Do foreign-born women in Sweden have an increased risk of non-normal childbirth?
BACKGROUND
In this cross-sectional study, we analyze whether foreign-born women in Sweden had more non-normal childbirths than Swedish-born women during 1996-1998, adjusting for age, parity, level of education, number of antenatal care visits, and complications in pregnancy.


METHODS
The study includes 215 497 singleton deliveries (including the first childbirth of each woman during the time period) of women aged 18-47 in Sweden during 1996-1998, divided into 12 subgroups of countries. The risk of non-normal birth was analyzed by means of logistic regression.


RESULTS
Women from Sub-Saharan Africa, Iran, Asia, and Latin America had a higher age-adjusted risk of non-normal childbirth than Swedish-born women that remained and even increased for the African and Latin American women in the main effect model. Interactions between country of birth and antenatal care visits showed that women from Sub-Saharan Africa, Iran, Asia, and Latin America had almost 50% higher risk of non-normal birth with > or =13 antenatal care visits than Swedish-born women. Interactions between country of birth and complications in pregnancy showed that women from Turkey, Iran, Asia, and Latin America had over 50% higher risk of non-normal birth than the Swedish-born women.


CONCLUSIONS
This study shows an association between being foreign-born and non-normal childbirth. Questions can be raised whether we are aware of, pay sufficient attention to, and allocate sufficient resources for these women at higher risk of non-normal birth in maternity care.
Robertson
Eva
E
Center for Family Medicine Stockholm, Karolinska Institute, Alfred Nobels allé 12, SE-141 83 Huddinge, Sweden. eva.robertson@klinvet.ki.se
Malmström
Marianne
M
Johansson
Sven-Erik
SE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004522:Educational Status; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000208:ethnology*; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data