International migration and caesarean birth: a systematic review and meta-analysis
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
BMC Pregnancy and Childbirth 2013, 13:27 doi:10.1186/1471-2393-13-27Published: 30 January 2013
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.