Refugee and refugee-claimant women and infants post-birth - Migration histories as a predictor of Canadian health system response to needs

Background: Minority women from conflict-laden areas with limited host-country knowledge are among the most vulnerable migrants. Their risk status and that of their infants is magnified during pregnancy, birth, and post-birth. We conducted a study to determine whether women's postnatal health concerns were addressed by the Canadian health system differentially based on migration status (refugee, refugee-claimant, immigrant, and Canadian-born) or city of residence. Methods: Women speaking any of 13 languages were recruited (with their infants) from postpartum units in the main Canadian receiving cities for newcomers (Toronto, Montreal, Vancouver; total n = 341 pairs from 10 hospitals) and followed at home after birth. Our primary interest was 'unaddressed concerns'; nurse-identified health concerns based on standards of postpartum care for the woman/infant at 7-10 days post-birth, for which no professional attention had been given or planned. Results: A difference in unaddressed concerns by migration status was not found in our primary model [OR refugees vs. Canadian-born = 1.40 (95% Cl: 0.67-2.93); refugee-claimants, 1.20 (0.61-2.34); immigrants, 1.02 (0.56-1.85)] although differences by city of residence remained after controlling for migration status, income, education, maternal region of birth, language ability, referral status, and type of birth [Toronto vs. Vancouver OR = 3.63 (95% Cl: 2.00-6.57); Montreal, 1.88 (1.15-3.09)]. The odds of unaddressed concerns were greater in all migrant groups [OR refugees vs. Canadian-born = 2.42 (95% Cl: 1.51-3.87); refugee-claimants, 1.64 (1.07-2.49); immigrants, 1.54 (1.00-2.36)] when analyses excluded variables which may be on the causal pathway. Interpretation: Women and their newborn infants living in Toronto or Montreal may require additional support in having their health and social concerns addressed. The definitive effect of migrant group needs confirmation in larger studies.