Pregnancy complications among refugee women: A systematic review.

INTRODUCTION: Pregnancy is a time of increased vulnerability for women. Women of refugee background may be further challenged in pregnancy due to a complex series of physical, psychological and social factors. Previous studies show ambiguous results, with some showing increased the risk of prenatal complications in refugees compared with their native counterparts, whereas other studies report the opposite. With the current steep rise in the number of refugees and displaced persons worldwide, research is important to understand whether pregnancy disparities between this population and their native counterparts exist, and the causes. This systematic literature review aims to find out whether refugee women have a higher prevalence of adverse pregnancy outcomes and prenatal infections compared with native women. MATERIAL AND METHODS: We conducted a literature search in the databases PubMed and Embase, supplemented with screening of reference lists and citations for relevant literature. We included studies published in English reporting risk of preeclampsia, spontaneous abortion and stillbirths, preterm birth, preterm prelabor rupture of membranes (PPROM) and adverse prenatal infectious diseases in women of refugee status. PROSPERO registration CRD42020205628. RESULTS: We identified 19 articles eligible for inclusion: 12 were cross-sectional, six were cohort studies and one was a case-control study. The most frequently reported outcome in the literature was preterm birth (reported in 16 of the studies) and preeclampsia (reported in 11 of the studies). Refugees had increased risk of stillbirth (reported relative risk ranging from 1.20 to 2.24) and spontaneous abortion (reported relative risk ranging from 1.56 to 1.58), when compared with native women and a decreased risk of preeclampsia (reported relative risk ranging from 0.65 to 0.81). CONCLUSIONS: The small number of articles eligible for inclusion in the review highlights the lack of research and knowledge on refugee health during pregnancy. Further research is required to understand and reduce disparities in pregnancy outcomes between refugee and non-refugee women.

Attitudes towards and health consequences of female genital mutilation/cutting: A qualitative study among Somali and Kurdish immigrants and descendants in Denmark.

Objectives: There is lack of in-depth knowledge of how immigrants who originate from countries where female genital mutilation/cutting (FGM/C) historically is practiced, perceive the practice after migrating to Europe. The aim of this study was to explore the attitude towards FGM/C among immigrants and descendants and the health consequences of living with FGM/C. Study design: Qualitative methods were used in the form of semi-structured interviews and focus group discussions. Female and male immigrants and descendants in Denmark from Somalia or Kurdish of Iraq/Iran participated in the study. The interview/focus group discussion guides were developed by the European Institute for Gender Equality. Purposely sampling was used, and participants were recruited by use of snowballing through gatekeepers and women's societies working within the Somali and Kurdish communities. Results: Sixteen persons participated in the study. No descendants had been cut, but all female immigrants had been cut prior to migrating and did not wish to pass on the practice. FGM/C was perceived as a harmful practice with severe sexual and mental health consequences. Women with Somali origin experienced that the practice was falsely associated with their origin, which led to stigmatisation. Women with Kurdish origin lacked healthcare support when suffering sexual consequences of FGM/C. It was generally perceived that the Danish healthcare system lacked cultural sensitivity. Conclusion: FGM/C is negatively perceived among Somali and Kurdish immigrants and descendants in Denmark and not practiced among these groups. The Danish healthcare system should adopt a more culturally sensitive approach when addressing sexual health among immigrants and descendants. Denmark and other European countries should work towards destigmatising the immigrant communities when it comes to FGM/C. Larger European studies with primary data are needed to generalise the findings of this study.