Maternal Health in the Refugee Crisis

Maternal Health in the Refugee Crisis

By Gina Colon

With women making up almost half of the refugee populations worldwide, and 1 in 10 of them being pregnant (1), we should be aware of the issues that are present in their lives. These women face multiple hardships that put themselves and their pregnancy at risk. These risks show how maternal health in the refugee crisis is a major concern that must be attended to.

A pregnant woman at a refugee camp in Ritsona, Greece. (Photo: Panayiotis Tzamaros/NurPhoto via Getty Images) 

A pregnant woman at a refugee camp in Ritsona, Greece. (Photo: Panayiotis Tzamaros/NurPhoto via Getty Images) 

Pregnancy brings many changes to a person’s body throughout its different stages. During all these stages, it is of utmost importance to provide adequate access to maternal health services and low-pressure environments to ensure the safety of the mother and the child. These services provide care and social support which are important for a safe pregnancy and delivery. However, many people, such as refugees, lack access to maternal care or similar services. Without the proper resources and help, these women are more likely to face birthing complications and postpartum depression in comparison to non-refugee populations (2). 

There are many actions that are recommended for a healthy pregnancy and labor. The World Health Organization (WHO) advises expectant mothers a minimum of 8 visits for antenatal (prenatal) care (3). This along with other recommendations, such as providing vitamin supplements, counseling on nutrition, screening for adverse effects with the patient’s health history, immunization for the mother, and ultrasounds are essential for a mother and their baby (3). However, many refugee women have competing needs, such as economic/social/environmental issues, that interfere in obtaining the recommended prenatal care. Existing health conditions and complications can add additional strain to these situations. 

The effects of these challenges and hardships that refugee women face, as shown in a recent report, demonstrate how 60% of preventable maternal deaths occur in settings of humanitarian crises (4). Likewise, another report stated that the risk of neonatal death increases by 40% when there is inadequate prenatal care (5). These deaths are damaging to families since many mothers are usually the ones who typically take care of the children. The passing of the mother also puts a heavy strain on the household. Likewise, stillbirths or the death of a newborn causes mental distress to the mother. Even if the mother or baby were to survive a complication, stress and depression is still experienced due to the ordeal. However, a lot of these deaths and complications are results of a lack of access to healthcare services. 

There are various barriers that are present which prevent refugees from obtaining care. For example, one major barrier that refugees face is not sharing a language with their host country. This causes a problem where there is a lack of information and communication about how the healthcare system of the host country works (6). Furthermore, it slows down the process for women to receive services. Another barrier that affects refugees is discrimination. Harmful stereotypes, racism, and other perceptions cause many refugees to have a negative experience (6). These experiences have also led to delayed services and inadequate care.

The barriers that refugee women face also affect their health during pregnancy/birth. This is seen with the increase in the rate of refugee women who have cesarean sections, stillbirths, and other morbidities when compared to non-refugee women (6). Other health effects included are postnatal/antenatal depression, anxiety, and PTSD (6). The negative health statuses that these women face can also have an adverse effect on the children they are bearing. Pregnancy complications, such as pre-eclampsia, can also cause issues where a child has a slow development and/or premature birth (7). In regards to mental health, the stress that a mother encounters during the pregnancy has an effect on how the child develops cognitively and emotionally. Studies show that stressful pregnancies can cause an increased risk for developmental issues due to the high amounts of the stress hormone, cortisol (8).

The challenges that refugee women face give rise to the importance of health equity and how services need to be available. With better access to care, many of these women have higher rates of successful and healthy births/pregnancies. Likewise, there are fewer complications and deaths associated with proper facilities. A common issue is miscommunication of symptoms or medical history due to a language barrier, which can lead to misdiagnosis (9). A proposed solution would be for interpreters to be more readily available to refugees for better patient-caretaker communication. Another way to promote health equity is by giving health care providers cultural sensitivity training which can help with understanding the cultural fears about certain medical procedures. Proper knowledge can help ease anxieties about those procedures. Educating health professionals about common experiences that refugees have can provide insight into their health, which allows for a thorough treatment. In addition, these refugee women should have more resources available to them that can help ease their situations and that promote their own physical and mental wellbeing. 

Refugee woman holding their child. (Photo: Panayiotis Tzamaros/NurPhoto via Getty Images)

Refugee woman holding their child. (Photo: Panayiotis Tzamaros/NurPhoto via Getty Images)

Multiple organizations focus their efforts on refugee and maternal health. One organization, the International Committee of the Red Cross (ICRC), are advocates for refugee crises and have volunteers in nearly every country, and provide aid to various refugee populations such as those from Iraq, Syria, and Ethiopia. The ICRC has also provided services, built maternal clinics, and distributed vaccines for mothers and pregnant women. Another organization called CARE is an international humanitarian group that has focused its efforts on women and children. This group has provided food, health services, and education to those in need throughout the world. These two organizations are just a couple of the many who dedicate their resources to help and support pregnant refugees/mothers and their families.

Their efforts can be followed here: 

International Committee of the Red Cross (icrc.org)

CARE - Fighting Global Poverty and World Hunger (care.org)

References

  1. Refugees Deeply. (2016, June 13). The Quiet Crisis Of Europe’s Pregnant Refugees. HuffPost. https://www.huffpost.com/entry/europe-pregnant-refugees_n_575eba7ce4b0ced23ca88e5e

  2. Dennis, C.-L., Merry, L., & Gagnon, A. J. (2017). Postpartum depression risk factors among recent refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Social Psychiatry and Psychiatric Epidemiology, 52(4), 411–422. https://doi.org/10.1007/s00127-017-1353-5

  3. New guidelines on antenatal care for a positive pregnancy experience. (2016, November 7). Who. https://www.who.int/news/item/07-11-2016-new-guidelines-on-antenatal-care-for-a-positive-pregnancy-experience

  4. In focus: Women refugees and migrants. (n.d.). UN Women | Europe and Central Asia. https://eca.unwomen.org/en/news/in-focus/women-refugees-and-migrants

  5. Neonatal Death Risk: Effect Of Prenatal Care Is Most Evident After. (2017a, February 3). Guttmacher Institute. https://www.guttmacher.org/journals/psrh/2002/09/neonatal-death-risk-effect-prenatal-care-most-evident-after-term-birth

  6. Heslehurst, N., Brown, H., Pemu, A., Coleman, H., & Rankin, J. (2018). Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC medicine, 16(1), 89. https://doi.org/10.1186/s12916-018-1064-0

  7. Federenko, I. S., & Wadhwa, P. D. (2004). Women’s Mental Health During Pregnancy Influences Fetal and Infant Developmental and Health Outcomes. CNS Spectrums, 9(3), 198–206. https://doi.org/10.1017/s1092852900008993

  8. Duley, L. (2009). The Global Impact of Pre-eclampsia and Eclampsia. Seminars in Perinatology, 33(3), 130–137. https://doi.org/10.1053/j.semperi.2009.02.010

  9. World Health Organization. (2018). Improving the health care of pregnant refugee and migrant women and newborn children. https://www.euro.who.int/__data/assets/pdf_file/0003/388362/tc-mother-eng.pdf