Child & Maternal Outcomes Child & Maternal Outcomes for for Migrant Women Migrant Women Understanding Understanding and Responding to the Needs of Vulnerable and Responding to the Needs of Vulnerable Migrant WomenMigrant Women

Monica Tolofari Consultant Midwife5th February 2015

ObjectivesObjectivesUnderstanding the needs of

Migrant womenUnderstanding the barriers to

meeting the needs of Migrant women

Responding to the need

OutcomesOutcomes Outcomes of Migrant Women are reported to have significantly greater

risk of adverse pregnancy outcomes >Stillbirths >Maternal deaths

Distinction between women who migrated due to humanitarian & non-humanitarian reason

References Gibson-Helm M, Teede H, Block A, Knight M, East C, Wallace EM, Boyle (2014) Maternal health and

pregnancy outcomes among women of refugee background from African countries: a

retrospective, observational study in AustraliaJ.

Maternal DeathsMaternal Deaths“Maternal health outcomes are significantly worse amongst migrant women than in the rest of the population. Compared to White women, maternal mortality rates are 3.85 times higher for Black African women, 3.75 times higher for Black Caribbean women, 1.77 times higher for Chinese women and 1.44 times higher for Asian women. Infant mortality is also higher amongst mothers born outside the

UK. Evidence suggests that the

majority of this is

preventable.”

BarriersBarriers•

Phase 1. Delay in seeking care – Late bookers

•Phase 2. Delay in reaching care – Transport,

communication geography, basic skills, access to primary care

•Phase 3. Delay in receiving adequate care – interpreting their needs NHS system eg appointment length,

language difficulties

• Developing and developed country understanding the mindset of the woman

Ref:- Maternity World Wide (2014). The Three Delays Model - Saving Lives of Mothers[Available from: http://www.maternityworldwide.org/ [Accessed on 8.9.14]

Access - Antenatal/Newborn Access - Antenatal/Newborn Screening PathwayScreening Pathway

Responding to the needs of Migrant Responding to the needs of Migrant womenwomen

Insanity: doing the same thing Insanity: doing the same thing over and over again and over and over again and expecting different results. expecting different results. Albert Einstein

Responding to the Service Responding to the Service UsersUsers

NHS Primary & Secondary Systems + Processes New Design Meeting new demands of the emerging population

Registering with a GP - Direct access to a Midwife – 24hr language services (consent to treatment) flexible services, review staffing ratios to meet increasing demands

Education of Staff Women’s rights, entitlements, asylum system, legislation, human rights, migrant women’s

health needs , challenging attitudes to migrant women, understanding diversity of culture other non UK health care systems

Fast Track Midwifery ServiceFast Track Midwifery Service

An example of good practice + key interventionCommenced in B’ham 2012 Set up to meet some of the maternity services

priorites.Identifying the vulnerable migrant womenCollaborative working with hospital, Children

Centre and local IA unitMapping current pathway & developing a

pathway which meets the women’s needs

Fast Track Midwifery ServiceFast Track Midwifery ServiceContinuedContinued Midwifery Fast Track Service – encouraging early booking Midwives Working collaboratively with nurses and staff in IA unit -

good access to language interpretation services Education of women & staff - NHS + Border Agency/Force – A/N clinic

Early bird & or Parentcraft classes in IA unit

Antenatal bookings in health room, joint working at IA unit Vulnerable women’s clinic at the local hospital Pharmacy - pregnancy testing - pre-conceptual care information Free direct access to Midwife & GP/Primary care Transport to clinic or funds/bus pass Doula/befriending support – support for labour in absence of birth

partner Psychological support – Freedom from Torture Charity etc

ConclusionConclusionEquipping staff through education to meet the

needs of migrant women, understanding the mindset, perspectives, barriers to access of care.

Proactive in identifying and tackling health inequalities Removing inequalities & discrimination – Remove NHS Surcharges for those who cannot pay – Eliminate or reduce poverty. Collaborative working across agencies.

Redesign & adapt services to meet the needs of new communities and local populations through service user engagement and adequate resources to ensure care is delivered

ReferencesReferences 1. Maternity Action & Refugee Council (2013) When Pregnancy Doesn’t Matter Dispersing Pregnant Women Seeking Asylum

Available Online from: http://www.refugeecouncil.org.uk/assets/0002/6402/When_Maternity_Doesn_t_Matter_-_Ref_Council__Maternity_Action_report_Feb2013.pdf Accessed [9.9.14]

2. Taylor B, Newall D (2008) Maternity Mortality & Migration The impact of New Communities. Available Online from: http://www.wmemployers.org.uk/media/upload/Library/Migration%20Documents/Publications/MMM_Document_FINAL_Webversion.pdf [Accessed 9.9.14]

3. Maternity Action (2014). Access to Maternity Care for Vulnerable Migrant Women. Available from: http://www.maternityaction.org.uk/wp/policy-campaigns/campaigns/access-to-nhs-maternity-care-for-vulnerable-migrant-women/ Accessed 9.9.14]

4. The Lancet (2013). Immigration and health in the UK. Lancet 2013; 382: 1459. Full Text | PDF(136KB) | PubMed

Joint Committee on Human Rights. Tenth Report. Provision of healthcare (135—43).

www.publications.parliament.uk/pa/jt200607/jtselect/jtrights/81/8107.htm. (Accessed 9.9.14)

5. The Lancet (2014). Global Burden of Diseases, Injuries, and Risk Factors Study 2013

http://www.thelancet.com/themed/global-burden-of-disease

6. Department of Health. Guidance on implementing the overseas visitors hospital charging regulations, 2012 (pp 43, 48). https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213015/GUIDANCE-October-2012-FINAL.pdf. (Accessed 9.9.14).

7. NICE (2013). National Institute for Health and Care Excellence. Pregnancy and complex social factors. http://www.nice.org.uk/nicemedia/live/13167/50822/50822.pdf. (Accessed 9.9.14.14).

7. Cantwell R, Clutton-Brock T, Cooper G, et al. Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006—2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118: 1-203. PubMed