Perspectives
Women's health Global health Social determinants of health
Volume 210 - Issue 11

Ending preventable stillbirths among migrant and refugee populations

Authors:  Jane Yelland, Elisha Riggs, Josef Szwarc and Stephanie J Brown

Med J Aust 2019; 210 (11): 488-489.e1. || doi: 10.5694/mja2.50199
Published online: 10 June 2019

There is an urgent need for stronger evidence to inform tailored health care strategies to address perinatal health disparities

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Engaging migrant communities and health professionals is critical for addressing disparities in preventable stillbirth

 

The Senate committee report on stillbirth research and education1 puts a spotlight on the tragedy of preventable stillbirth. Public health attention to this devastating but low visibility issue is long overdue. As more coordinated efforts are made to end preventable stillbirth in high income countries, it is critical to ask what steps are being taken to reduce persistent equity gaps in stillbirth rates. More specifically, what role can health services play in ensuring that campaign messages and clinical responses benefit populations vulnerable to poor perinatal outcomes.

In Australia and in other high income countries, there are marked socio‐economic disparities in stillbirth rates. Aboriginal and Torres Strait Islander people and people from some low and middle income countries, particularly those coming as humanitarian entrants to Australia, are among the most likely to experience stillbirth.2,3,4,5 The reasons for this are multifaceted, with emerging evidence that difference in gestational length and fetal growth restriction explain a proportion of stillbirths to migrant women from South Asian countries.6 Barriers to access and engagement with antenatal care and limited health literacy are also likely to be on the pathway to stillbirth.7 More distal risk factors include complex social determinants of health and the cumulative impact of stressful life events and social disadvantage.2

There is a call for action to end preventable stillbirth in high income countries by improving the health status of women, addressing quality improvement in maternity care, and reducing social inequities.2 Strategies to end preventable stillbirth require both a focus on communities at risk and health service innovation, as reflected in the work of the Stillbirth Centre of Research Excellence (www.stillbirthcre.org.au). For migrant and refugee women, overcoming communication barriers is key. Women of migrant and refugee background are at risk of missing critical information about ways to optimise their health and that of their baby. Messages about sleep position, smoking cessation, management of diabetes, warning signs of pregnancy complications, and when and how to seek help need to be communicated in ways that will be both easy to understand and meaningful in the context of women's lives and prior experiences of health services. Without interpreters, time and attention to building relationships and understanding, information may be misunderstood. Women taking part in our study reported limited access to understandable information and explanations about routinely conducted tests and procedures and test results.10

Stronger evidence to inform the development of tailored strategies to overcome communication barriers in perinatal care is urgently needed. Digital recording of consultations — trialled successfully in oncology settings11 — has not been tested in maternity care or in interpreter‐mediated conversations. Patient‐held recordings of consultations conducted with an interpreter have the potential for non‐English speaking women to replay consultations in their own language and listen to them or watch them with family members. In collaboration with Victorian public hospitals, maternal and child health services, and settlement services, our group is currently evaluating group pregnancy care provided by a multidisciplinary team as an innovative way to overcome communication barriers and improve access to high quality antenatal care. The multidisciplinary team comprises clinical midwives, maternal and child health nurse, an interpreter and a bicultural worker, and has been co‐designed with local community input. Early findings suggest that the combination of care close to where women live, access to both an interpreter and a bicultural worker, and the orientation to provide information in ways that is asked for by women are resulting in greater uptake and retention of health information, including information about when and how to seek help related to pregnancy.12

We believe that understanding what matters to women and communities new to Australia is fundamental to health care reform to end preventable stillbirth. It is clear that new clinical and service interventions will only work when informed by service staff and health consumers, and both are engaged in the process of change.13,14

Authors

  • Jane Yelland1,2
  • Elisha Riggs1,2
  • Josef Szwarc3
  • Stephanie J Brown1,2
  • 1. Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, VIC
  • 2. University of Melbourne, Melbourne, VIC
  • 3. Victorian Foundation for Survivors of Torture, Melbourne, VIC

Correspondence: Jane.Yelland@mcri.edu.au

Competing interests

No relevant disclosures.

Acknowledgements

We acknowledge the support of the Victorian Government's Operational Infrastructure Support Program. Jane Yelland is supported by a National Health and Medical Research Council (NHMRC) Translating Research into Practice Fellowship (2018–2019). Stephanie Brown is supported by an NHMRC Senior Research Fellowship (2016–2020).

References

Linked content

  • InSight+: Stillbirth taboo: start by saying the word

  • MJA Podcast: Associate Professor Jane Yelland

Provenance: Not commissioned; externally peer reviewed.

View this article on Wiley Online Library