移民妇女能否平等获得由助产士提供的连续性护理服务？

Do migrant women have equity of access to midwife continuity of care?

作者信息

Melov Sarah J, Elhindi James, Qian Helena, Byrnes Olivia, Cheung N Wah, Michelle de Vroome P, Gilroy Geraldine, Nippita Tanya, Simmons Michelle, Talla Gayatri, White Lisa, Zachariah Dipti, Cummins Allison, Pasupathy Dharmintra

机构信息

Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Westmead Institute for Maternal and Fetal Medicine, Women's and Newborn Health, Westmead Hospital, Westmead, Australia.

Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

出版信息

Women Birth. 2025 Jul;38(4):101918. doi: 10.1016/j.wombi.2025.101918. Epub 2025 May 9.

DOI:10.1016/j.wombi.2025.101918

PMID:40347552

Abstract

BACKGROUND

Migrant populations are recognised to be at increased risk of adverse health outcomes including perinatal outcomes. Structural barriers to maternity care and racism are recognised globally as an urgent issue for migrants. Midwife continuity of care (MCoC) has well known improved perinatal benefits.

AIM

To investigate if duration since migration was associated with reduced access to MCoC.

METHODS

We conducted a retrospective cohort study from June 2020-November 2023 at six Australian hospitals. MCoC was investigated by hospital and self-identified ethnic group for women who migrated < 5 years, ≥ 5 years compared to the Australian born population. Regression models adjusted for significant factors including use of interpreter and co-morbidities.

FINDINGS

There were 48,240 participants for analysis. Most in the cohort were Australian born (54.7 %, n = 26,365), migrants of < 5 years comprised 13.2 % (n = 6388) and those who migrated ≥ 5 years 32.1 % (n = 15,487). At all study hospitals, new migrants had the least access to MCoC. Compared to Australian born women, new migrants were 70 % less likely to receive MCoC (aOR 0.30; 95 %CI 0.27-0.34) and migrants of ≥ 5 years were 49 % less likely (aOR 0.51; 95 %CI 0.48-0.56). We identified a difference to access to MCoC between ethnic groups.

DISCUSSION

Health literacy needs of women who are migrants should be addressed to improve equity of access to a model of care that is evidenced based to improve perinatal outcomes.

CONCLUSION

It is incumbent on health services to measure equity of access and adjust services to ensure equity of access for all populations.

摘要

背景

移民群体被认为面临包括围产期结局在内的不良健康结局的风险增加。全球范围内，产妇护理的结构性障碍和种族主义被视为移民的一个紧迫问题。助产士连续性护理（MCoC）具有众所周知的改善围产期结局的益处。

目的

调查移民后的时间长短是否与获得MCoC的机会减少有关。

方法

我们于2020年6月至2023年11月在澳大利亚的六家医院进行了一项回顾性队列研究。通过医院和自我认定的种族群体，对移民时间<5年、≥5年的女性与澳大利亚出生的女性进行MCoC调查。回归模型对包括使用口译员和合并症等重要因素进行了调整。

结果

共有48240名参与者纳入分析。队列中大多数为澳大利亚出生（54.7%，n = 26365），移民时间<5年的占13.2%（n = 6388），移民时间≥5年的占32.1%（n = 15487）。在所有研究医院中，新移民获得MCoC的机会最少。与澳大利亚出生的女性相比，新移民接受MCoC的可能性低70%（调整后比值比[aOR] 0.30；95%置信区间[CI] 0.27 - 0.34），移民时间≥5年的女性可能性低49%（aOR 0.51；95%CI 0.48 - 0.56）。我们发现不同种族群体在获得MCoC方面存在差异。