International migration and caesarean birth: a systematic review and meta-analysis

• Published in: BMC pregnancy and childbirth 2013-01, Vol.13 (1), p.27-27, Article 27
• Main Authors: Merry, Lisa, Small, Rhonda, Blondel, Béatrice, Gagnon, Anita J
• Format: Article
• Language: English
• Subjects: Cesarean Section - statistics & numerical data; Communication Barriers; Culture; Emigration and Immigration - statistics & numerical data; Female; Gynecology and obstetrics; Health care; Human health and pathology; Humans; Life Sciences; Medical research; Pregnancy; Prenatal Care; Risk Factors; Socioeconomic Factors; Studies; Womens health
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/1471-2393-13-27

Perinatal health disparities including disparities in caesarean births have been observed between migrant and non-migrant women and some literature suggests that non-medical factors may be implicated. A systematic review was conducted to determine if migrants in Western industrialized countries consistently have different rates of caesarean than receiving-country-born women and to identify the reasons that explain these differences. Reports were identified by searching 12 literature databases (from inception to January 2012; no language limits) and the web, by bibliographic citation hand-searches and through key informants. Studies that compared caesarean rates between international migrants and non-migrants living in industrialized countries and that did not have a 'fatal flaw' according to the US Preventative Services Task Force criteria were included. Studies were summarized, analyzed descriptively and where possible, meta-analyzed. Seventy-six studies met inclusion criteria. Caesarean rates between migrants and non-migrants differed in 69% of studies. Meta-analyses revealed consistently higher overall caesarean rates for Sub-Saharan African, Somali and South Asian women; higher emergency rates for North African/West Asian and Latin American women; and lower overall rates for Eastern European and Vietnamese women. Evidence to explain the consistently different rates was limited. Frequently postulated risk factors for caesarean included: language/communication barriers, low SES, poor maternal health, GDM/high BMI, feto-pelvic disproportion, and inadequate prenatal care. Suggested protective factors included: a healthy immigrant effect, preference for a vaginal birth, a healthier lifestyle, younger mothers and the use of fewer interventions during childbirth. Certain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.