Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the ‘migration three delays’ model

BMC Pregnancy and Childbirth

Birgitta Essén²  Ajlana Mulic-Lutvica²  Ulf Högberg²  Birgit Bødker¹  Pauline Binder-Finnema²  Annika Esscher² 

[1] Department of Obstetrics and Gynaecology, Hillerød Hospital, Hillerød, Denmark;Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden

关键词: Low-income country;    Maternal death audit;    Structured implicit review;    Foreign-born;    Maternal migration effect;   

Others  :  1127416
DOI  :  10.1186/1471-2393-14-141

 received in 2013-11-01, accepted in 2014-04-09,  发布年份 2014

【 摘 要 】

Background

Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988–2010.

Methods

A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the ‘migration three delays’ framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context.

Results

Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups.

Conclusions

Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.

【 授权许可】

   
2014 Esscher et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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