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Open Access Research article

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

Lisa Merry1*, Rhonda Small2, Béatrice Blondel3 and Anita J Gagnon4

Author Affiliations

1 Ingram School of Nursing, McGill University, Montreal, QC, Canada

2 Mother and Child Health Research, La Trobe University, Melbourne, VIC, Australia

3 Unité 953, Recherche épidémiologique en santé périnatale et santé des femmes et des enfants, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France

4 Ingram School of Nursing and Department of Obstetrics and Gynecology, McGill University; McGill University Health Centre (MUHC), Montreal, QC, Canada

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BMC Pregnancy and Childbirth 2013, 13:27  doi:10.1186/1471-2393-13-27

Published: 30 January 2013

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

Certain groups of international migrants consistently have different caesarean rates than receiving-country-born women. There is insufficient evidence to explain the observed differences.

Keywords:
Caesarean; Immigrants; Refugees; Risk factors; Meta-analysis