Perinatal and obstetric health outcomes of eastern African immigrant women in Victoria, Australia: a population-based study

Submission note: A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Public Health to the Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora.

Background: Births to immigrant women are increasing in many developed countries including Australia, where over a quarter of births are to foreign-born women. Previous obstetric and perinatal health outcome studies of immigrant populations have yielded mixed results. Therefore, understanding of immigrant women’s birth outcomes is far from complete. Australia has admitted many African immigrants of refugee background beginning in the 1990s, but evidence about African women’s birth outcomes in general and Eastern African immigrants in particular is lacking in Australia. This study described and investigated the independent association of adverse perinatal outcomes [low birthweight, preterm birth, small for gestational age births, 5’Apgar score, perinatal mortality] and obstetric health outcomes [caesarean section (CS), trial of labour and successful vaginal birth after caesarean section (VBAC), episiotomy use and severe perineal tear] for Eastern African maternal countries of birth in comparison with Australian born women. Methods: A population-based study of singleton births to women born in one of the Eastern African (Eritrea, Ethiopia, Somalia and Sudan) countries or Australia was conducted using the routine state-wide validated Victorian Perinatal Data Collection (VPDC) in Australia. Results: Compared with mothers born in Australia, Eastern African immigrants had elevated odds of perinatal mortality and a number of other adverse perinatal health outcomes. Moreover, primary CS, failed attempted VBAC, severe perineal tear and episiotomy use were more common among Eastern African immigrants. The observed associations remained strong even after adjusting for available clinical and socio-demographic confounding factors. Nonetheless, individual country of birth analysis also indicated differentiated results. Conclusions: Overall, Eastern African maternal countries of birth were associated with increased adverse perinatal health outcomes and increased obstetric interventions. However, adverse outcomes were not readily explained by maternal characteristics or clinical risk factors. The findings suggest the need for enhanced surveillance and improved health care delivery for these immigrants. Further research around other potential explanatory factors (communication issues, support available for pregnant immigrant women, care differentials) is also needed.