Contribution of HIV to maternal morbidity among refugee women in Canada

S. Wanigaratne, D.C. Cole, K. Bassil, I. Hyman, R. Moineddin and M.L. Urquia

American Journal of Public Health, 2015, vol. 105, issue 12, 2449-2456

Abstract: Objectives. We compared severe maternal morbidity (SMM) and SMM subtypes, including HIV, of refugee women with those of non refugee immigrant and nonimmigrant women. Methods. We linked 1 154 421 Ontario hospital deliveries (2002-2011) to immigration records (1985-2010) to determine the incidence of an SMM composite indicator and its subtypes. We determined SMM incidence according to immigration periods, which were characterized by lifting restrictions for all HIV-positive immigrants (in 1991) and refugees who may place "excessive demand" on government services (in 2002). Results. Refugees had a higher risk of SMM (17.1 per 1000 deliveries) than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among SMM subtypes, refugees had a much higher risk of HIV than did immigrants (risk ratio [RR] = 7.94; 95% confidence interval [CI] = 5.64, 11.18) and nonimmigrants (RR = 17.37; 95% CI = 12.83, 23.53). SMM disparities were greatest after the 2002 policy came into effect. After exclusion of HIV cases, SMM disparities disappeared. Conclusions. An apparent higher risk of SMM among refugee women in Ontario, Canada is explained by their high prevalence of HIV, which increased over time parallel to admission policy changes favoring humanitarian protection.

Keywords: adolescent; adult; complication; female; health disparity; HIV Infections; human; migrant; Ontario; parity; pregnancy; Pregnancy Complications, Infectious; refugee; risk factor; statistics and numerical data; young adult, Adolescent; Adult; Emigrants and Immigrants; Female; Health Status Disparities; HIV Infections; Humans; Ontario; Parity; Pregnancy; Pregnancy Complications, Infectious; Refugees; Risk Factors; Young Adult (search for similar items in EconPapers)
Date: 2015
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2015.302886_7

DOI: 10.2105/AJPH.2015.302886

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