The perinatal health and lived experiences of Sub-Saharan African and Eastern European migrant women in Malta

Abstract

The multifaceted challenges that migrant women experience in the host country predispose them to unfavourable perinatal health outcomes. Recently, Malta has seen an influx in maternities among sub-Saharan African (SSA) and Eastern European (EE) migrants; however, this population has not gained much research attention from a local and international perspective. This research was led by a thorough review of the literature, which identified adverse perinatal health outcomes in SSA migrants and inconclusive evidence regarding the outcomes reported for EE migrants. Additionally, the review confirmed the paucity of research on the perinatal experiences of SSA and EE migrant women both internationally and in Malta. This research contributed to academia by addressing the literature gaps in two separate studies that aimed to compare the maternal and infant perinatal health outcomes of SSA and EE migrant women who gave birth in Malta between 2007 and 2016, to the outcomes reported for Maltese women, and to explore how SSA and EE women perceive and experience the perinatal period as migrant women in Malta. This research was guided by the Iceberg Model of Culture and the Conceptual Framework of Access to Health Care. Study one involved a retrospective analysis of maternal (38509) (Maltese, SSA and EE) and neonatal (39207) data registered in Malta (2007-2016). Statistical comparison was conducted using the Pearson’s chi-square test. Study two adopted an interpretative phenomenological analysis methodology. Following ethical clearance, one-to-one in-depth interviews were carried out with a purposive sample of eight SSA (Eritrean and Nigerian) and twelve EE (Bulgarian, Romanian, and Serbian) women, recruited from the Discharge Liaison Midwives’ service. The interviews were audio-recorded, transcribed verbatim and analysed by close, line-by-line interpretation of participants’ narratives. The retrospective study indicated that both migrant populations commenced prenatal care later than the Maltese cohort; however, while SSA experienced worse perinatal outcomes, less antenatal complications were reported for EE women. The second study recognised the struggles that SSA and EE women endured during the perinatal period in Malta, their longing for community support, and the disruptions brought about by the domino effect of the COVID-19 pandemic. EE migrant’s perceptions towards normalising medicalisation of pregnancy and childbirth contrasts SSA women’s beliefs towards normality; these views were mostly shaped by cultural influences. Participants valued receiving compassionate and respectful care and felt safe in the hands of health professionals in Malta. The findings of this innovative research could be used as the groundwork for the implementation of a community-based perinatal support service that reaches SSA and EE migrant women. Cultural competence training for maternity health professionals is needed along with the provision of information to migrant women outlining the perinatal services available. Future studies need to research the viewpoints of service providers delivering care to SSA and EE migrants. The implementation of integration policies focusing on safeguarding the health of migrant women is recommended.