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Migration and perinatal health surveillance: An international Delphi survey. Anita Gagnon, Jennifer Zeitlin, Meg Zimbeck for the ROAM collaboration & in conjunction with EURO-PERISTAT. Sophie Alexander, Université libre de Bruxelles (Belgium) B é atrice Blondel, INSERM (France)

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migration and perinatal health surveillance an international delphi survey

Migration and perinatal health surveillance:An international Delphi survey

Anita Gagnon, Jennifer Zeitlin,

Meg Zimbeck

for the ROAM collaboration & in conjunction with EURO-PERISTAT

roam r eproductive o utcomes a nd m igration an international research collaboration
Sophie Alexander, Université libre de Bruxelles (Belgium)

Béatrice Blondel, INSERM (France)

Simone Buitendijk, TNO Institute – Prevention and Care (Netherlands)

Marie Desmeules, Public Health Agency of Canada

Dominico DiLallo, Agency for Public Health – Rome (Italy)

Anita Gagnon (co-leader), McGill University/MUHC, (Canada)

Mika Gissler, STAKES (Finland)

Richard Glazier, Inst. For Clinical Evaluative Sciences (Canada)

Maureen Heaman, University of Manitoba (Canada)

Dineke Korfker, TNO Institute – Prevention and Care (Netherlands)

Alison Macfarlane, City University of London (UK)

Edward Ng, Statistics Canada

Carolyn Roth, Keele University (UK)

Rhonda Small (co-leader), LaTrobe University (Australia)

Donna Stewart, Univ. Hlth Netwk of Toronto/U of T (Canada)

Babill Stray-Pederson, University of Oslo (Norway)

Marcelo Urquia, Inst. For Clinical Evaluative Sciences (Canada)

Siri Vangen, Dept Ob/Gyn of The National Hospital of Norway

Jennifer Zeitlin, INSERM and EURO-PERISTAT (France)

Meg Zimbeck, INSERM and EURO-PERISTAT (France)

ROAM = Reproductive Outcomes And Migration: An international research collaboration:
funding acknowledgements
Funding acknowledgements
  • Canadian Institutes of Health Research (CIHR) - International Opportunities Program
  • Start-up support: Immigration et métropoles (Center of Excellence in Immigration Studies - Montreal)
  • Career support to AJG: Le fonds de la recherche en santé du Québec (FRSQ)
  • Visiting Scientist Scholarship to AJG: l'Institut national de la santé et de la recherche médicale (INSERM, France)
background
Background
  • Perinatal health of migrant women is a priority for many governments
  • No consensus exists on indicators for monitoring migration and perinatal health
  • ROAM began its work by undertaking an extensive review of the literature:
    • One purpose was to inventory migrant terms and definitions used to study this issue
    • This inventory formed the basis from which the expertise of researchers specializing in this topic was sought to identify the most appropriate indicators to be used through a Delphi process
objectives for this project
Objectives for this project
  • To achieve consensus on migration indicators to be used internationally for:
    • Perinatal health surveillance indicator sets &
    • Routine population-based perinatal surveys
  • To obtain suggestions on migration indicators and definitions to be used for research projects.
methods modified delphi process
Methods:Modified Delphi process
  • A formalized consensus method:
    • A panel of people respond to successive series of questionnaires with the aim of achieving a consensus on key principles/proposals
    • Participants rank items by priority or importance; can give comments
  • Participants:
    • 38 perinatal clinicians, epidemiologists, experts in health information systems from EURO-PERISTAT, ROAM, and others (recommended by ROAM)
    • 22 countries including Europe, Scandinavia, Australia, Canada
  • Questionnaires:
    • Derived from the ROAM systematic review of literature
    • Each participant completed between 1 and 3 questionnaires (“rounds” of questionnaires)
    • Summary results of each preceding round of questionnaires were provided in conjunction with a new set of questions
importance of indicator
Importance of indicator
  • Concepts considered important/essential by >50%:
    • Country of birth
    • The time that the migrant has been in the country (measured by: recent immigrant, length of time in country, age at migration and year of migration)
    • Immigration status (undocumented, irregular migrant, immigration status, asylum seeker, refugee)
    • Language fluency
    • Ethnicity
feasibility of indicator
Feasibility of indicator
  • Generally low
  • Country of birth had the highest rating
    • 65% thought this indicator could be collected in data registries with no or minor modifications
    • 69% in routine population surveys
  • In general, feasibility was considered to be higher in routine population surveys.
  • Poor feasibility for: undocumented/ irregular status, asylum-seeker/refugee status, ethnicity, receiving country language fluency
consensus to reduce the migration indicator list
Consensus to reduce the migration indicator list
  • Agreement with the reduced list of indicators to consider = 79%
    • Country of birth
    • Recent immigrant
    • Immigration status
    • Language
    • Ethnicity
recommendations recommended indicator specific studies or added to routine data collection cont d
Recommendations:Recommended indicator - specific studies or added to routine data collection (cont’d)
additional info to be provided when issuing common recommendations ethics
Additional info to be provided when issuing common recommendations: Ethics
  • Collecting and presenting data on migration requires special attention to ethics and the way that these data are used and interpreted in my country:

Yes = 70%

No = 18%

No response = 12%

  • Comments:
    • Useful for healthcare providers not to know about legal status of patients – can’t refuse them treatment
    • Several privacy laws apply
    • Info may be censored with small sample sizes
    • Using broader categories to report results may reduce “singling out” any particular group
additional info to be provided when issuing common recommendations ethics cont d
Additional info to be provided when issuing common recommendations: Ethics (cont’d)
  • Comments (cont’d):
    • Use of data on migrant groups is always a worry even when we are clear on our intentions regarding optimizing care…
    • We could be helping to create negative social stereotypes
  • Precautions to be taken:
    • Try to get government buy-in
    • Consult those upholding privacy regulations
    • Could ensure measuring aspects of health thought to be positive in migrants at the same time as measuring those that are negative
    • Be aware of the discourse…
    • Inform women of their privacy rights
    • Create institutions with legal mandates to collect this information
    • Include migrants in data interpretation and reporting
conclusions
Conclusions
  • Our group recommends:
    • Essential indicator to be used in international comparisons of migration and perinatal health be migrant country of birth
    • Perinatal mortality rates by migrant country of birth be presented for each source region (data not presented)
    • Time since arrival in receiving country be added to routine data collection
    • Studies be undertaken to complement routine data collection on:
      • immigration status
      • receiving country language fluency
      • ethnic origin as defined by maternal parents’ place of birth
    • As soon as available, present several perinatal indicators with the recommended migration indicators
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