Differences in postpartum mental healthcare among women with identified needs: The role of migration status.

AIMS: The aim of this study was to examine the association between women's migrant status (majority, immigrant, descendant) and use of postpartum mental healthcare and investigate whether migration characteristics are associated with mental healthcare use. METHODS: Retrospective cohort study. We included all mothers of children born between 2002 and 2018 in 34 municipalities of Denmark who had an identified mental health need as clinically assessed by a child health visitor (CHV) or by a score of 11 or more on the Edinburgh Postpartum Depression Scale (EPDS). Women were followed until the first mental healthcare received 2 years' postpartum, death or emigration. Using Cox regression models, we estimated the time to mental healthcare by migrant status and explored the role of migration characteristics. RESULTS: A total of 29% of women (n = 45,573) had a mental health need identified by the CHV, and 7% (n = 4968) had an EPDS ⩾ 11. Immigrants accounted for 19.5%, and descendants for 4.7% of the sample. Immigrants were at lower risk of using mental healthcare than the majority group (CHV: hazard ratio adjusted (HRa) 0.75 (0.70-0.79), EPDS: HRa 0.67 (0.58-0.78)), as were descendants (CHV: HRa 0.77 (0.70-0.86), EPDS: HRa 0.69 (0.55-0.88)). Among migrants, those not refugees, newly arrived, whose partners were immigrants or descendants, and those originally from Africa showed a lower risk of using postpartum mental healthcare. CONCLUSIONS: Our findings emphasize the need to strengthen access to mental healthcare for immigrants and descendants experiencing postpartum mental health concerns and consider migration characteristics as indicators of potential inequalities in access to maternal mental healthcare.

Infants born to first-time mothers with a refugee background faced an increased risk of regulatory problems.

AIM: This study investigated the association between mothers' migration background and infant regulatory problems and analysed the mediating role of maternal mental health. We also explored whether the child's sex, parity and length of residence moderated the effect of a maternal migrant background. METHODS: Child health surveillance data from the Danish home visiting programme were used. Community health nurses followed infants from birth to 12 months of age. The source population comprised 103 813 infants born between 1 January 2008 and 31 December 2018. The final sample comprised 62 964 infants, including 3.4% with a refugee background. A maternal migrant background was the primary exposure. The results are presented as risk ratios (RR) and 95% confidence intervals (CI). RESULTS: A maternal refugee background increased the risk of regulatory problems in offspring (RR 1.34, 95% CI: 1.18-1.51). The effect was partially mediated by maternal postpartum mental health concerns. The association between maternal refugee background and infant regulatory problems was more pronounced in first-time mothers (RR 1.80, 95% CI: 1.51-2.15). CONCLUSION: The risk of infant regulatory problems was higher in the first-born children of refugee mothers. First-time refugee parents may need tailored support to identify mental health needs and infants with regulatory problems.

Interventions to improve perinatal outcomes among migrant women in high-income countries: a systematic review protocol.

INTRODUCTION: Women who are migrants and who are pregnant or postpartum are at high risk of poorer perinatal outcomes compared with host country populations due to experiencing numerous additional stressors including social exclusion and language barriers. High-income countries (HICs) host many migrants, including forced migrants who may face additional challenges in the peripartum period. Although HICs' maternity care systems are often well developed, they are not routinely tailored to the needs of migrant women. The primary objective will be to determine what interventions exist to improve perinatal outcomes for migrant women in HICs. The secondary objective will be to explore the effectiveness of these interventions by exploring the impact on perinatal outcomes. The main outcomes of interest will be rates of preterm birth, birth weight, and number of antenatal or postnatal appointments attended. METHODS AND ANALYSIS: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines. EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, and Web of Science, as well as grey literature sources will be searched from inception up to December 2022. We will include randomised controlled trials, quasi-experimental and interventional studies of interventions, which aim to improve perinatal outcomes in any HIC. There will be no language restrictions. We will exclude studies presenting only qualitative outcomes and those including mixed populations of migrant and non-migrant women. Screening and data extraction will be completed by two independent reviewers and risk of bias will be assessed using the Quality Assessment Tool for Quantitative Studies. If a collection of suitably comparable outcomes is retrieved, we will perform meta-analysis applying a random effects model. Presentation of results will comply with guidelines in the Cochrane Handbook of Systematic Reviews of Interventions and the PRISMA statement. ETHICS AND DISSEMINATION: Ethical approval is not required. Results will be submitted for peer-reviewed publication and presented at national and international conferences. The findings will inform the work of the Lancet Migration European Hub. PROSPERO REGISTRATION NUMBER: CRD42022380678.

Tactics employed by healthcare providers in the humanitarian sector to meet the sexual and reproductive healthcare needs of undocumented migrant women in Denmark: A qualitative study.

OBJECTIVES: To explore the tactics adopted by healthcare providers in the humanitarian aid sector to meet the sexual and reproductive healthcare needs of undocumented immigrant women whose entitlements in the Danish national health services are restricted to emergency care only. METHODS: We conducted six semi-structured interviews between January 2020 and April 2020 with healthcare providers working across four health centers providing sexual and reproductive healthcare to undocumented migrants in Copenhagen. The interviews were digitally recorded, transcribed and subjected to a thematic network analysis. RESULTS: Healthcare providers adopted a number of tactics tomeet the SRH needs of undocumented women. They used their position as volunteers to gain women's trust, drew on personal networks in the public healthcare sector, accompanied women to public hospitals, worked with professionals from the migrant communities, and promoted secondary prevention using their cultural knowledge to respond to the SRH needs of undocumented women. Results highlight that while "informal" settings enable these flexible tactics, fully meeting the SRH needs of undocumented migrants is negatively affected by their limited entitlements to public healthcare. CONCLUSION: These tactics demonstrated the efforts of healthcare providers to use the NGO space to try to achieve SRH of undocumented women in a restrictive public healthcare sector. Nonetheless, these tactics, particularly the use of personal networks, did not always result in undocumented migrants having their SRH needs met, particularly in cases of serious illness, demonstrating a concerning gap in care.

Household composition after resettlement and emotional health in adolescent migrants.

Background: Migration during adolescence constitutes an important stressor that particularly impacts unaccompanied minors (UAM). Adolescent UAM in the United States (U.S.) are relatively understudied, especially regarding their resilience and emotional well-being after resettlement. Small school-based studies have documented the mental health status of UAM who resettled reuniting with their parents. However, many do not resettle with parents and less is known about the degree to which post-resettlement household composition impacts resilience and emotional well-being. Methods: Our goal was to examine how migration characteristics, supports, resilience, and emotional well-being vary by UAM resettlement household composition (reunification with parents, reunification with a non-parental family member, or living in a household not containing any family members). Using a mixed-methods (quantitative-qualitative) cross-sectional approach, we assessed 46 Latin American adolescent UAM to the U.S. who resettled into these three household types. Results: Youth experienced support differently by household type, influencing their strategies for adapting and coping post-resettlement, impacting their resilience (Kruskal Wallis-H 4.8; p<0.09) and emotional well-being (Kruskal Wallis 5.3; p<0.07). Youth living in households without relatives (n = 9) had lower resilience (Fisher's exact test p<0.002) and positive affect (Fisher's exact test p<0.003) and needed to expend greater efforts to mobilize social supports than youth living with parents (n = 22) or with non-parental family members (n = 15). Conclusion: The needs and coping abilities of UAM migrants vary with the composition of their immediate receiving environment, their post-resettlement household. Understanding differences associated with these household characteristics can guide interventions to maximize emotional health and resilience.

Poverty after Birth: How Mothers Experience and Navigate U.S. Safety Net Programs to Address Family Needs.

Although pregnancy and the first year of life are sensitive windows for child development, we know very little about the lived experiences of mothers living in poverty or near poverty during the perinatal period; specifically, how they perceive and use public resources to support themselves and their newborn. In this qualitative study, we explore how predominantly Black and Latinx mothers with infants living in or near poverty and engaged in public assistance manage to meet their family's needs with available resources from safety net programs and social supports. We conducted 20 qualitative interviews with mothers living in (85%) or near poverty in New York City (NYC). All participants (mean age = 24) had an 11-month-old infant at the time of the interview. Using thematic analysis, we identified five main themes reflecting how mothers experience and navigate living with very low incomes while engaging in public assistance programs: (1) experiencing cascading effects of hardships during pregnancy, (2) relying on food assistance and informal supports amid scarcity, (3) waiting for limited affordable housing: 'life on hold', (4) finding pathways towards stability after the baby's birth, (5) making it work: efforts to look forward. Results describe how the current focus on "work first" of existing federal and state policies adds a layer of stress and burden on the lives of single mothers experiencing low incomes and entangled hardships during pregnancy and after birth. We document how mothers experience coverage gaps and implementation challenges navigating the patchwork of public assistance programs, yet how the support of flexible caseworkers accessing, using, and coordinating assistance has the potential to help mothers plan for longer-term goals.

Disparities in postpartum depression screening participation between immigrant and Danish-born women.

BACKGROUND: Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration. METHODS: The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk. RESULTS: In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening. CONCLUSIONS: Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.