Aspects of foreign-born womens health and childbirth-related outcomes : An epidemiological study of women of childbearing age in Sweden

Abstract: This thesis aims to study the association between aspects of health and childbirth-related outcomes and country of birth. A theoretical model has been developed from a feministic perspective to reflect foreign-born women's risk of poor health and childbirth-related outcomes in a broader context Objectives: Study I analyses the association between self-reported poor health and psychosomatic complaints and country of birth, adjusting for sociodemographic factors. Study II analyses the longitudinal influence of migration status (1st and 2nd generation) and socio-demographic factors on self-reported long-term illness in Swedish and immigrant women. Study III examines whether morbidity, defined as the first psychiatric hospital admission and the first somatic hospital admission, differs among foreign-born and second-generation women compared to Swedishborn women even after adjusting for sociodemographic factors. Study IV analyses the influence of country of birth of the women on the risk of non-normal childbirth in the first singleton delivery in Sweden during 1996-98, adjusting for the number of antenatal care visits, age, parity and education. Study V analyses the association between foreignborn women and the use of non-pharmacological methods for pain relief at childbirth and pain control by epidural analgesia at childbirth in the first singleton delivery of women giving birth during 1996-98. Methods: Study I. A cross-sectional study of 10,661 women aged 20-49 in Sweden in 1980-85 and 9,585 women in 1992-97 was carried out. Study II: A simple random sample of 5,037 Swedish-born and 629 foreignborn women (aged 2041 the first occasion) was interviewed during 1983-1990 and 1991-1998. The risk of Limiting Longstanding illness (LLSI) was estimated by applying logistic regression for correlated data. Study III: In this followup study, the population consisted of 1,452,944 women, 369,771 of whom have an immigrant background (including 2nd-generation immigrants), aged 20-45 years, 1994-98. Studies X+V.. The studies included 215, 497 childbirths to women, aged 18-47, and divided into 12 subgroups of countries, with the first singleton delivery in Sweden 199698. The risk was analysed by logistic regression. Results: Study I. Women front Southern Europe, refugees and Finnish women had a higher risk of poor selfreported health and psychosomatic complaints than Swedish-born women after adjustment for sociodemographic variables. Women from Sweden and Finland and refugees had poorer health in the 1990s than in the 1980s. Study II. Firstgeneration labour-migrant, refugee and second-generation women had a higher risk of LLSI than Swedish-born women after adjustment for marital status, socio-economic status, feelings of insecurity and the longitudinal effect of age. However, immigrant women's health did not deteriorate more than that of Swedishborn women. Study III. All foreign-born and second-generation women had higher age-adjusted risks of a first psychiatric hospital admission than Swedish-born women. However, only Non-European refugee women had increased first somatic hospital admissions. Study IV: Women from Sub-Saharan Africa, Iran, Asia and Latin America had a higher risk of non-normal childbirth than Swedish women. However women from Southern Europe, Turkey and Arab countries a smaller less risk of non-normal childbirth than Swedish women. Study V: Women from Bosnia and Turkey and Southern Europe, Arab, Sub-Saharan African, and Asian countries had higher odds for non-pharmacological methods for pain relief and lower odds for pain control by epidural/spinal analgesia at childbirth than Swedish women. However, h~ and Latin American women had higher odds of pain control by epidurallspinal analgesia at childbirth than Swedish born women. Conclusions: The results in this thesis demonstrate associations between country of birth and women's health, shown as self-reported health and hospital admission, non-normal childbirth and use of non-pharmacological methods for pain relief and pain control by epidural analgesia at childbirth. The theoretical model suggest that foreign-born women have restricted opportunities to influence and handle decisive life experiences such as poor health and childbirth. But, with awareness, women can find a balance in setting limits for their constant accessibility and sensitivity to the needs of others and manage to acquire or create an intrinsic worth of their own as women.