There is convincing evidence that migrant mothers can suffer from more complications during pregnancy and after birth.
In addition to their experiences at home and the difficult journey they have been on, there are other problems that impact their health too, including social isolation, economic deprivation and in some cases discrimination. So they are a group that urgently needs more help and support.
We have been working towards an evidence-based support model as part of the ORAMMA project, a Europe-wide initiative with input from a range of universities and clinical bodies.
Beyond the clinical
Our work began with a systematic literature review, including evidence from many different countries within Europe regarding experiences of migrant women. What we found above all was that women said their needs go beyond the clinical.
They were very much concerned about their socioeconomic status and their living conditions – in fact, the socioeconomic and psychosocial aspect of care seemed to be more important than the clinical aspects for them, partly because they felt they already got a good standard of clinical care.
We also found significant issues and complications related to communication. Not just in terms of language, but also in terms of cultural and system barriers that hinder women from accessing services.
So there are lots of implications for us in terms of providing the right and adequate training for healthcare professionals, and also providing a supportive environment for women, so that they feel able to ask questions and get the right care.
The integrated care model
With the help of other disciplines and an international team of experts, we put together an integrated care model, putting at its core the midwife-led continuity model, for which there is already a strong evidence base.
Our model also introduced what we call cultural maternity peer supporters. We recruited women from ethnic minority and migrant backgrounds who have been living in their new country for a longer period of time, and trained them to support new migrants during pregnancy.
These peer supporters have first-hand experience of the issues that a new migrant woman might face, in terms of not being familiar with the system or the culture – so they can help to bridge the gap between these mothers and health professionals.
Interestingly, our findings suggest that the benefits of the approach go both ways, benefiting supporters as well as mothers. Our peer supporters told us that they find helping others fulfilling, and we also have evidence of them growing more active and confident in their job seeking activity and community engagement.
Encouraging feasibility trials
So far, the feasibility of implementing our integrated care model has been tested in the UK, the Netherlands and Greece – three countries with very different backgrounds in terms of their healthcare systems and cultural settings, as well as in terms of the types of migrants they receive.
The findings are encouraging. We now know that it is quite feasible to implement the integrated care model in a range of contexts, and we have developed training packages for both peer supporters and healthcare providers.
We are currently analysing the full data set from the feasibility study to look deeper into the qualitative aspects of mothers’ experiences, and also the experiences of our cultural maternity peer supporters. A distinctive feature of this project is that we have involved migrant women themselves in our research programme to make sure we answer the right questions, but more importantly it helps with community engagement and social inclusion. With their input, we are moving closer to reducing health inequalities for migrant mothers and babies.