Do migrant women have equity of access to midwife continuity of care?

Abstract

Migrant populations are recognised to be at increased risk of adverse health outcomes including perinatal outcomes. Structural barriers to maternity care and racism are recognised globally as an urgent issue for migrants. Midwife continuity of care (MCoC) has well known improved perinatal benefits. To investigate if duration since migration was associated with reduced access to MCoC. We conducted a retrospective cohort study from June 2020-November 2023 at six Australian hospitals. MCoC was investigated by hospital and self-identified ethnic group for women who migrated < 5 years, ≥ 5 years compared to the Australian born population. Regression models adjusted for significant factors including use of interpreter and co-morbidities. There were 48,240 participants for analysis. Most in the cohort were Australian born (54.7 %, n = 26,365), migrants of < 5 years comprised 13.2 % (n = 6388) and those who migrated ≥ 5 years 32.1 % (n = 15,487). At all study hospitals, new migrants had the least access to MCoC. Compared to Australian born women, new migrants were 70 % less likely to receive MCoC (aOR 0.30; 95 %CI 0.27-0.34) and migrants of ≥ 5 years were 49 % less likely (aOR 0.51; 95 %CI 0.48-0.56). We identified a difference to access to MCoC between ethnic groups. Health literacy needs of women who are migrants should be addressed to improve equity of access to a model of care that is evidenced based to improve perinatal outcomes. It is incumbent on health services to measure equity of access and adjust services to ensure equity of access for all populations.