Assessing disparities in socio-behavioral perinatal health risk indicators among immigrants in Manitoba
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Date
2022-08-26
Authors
Ewesesan, Roheema
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Abstract
Background: Perinatal risk factors can vary by immigration status. To advance knowledge on socio-behavioral perinatal health risks among childbearing immigrant women, this study compared select psychosocial and behavioral perinatal health risk indicators between immigrant and non-immigrants overall and according to key immigrant characteristics such as refugee status, secondary migration, birth region, and duration of residence.
Methods: A population-based cross-sectional study was conducted among 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15-55 years, who had a live birth and available data from the universal newborn screen completed within two weeks postpartum, between January 2000, and December 2017. Immigration characteristics were obtained from the Canadian federal government immigration database. Odds Ratios (OR) with 95% confidence intervals (CI) were computed from logistic regression with Generalized Estimating Equations to estimate the associations between immigration characteristics and perinatal health risk indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care.
Results: More immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more), but lower odds relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care, while secondary migration was associated with lower prevalence of social isolation, relationship distress, and smoking during pregnancy. Relationship distress and behavioral health indicators varied by maternal birth region.
Interpretation: Immigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health risk indicators than non-immigrants. Among immigrants, there was heterogeneity according to immigrant characteristics. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.
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Keywords
Maternity, Perinatal, Postpartum, Immigrant, Canada, Depression, Social isolation, Partner violence, Relationship distress, Health behaviors, Prenatal care