title: Maternity services are not meeting the needs of immigrant women of non-English speaking background: Results of two consecutive Australian population based studies.
abstract: BACKGROUND
  women of non-English speaking background who migrate by choice or seek refuge in developed countries such as Australia have notably poorer perinatal outcomes than local-born women. Using data collected in two consecutive population-based surveys conducted in 2000 and 2008, the objective of this paper is to compare the views and experiences of immigrant women of non-English speaking background (NESB) giving birth in Victoria, Australia with those of women who were born in Australia.
  
  
  METHODS
  consecutive population-based surveys of women giving birth in Victoria, Australia conducted in 2000 and 2008. Questionnaires were distributed to women giving birth in a two-week period in 2000 and a four-week period in 2008 by hospitals and home birth practitioners. Surveys were mailed to women at five to six months post partum.
  
  
  RESULTS
  completed surveys were received from 67% of eligible women in 2000 (1616/2412), and 51.2% in 2008 (2900/5667). Compared to Australian-born women, immigrant women of NESB were more likely to report negative experiences of antenatal, intrapartum and postnatal care. In 2008, 47.1% of immigrant women expressed dissatisfaction antenatal care compared with 26.8% of Australian born women (Adj OR 2.17, 95% CI 1.7-2.7). Similarly, 40.5% of immigrant women were dissatisfied with intrapartum care compared with 25.5% of Australian born women (Adj OR 1.81, 95% CI 1.4-2.3), and 53.5% of immigrant women rated their postnatal care negatively compared with 41.0% of Australian born women (Adj OR 1.52, 95% CI 1.2-1.9). There was no evidence of improvement between the two surveys. Immigrant women were more likely than Australian-born women to say that health professionals did not always remember them between visits, make an effort to get to know the issues that were important to them, keep them informed about what was happening during labour or take their wishes into account.
  
  
  CONCLUSIONS
  data from repeated population-based surveys of recent mothers provides one of the few avenues for gauging whether changes to the organisation of maternity services is making a difference to immigrant women's experiences of care. Our findings showing no change over an eight year period - during which there were major efforts to increase access to midwifery led models of care and provide greater continuity of caregiver - suggest that different approaches, more specifically tailored to the needs of immigrant families are needed to enhance women's experiences of care and improve outcomes.
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3052, Australia. Electronic address: jane.yelland@mcri.edu.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Yelland
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3052, Australia. Electronic address: elisha.riggs@mcri.edu.au.
authors.forename: Elisha
authors.initials: E
authors.lastname: Riggs
authors.affiliation: Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, Victoria 3000, Australia. Electronic address: R.Small@latrobe.edu.au.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Small
authors.affiliation: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3052, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria 3052, Australia. Electronic address: stephanie.brown@mcri.edu.au.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brown
mesh_terms: D000328:Adult; D003144:Communication Barriers; D054242:Emigrants and Immigrants; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D008880:Midwifery; D017060:Patient Satisfaction; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014739:Victoria; D055815:Young Adult
keywords: Immigrant women; Maternity care; Population-based survey