title: Maternal mortality and severe morbidity in a migration perspective.
abstract: Among migrants in high-income countries, maternal mortality and severe morbidity generally occur more frequently as compared to host populations. There is marked variation between groups of migrants and host countries, with much elevated risks in some groups and no elevated risk at all in others. Those without a legal resident permit are most vulnerable. A reason for these elevated risks could be a different risk profile in migrants, but risk factors are unevenly distributed and not always present. Another reason is substandard care, which is identified more frequently in migrants, and comprises patient delays, for example, due to a lack of knowledge about the health system in the host country, and health worker delays, often compounded by communication barriers. Improvements in family planning and antenatal services are needed, and audits and confidential enquiries should be extended to include maternal morbidity and ethnic background. This requires scientific and political efforts.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Postbus 9600, 2300RC Leiden, The Netherlands. Electronic address: t.h.van_den_akker@lumc.nl.
authors.forename: Thomas
authors.initials: T
authors.lastname: van den Akker
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Postbus 9600, 2300RC Leiden, The Netherlands; Athena Institute, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085-1087, 1081HV Amsterdam, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D065246:Culturally Competent Care / Q000592:standards*; D019049:Developed Countries; D003906:Developing Countries; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality / Q000208:ethnology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D014171:Transients and Migrants / Q000706:statistics & numerical data*
keywords: maternal health services; maternal mortality; pregnancy complications; quality of health care; severe acute maternal morbidity; transients and migrants