Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

Frode Eick; Odd Martin Vallersnes; Heidi E Fjeld; Ingvil Krarup Sørbye; Guro Storkås; Marthe Ekrem; Marie Børmer; Sara Andrea Løberg; Cathrine Ebbing; Nanna Voldner; Cecilie Dahl

doi:10.1186/s12884-022-05112-0

Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

BMC Pregnancy Childbirth. 2022 Oct 24;22(1):789. doi: 10.1186/s12884-022-05112-0.

Authors

Affiliations

¹ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway. frode.eick@medisin.uio.no.
² Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
³ Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway.
⁴ Department of Obstetrics, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
⁵ Faculty of Medicine, University of Oslo, Oslo, Norway.
⁶ Faculty of Medicine, University of Bergen, Bergen, Norway.
⁷ Division of Gynaecology and Obstetrics, Akershus University Hospital, Oslo, Norway.
⁸ Department of Obstetrics and Gynaecology, Haukeland University Hospital, and Department of clinical medicine, University of Bergen, Bergen, Norway.
⁹ Faculty of Health Studies, VID specialized university, Oslo, Norway.

Abstract

Background: 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.

Methods: 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.

Results: 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%.

Conclusion: 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.

Keywords: Antenatal care; Non-governmental organizations; Pregnancy; Structural vulnerability; Undocumented migrants.

MeSH terms

Cesarean Section
Cohort Studies
Female
Humans
Infant, Newborn
Pregnancy
Pregnancy Complications* / epidemiology
Pregnancy Outcome / epidemiology
Premature Birth*
Prenatal Care

Grants and funding

2021/FO347363/EkstraStiftelsen Helse og Rehabilitering (Stiftelsen Dam)