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- Time-trends in pregnancy: findings from PortugalPublication . Lopes, Sofia; Teixeira, Cristina; Barros, HenriqueTo examine trends in pregnancy and abortion rates observed in Portugal in the last decade. We abstracted all delivery and abortionrelated-admissions to Portuguese public hospitals (2000–2010) using a nationwide inpatient database(corresponding to nearly 96% of all deliveries). We computed age-specific pregnancy and termination of pregnancy rates (all and induced abortion)considering the age groups less than 15, 15–19, 20–34, 35–39 and more than 39 years, using national population estimates as denominator. Joinpoint regression was used to estimate average annual percent change (AAPC) in rates and to identify points in time when significant changes in trend occurred. Youngest teenager pregnancy rates (less than 15 yrs.)decreased significantly from 0.6 to 0.3 per 1000 women (AAPC=-4.9%; p=0.01) with a non-significant decrease in abortion rates (AAPC=-4.1%; p=0.100). Pregnancy and abortion rates per 1000 15–19 year old girls, showed no significant variation up to 2003 (AAPC=-1.8%;p=0.071 for pregnancy and AAPC=2.5%; p=0.449 for abortion). Then, a significant decrease was observed either in pregnancy (from 20.1 to 14.6; AAPC=-5.2%; p<0.001) and in abortion rates (from 2.5 to 1.5; AAPC =-8.2%; p<0.001). Pregnancy rates per 1000 women aged 20–34 decreased from 78.1 to 66.5. It corresponded to a significant decline up to 2004 (AAPC=-3.1%; p=0.020) but a stable course onwards (AAPC=-0.6%; p=0.389). Abortion rates in this age group steadily decreased from 7.7 to 5.5 per 1000 women (AAPC=-3.24%; p<0.001). In contrast,there was a significant increase in pregnancy rates from 32.3 to 37.5 per 1000 women aged 35–39(AAPC=1.54; p<0.001) and from 2.9 to 3.2 per 1000 women aged 40 or more (AAPC=1.21; p<0.001). Abortion rates per 1000 women aged 35–39 showed an inflexion point such that up to 2005 there was no significant annual change (AAPC=1.5; p=0.239), while from 2005 onwards this rate decreased significantly from 5.7 to 4.6 (AAPC=-4.3; p=0.011). Among women aged 40 or more, abortion rates steadily decreased from 0.9 to 0.7 (AAPC=-4.3; p=0.011). Along this time period,induced abortion rates showed no significant changes in all age groups. Conclusions: Pregnancy rates showed downward trend among adolescent girls but an upward trend among older women. Still, no considerable changes occurred in induced abortion rates. Our results suggest the influence of family planning and also the postponement of pregnancy to older ages. There is evidence of increasing trend in planned pregnancy.
- Migrants and perinatal health: access to health servicesPublication . Carrapatoso, Mariana; Teixeira, Cristina; Carvalho, Carlos Duarte; Barros, HenriqueInequities in access to health care between migrant and native women have been reported, but determinants of such inequities remain a matter of controversy. According to the national law, health care is provided to all residents with the same conditions of Portuguese citizens, in a universal, tax-financed National Health Service. This study intended to review the available evidence on the access of migrant women to perinatal health services in Portugal, in order to assess if there are differences between migrant and native population. Métodos: A systematic search of relevant literature was conducted on Web of Science and reference lists for articles published up to March 2017. We considered all studies providing information on access to health care services by migrant women in Portugal. Resultados: After excluding irrelevant citations for the question under research (n = 6) and abstracts with no results of interest (n = 3), 10 studies were included in this systematic review. There were six quantitative studies, describing determinants and patterns of healthcare utilization by immigrants in Lisbon (n = 3), assessing prenatal and obstetric care among migrants in Porto (n = 1), describing prenatal vigilance in Portugal (n = 1) and reporting the health professionals’ perspective (n = 1). Migrants were more likely than native women to have the first pregnancy appointment after 12 weeks and to have less than 3 prenatal visits. Although not exclusively related to perinatal care, waiting times and provider’s attitudes were the main barriers identified by migrants, observed differently depending on their country of origin. However, a more recent study showed that only 1% of migrant participants reported having been discriminated by health professionals. Positive attitudes towards migrant people were more likely to be shown by doctors and nurses than clerical staff, by younger than older doctors and by workers who have less daily contact with migrants. Four qualitative studies analysed the access, satisfaction and perceived quality of received health care during pregnancy. All stated that initial unfamiliarity with the National Health Service by the users and misinformation of clerks about national law and administrative procedures, particularly when dealing with undocumented users, were important obstacles to access to health care. Conclusiones/Recomendaciones: Available data on the access of migrant women to perinatal health care services in Portugal is scarce and more quantitative studies are needed, in order to adjust existing responses and improve the quality of healthcare provided to migrants.
- Equitable perinatal healthcare for migrants, Portugal: comparative analysis of a self-assessment toolPublication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, HenriqueMigration is seen as a common risk factor in obstetricmanagement. Migrants often have a higher risk of experience worse pregnancy outcomes, higher rates of operative delivery, and a higher likelihood to receive less adequate postpartum care when compared to native women. This study evaluates self-perceived assessment of migrant women and hospital directors on equitable migrant friendly perinatal healthcare quality and access during intrapartum and postpartum period at public maternity units across Portuguese mainland between 2017-2019. This cross-sectional study analyses perinatal health data from migrant women over 18 years giving birth in public maternity units from between April 2017 and March 2019 as part of the baMBINO project. Data on the assessments of maternity units’ directors on equitable migrant friendly healthcare was collected in a self-assessment tool. Two standards on healthcare access and on healthcare quality were developed by: 1) scoring 25 and 30 questions, respectively, from 0 (worst) to 5 (best); 2) calculating the average of each score. The OneSample Wilcoxon Test (non-parametric) was applied to compare the assessment of hospital directors with the migrant mothers and the Kruskal-Wallis one-way analysis of variance to test for regional differences. Significant differences between migrant woman and healthcare directors’ assessments on migrant friendly healthcare access and quality of care were found. Directors rated healthcare access with a median score of 2.4, twice as good as migrant women (1.3). Migrant women rated healthcare quality with a median score of 4.0 (directors: 3.2). Significant differences between the regions for quality of care and healthcare access were found. Statistically significant difference between migrants from Portuguese and non-Portuguese speaking countries was identified for healthcare access (p-value <0.001) and healthcare quality (p-value < 0.05).