title: Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis.
abstract: BACKGROUND
  Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes.
  
  
  METHODS
  We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings.
  
  
  RESULTS
  Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to configure maternity services and programs appropriately.
  
  
  CONCLUSIONS
  Although immigrant women in Canada are generally given the opportunity to obtain necessary services, they face many barriers in accessing and utilising these services. These barriers include lack of information about or awareness of the services, insufficient supports to access these services and discordant expectations between the women and their service providers.
  
  
  BACKGROUND
  PROSPERO registration number: CRD42012002185 .
authors.affiliation: Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada. gina.higginbottom@ualberta.ca.
authors.forename: Gina M A
authors.initials: GM
authors.lastname: Higginbottom
authors.affiliation: King's College London, Primary Care and Public Health Sciences London, London, SE1 3QD, UK. myfanwy.morgan@kcl.ac.uk.
authors.forename: Myfanwy
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Citizenship and Immigration Canada, New Multiculturalism Grants and Contributions Program, Canada Place, Edmonton, AB, T5J 4C3, Canada. mirande.alexandre@cic.gc.ca.
authors.forename: Mirande
authors.initials: M
authors.lastname: Alexandre
authors.affiliation: Multicultural Health Brokers Co-operative, Edmonton, AB, T5H 2M6, Canada. yvonne.chiu@shaw.ca.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Chiu
authors.affiliation: Lois Hole Hospital, Alberta Health Services, Edmonton, AB, T5H 3V9, Canada. joan.forgeron@albertahealthservices.ca.
authors.forename: Joan
authors.initials: J
authors.lastname: Forgeron
authors.affiliation: Health Canada, Public Health Agency of Canada, Calgary, AB, T2G 4X3, Canada. debbie.kocay@phac-aspc.gc.ca.
authors.forename: Deb
authors.initials: D
authors.lastname: Kocay
authors.affiliation: Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, T6G 1C9, Canada. barolia@ualberta.ca.
authors.forename: Rubina
authors.initials: R
authors.lastname: Barolia
mesh_terms: D002170:Canada; D054521:Cultural Competency; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services; D033262:Narration; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome