (documented (D), undocumented (U), or asylum seeker (AS)); and economic precariousness (precarious (P) or non-precarious (NP)). The analysis compared the quality of care received and health outcomes across six sub-groups: Swiss non-precarious women (SNP, 25.3%), Swiss precarious women (SP, 12.2%), documented migrant non-precarious women (DMNP, 34.8%), documented migrant precarious women (DMP, 23.3%), undocumented migrants (UM, 2.4%), and asylum seekers (AS, 2.0%). Precarious patients represented 35.5% of 339 women. Economic precarity was more highly associated with poor health outcomes than legal or migration status. Due to the small samples of undocumented migrants (UM) and asylum seekers (AS), the study had limited capacity to achieve statistical significance for findings. The findings from this exploratory study suggest that, where a program exists to reach pregnant undocumented migrants, a pregnant woman's economic status is also very important in determining her experience with the healthcare system during pregnancy and delivery. More than one third of pregnant women delivering at HUG are in a situation of vulnerability, whether economic or legal. This study had few statistically significant results due to small sample sizes. However, it clearly highlights the need for further research into how best to address various vulnerability factors during pregnancy.
2020年,约有2.81亿人生活在其出生国以外的国家。在瑞士日内瓦,出生于其他国家的人占当地人口的40.2%。我们旨在描述在日内瓦大学医院(HUG)产科分娩的孕妇群体,并确定法律身份、移民身份以及经济不稳定状况与优质护理和健康结局之间的关联。我们开展了一项探索性横断面回顾性研究,纳入了2019年5月在HUG产科分娩的所有女性(n = 339)。该群体按三种方式进行细分:按移民身份(瑞士人(S)或移民(M));按法律身份(有证件(D)、无证件(U)或寻求庇护者(AS));以及经济不稳定状况(不稳定(P)或非不稳定(NP))。分析比较了六个亚组所接受的护理质量和健康结局:瑞士非不稳定女性(SNP,25.3%)、瑞士不稳定女性(SP,12.2%)、有证件移民非不稳定女性(DMNP,34.8%)、有证件移民不稳定女性(DMP,23.3%)、无证件移民(UM,2.4%)和寻求庇护者(AS,2.0%)。不稳定患者占339名女性的35.5%。与法律或移民身份相比,经济不稳定与不良健康结局的关联更为密切。由于无证件移民(UM)和寻求庇护者(AS)的样本量较小,该研究对研究结果达成统计学显著性的能力有限。这项探索性研究的结果表明,在存在针对无证件移民孕妇的项目的情况下,孕妇的经济状况在决定其孕期和分娩期间与医疗保健系统的经历方面也非常重要。在HUG分娩的孕妇中,超过三分之一处于经济或法律方面的脆弱状况。由于样本量较小,本研究几乎没有统计学上显著的结果。然而,它明确凸显了进一步研究如何在孕期最佳地应对各种脆弱因素的必要性。
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