Migration and perinatal health surveillance: an international DELPHI survey

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Migration and perinatal health surveillance an
international DELPHI survey

•  
• Mika Gissler1, Anita Gagnon2, Meg Zimbeck3, and
  Jennifer Zeitlin3 for the ROAM collaboration
• Reproductive Outcomes and Migration An
  International Research Collaboration
•  
• 1 THL National Institute for Health and Welfare,
  Helsinki, Finland
• Nordic School of Public Health, Gothenburg,
  Sweden
• 2 McGill University, Montreal, Canada McGill
  University Health Centre, Montreal, Canada
• 3 INSERM, Epidemiological Research Unit on
  Perinatal and Womens Health, Paris, France

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Background

• Perinatal health of migrant women is a priority
  for many governments.
• No consensus exists on indicators for monitoring
  migration and perinatal health.
• ROAM began its work by undertaking an extensive
  review of the literature
• One purpose was to inventory migrant terms and
  definitions used to study this issue.
• This inventory formed the basis from which the
  expertise of researchers specializing in this
  topic was sought to identify the most appropriate
  indicators to be used through a Delphi process.

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Objectives for this project

• To achieve consensus on migration indicators to
  be used internationally for
• Perinatal health surveillance indicator sets.
• Routine population-based perinatal surveys.
• To obtain suggestions on migration indicators and
  definitions to be used for research projects.

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Methods Modified Delphi process

• A formalized consensus method
• A panel of people respond to successive series of
  questionnaires with the aim of achieving a
  consensus on key principles/proposals.
• Participants rank items by priority or
  importance can give comments.
• Participants
• 38 perinatal clinicians, epidemiologists, experts
  in health information systems from EURO-PERISTAT,
  ROAM, and others (recommended by ROAM).
• 22 countries including Europe, Australia, Canada.

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Methods Modified Delphi process

• Questionnaires
• The questionnaires were derived from the ROAM
  systematic review of literature.
• Each participant completed between 1 and 3
  questionnaires (rounds of questionnaires).
• Summary results of each preceding round of
  questionnaires were provided in conjunction with
  a new set of questions.

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Importance of indicator

• Concepts considered important or essential by 50
  or more
• Country of birth
• The time that the migrant has been in the country
  
• measured by recent immigrant, length of time in
  country, age at migration and year of migration
• Immigration status
• undocumented, irregular migrant, immigration
  status, asylum seeker, refugee
• Language fluency
• Ethnicity

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Feasibility of indicators

• Generally the feasibility was low.
• Country of birth had the highest rating
• 65 thought this indicator could be collected in
  data registries with no or minor modifications.
• 69 in routine population surveys.
• In general, feasibility was considered to be
  higher in routine population surveys.
• Poor feasibility
• undocumented/irregular status, asylum-seeker/refug
  ee status
• ethnicity
• receiving country language fluency.

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Consensus to reduce the migration indicator list

• Agreement with the reduced list of indicators to
• consider 79
• Country of birth
• Recent immigrant
• Immigration status
• Language
• Ethnicity

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Recommendations Core indicator - routine data
collection
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Recommendations Recommended indicator - routine
data collection
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Recommendations Recommended indicator -
specific studies or added to routine data
collection
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Recommendations Recommended indicator -
specific studies or added to routine data
collection (contd)
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Conclusions

• Our group recommends
• Essential indicator to be used in international
  comparisons of migration and perinatal health be
  migrant country of birth. Outcomes should be
  presented for each source region.
• Time since arrival in receiving country should be
  added to routine data collection.
• Studies be undertaken to complement routine data
  collection on
• immigration status
• receiving country language fluency
• ethnic origin as defined by maternal parents
  place of birth
• As soon as available, present several perinatal
  indicators with the recommended migration
  indicators.
• Collecting and presenting data on migration
  requires special attention to ethical questions.

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ROAM Reproductive Outcomes And Migration An
international research collaboration

• Alison Macfarlane, City University of London (UK)
• Edward Ng, Statistics Canada
• Carolyn Roth, Keele University (UK)
• Rhonda Small (co-leader), LaTrobe University
  (Australia)
• Donna Stewart, University Health Network of
  Toronto (Canada)
• Babill Stray-Pederson, University of Oslo
  (Norway)
• Marcelo Urquia, Institute For Clinical Evaluative
  Sciences (Canada)
• Siri Vangen, Dept Ob/Gyn of The National Hospital
  of Norway
• Jennifer Zeitlin, INSERM and EURO-PERISTAT
  (France)
• Meg Zimbeck, INSERM and EURO-PERISTAT (France)

• Sophie Alexander, Université libre de Bruxelles
  (Belgium)
• Béatrice Blondel, INSERM (France)
• Simone Buitendijk, TNO Institute Prevention and
  Care (Netherlands)
• Marie Desmeules, Public Health Agency of Canada
• Dominico DiLallo, Agency for Public Health Rome
  (Italy)
• Anita Gagnon (co-leader), McGill University/MUHC,
  (Canada)
• Mika Gissler, THL (Finland)
• Richard Glazier, Institute for Clinical
  Evaluative Sciences (Canada)
• Maureen Heaman, University of Manitoba (Canada)
• Dineke Korfker, TNO Institute Prevention and
  Care (Netherlands)

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Funding acknowledgements

• Canadian Institutes of Health Research (CIHR) -
  International Opportunities Program
• Start-up support Immigration et métropoles
  (Center of Excellence in Immigration Studies -
  Montreal)
• Career support to AJG Le fonds de la recherche
  en santé du Québec (FRSQ)
• Visiting Scientist Scholarship to AJG l'Institut
  National de la Santé et de la Recherche Médicale
  (INSERM, France)

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Additional info to be provided when issuing
common recommendations Ethics

• Collecting and presenting data on migration
  requires special attention to ethics and the way
  that these data are used and interpreted in my
  country
• Yes 70
• No 18
• No response 12
• Comments
• Useful for healthcare providers not to know about
  legal status of patients cannot refuse them
  treatment.
• Several privacy laws apply.
• Info may be censored with small sample sizes.
• Using broader categories to report results may
  reduce singling out any particular group.
• Use of data on migrant groups is always a worry
  even when we are clear on our intentions
  regarding optimizing care.
• We could be helping to create negative social
  stereotypes.

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Additional info to be provided when issuing
common recommendations Ethics

• Precautions to be taken
• Try to get government buy-in.
• Consult those upholding privacy regulations.
• Could ensure measuring aspects of health thought
  to be positive in migrants at the same time as
  measuring those that are negative.
• Be aware of the discourse.
• Inform women of their privacy rights.
• Create institutions with legal mandates to
  collect this information.
• Include migrants in data interpretation and
  reporting.