1. Birthing experiences of immigrant and refugee women in Canada
Olive Wahoush
March 7th 2014
IRWHP
9/19/2018
Olive Wahoush

2. Migration Process Influence on health Pre-Migration Post Migration
Persecution, repression and deprivation, war, famine
MIGRATION
Separation from family
Overcrowding, lack of food & security
Grueling process, multiple interviews
POST MIGRATION
Acculturation
Racism
Poverty
Poor access to health and social services
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Olive Wahoush

3. Newcomer Health in Canada
Insurance gaps
Health care equity current research shows healthy immigrant effect with reductions for newcomers and subsequent generations
Consider Health care Access vs. outcomes
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Olive Wahoush

4. Loans for medical exam and transportation to Canada
Most refugee families start their new life in Canada with a debt of up to $10,000. 
They must repay this loan with interest.
Payments start three months after arrival
Loan repayment rate is 91% – an astonishingly high rate given the sacrifice repayment entails for many refugees
9/19/2018
Olive Wahoush

5. Research
CHARSNN 2006 – 2010
Maternal newborn study of health up to 4 months afterbirth (Quebec, Ontario & British Columbia)
First 18 months in Canada GARs ( ).
(Hamilton & Kitchener/Waterloo, Ontario)
9/19/2018
Olive Wahoush

6. CHARSNN STUDY: Concerns at Second home visit I
Cut/skip meals persists and remains most common for asylum seeking mothers
some increase across groups of women and in each city except for asylum seekers in Montreal
Developmental delays (2 or more no on Nipissing)
Most commonly reported in Toronto and similar pattern for Toronto & Vancouver
Highest among refugees (16%) and lowest among Canadian born (1-2%)
Small increases in proportion reports skipping meals because of money and more in Toronto and Canadian born women in Vancouver also start to report this.
Striking difference in Montreal – few reports of 2 or more than 2 Nos on the Nipissing
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Olive Wahoush

7. 7

8. 8

9. Concerns at Second home visit II
Mothers Vaccinations not up to date
Very common among all migrant groups (60-80%)
Toronto > Montreal > Vancouver
Same pattern among Canadian born women (8, 12, 31%)
Physical Abuse in the past year
least reported by Canadian born and non refugee immigrant women
Most common among Asylum seeker mothers (12-20%)
Physical abuse more common among asylum seekers & refugees differences in cities (TO & Montreal) may reflect city demographics
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Olive Wahoush

10. 10

11. Concerns at Second home visit III
Risk of Post Partum Depression
Risks may be reduced but still identified in all groups
Refugees & Asylum seekers most often identified
Reported symptoms of Post Traumatic Stress Disorder
Reported in all migrant groups
30% of refugee mothers & 50% of Asylum seekers
Toronto > Montreal
Note 20% of non refugee immigrants reported symptoms of PTSD in Toronto
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Olive Wahoush

12. 12

13. 13

14. Concerns at Second home visit IV
>3 concerns reported by
50-65% of refugee & asylum seeking mothers
Mothers in Montreal > Toronto or Vancouver
Average unaddressed concerns (40-80%)
Reported by a greater proportion of mothers in all groups than was reported at the first home visit
60-80% across all migrant groups in each city
Pattern similar in all cities Asylum seekers highest proportion of > 3 concerns, other migrants very close and Canadian born least.
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Olive Wahoush

15. 15

16. 16

17. Post Migration (2012) Health Insurance OHIP 46% (6) IFHP 23% (3)
Both 23% (3)
Income limited >35% spent on housing
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Olive Wahoush

18. Income after Rent (per month)
Amount % (n) Family size
<$ % (3) – 6
$ % (3) – 6
$1001 – % (5) – 8
$1500 – % (2) – 6
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Olive Wahoush

19. Health issues Racialization Under or never served
Health insurance gaps
Lack of awareness of issue or services
Transportation
Costs direct and indirect
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Olive Wahoush

20. Systematic Review 2013
Sub-Saharan African, Somali, and South Asian migrants consistently have higher caesarean rates while Eastern-European and Vietnamese migrants have lower overall caesarean rates compared to receiving-country-born women.
North-African/West Asian and Latin American migrant women have higher emergency caesarean rates. To date there is inadequate empirical evidence to explain observed differences in caesarean rates; more focused research is urgently needed.
Merry, Lisa, et al. "International migration and caesarean birth: a systematic review and meta-analysis." BMC Pregnancy and Childbirth 13 (2013): 27. Academic OneFile. Web. 7 Mar

21. Global review
Migrant women consistently have different rates of caesarean compared to receiving-country-born women,
Non-medical factors such as
communication barriers
support and/or care practices during labour and delivery
female genital cutting
cultural preference may also be implicated in caesarean rate differences

22. References http://www.unhcr.ca/ http://www.unhcr.org/4ec262df9.html
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Olive Wahoush

23. References Cont’d
Gagnon,A.J.; Wahoush,O.; Dougherty,G.; Saucier,J.-F.; Dennis,C.-L.; Merry,L.; Stanger,E.; Stewart,D.E. (2006). The childbearing health and related service needs of newcomers (CHARSNN) study protocol. BMC, Pregnancy and Childbirth. Dec /2006; 6:31. DOI: /
Gagnon,A.J.; Dougherty,G.; Platt,R.W.; Wahoush,O.; George,A.; Stanger,E.; Oxman-Martinez,J.; Saucier,J.F.; Merry,L.; Stewart,D.E. (2007). Refugee and refugee-claimant women and infants post-birth: migration histories as a predictor of Canadian health system response to needs. Can.J.Public Health, 2007, 98, 4, , Jul-Aug
Stewart,D.E.; Gagnon,A.; Saucier,J.F.; Wahoush,O.; Dougherty,G. (2008). Postpartum depression symptoms in newcomers. Can.J.Psychiatry, 2008, 53, 2,
Ahmed,A.; Stewart,D.E.; Teng,L.; Wahoush,O.; Gagnon,A.J. (2008). Experiences of immigrant new mothers with symptoms of depression. Arch.Women Ment.Health., 2008, 11, 4, ,
Wahoush,E.O., (2009). Equitable health-care access: the experiences of refugee and refugee claimant mothers with an ill preschooler. Can.J.Nurs.Res., 2009, 41, 3,
Wahoush, O. (2014), Primary Health Care: Provider Perspectives on their Services for Preschool Children in Refugee & Refugee Claimant Families. Primary Health Care:Open Access 10/2013; 3(140). DOI: /
9/19/2018
Olive Wahoush