Untitled

Funder

Organizational Unit

Publications

Marketing of breastmilk substitutes and early breastfeeding practices among native and migrant women

Publication . Lisi, Cosima; Teixeira, Cristina; Al Hamwi, Sousan; Rodrigues, Carina; Lopes, Sofia; Barros, Henrique

There is a large body of evidence regarding the benefits of breastfeeding for mothers and their children. However, the influence of marketing of breastmilk substitutes on breastfeeding practices remains a big concern. The aim of this study is to examine the association between exposure to different breastmilk substitutes market factors and never breastfeeding or dropping exclusive breastfeeding within 1 month postpartum, comparing migrant with native women. Methods: This study is part of the project baMBINO, an ongoing research on perinatal health among migrant and native women in Portugal. Women with a live-birth and aged ≥ 18 years were recruited in 32 Portuguese public hospitals during admission for delivery. Data on breastfeeding practices and exposure to market factors were collected by telephone interviews at 1-3 months postpartum. According to their feeding practices within 1 month after delivery, women were classified into two categories: those who have never breastfed or have dropped exclusive breastfeeding, and those who have maintained exclusive breastfeeding. Five market factors were assessed: free samples, discounts, television, newspaper/magazine, and shop/ pharmacy advertisement. Logistic regression models were used to study the association between each market factor and early breastfeeding practices, adjusting for maternal age, education, parity, mode of delivery, and skin-to-skin contact in the first hour after birth. All analyses were stratified by women’s country of birth (native vs. migrant). Adjusted odds-ratio (aOR) and a respective 95% confidence interval (95%CI) were obtained. Results: Out of 539 natives and an equal number of migrant women, 43.4% and 36.7%, respectively, have either never breastfed or dropped exclusive breastfeeding within 1 month postpartum. After adjustment, natives exposed to free samples were more likely to never breastfeed or drop exclusive breastfeeding within 1 month after delivery (aOR = 1.90, 95%CI: 1.06-3.42), while those exposed to shop/pharmacy advertisement were less likely to (aOR = 0.62, 95%CI 0.43-0.89). Conversely, migrants exposed to newspaper/magazine advertisement were less likely to never breastfeed or drop exclusive breastfeeding within 1 month postpartum (aOR = 0.54, 95%CI 0.31-0.95). Conclusions/Recommendations: Our results revealed differences in the effect of market factors on breastfeeding practices between native and migrant women, which might be explained by cultural factors. Future research should investigate the mechanisms underlying the direction of association between specific market factors and early breastfeeding practices.

2018Conference object

Open access

Equitable perinatal healthcare for migrants, Portugal: comparative analysis of a self-assessment tool

Publication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, Henrique

Migration 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).

2020Conference object

Open access

Obstetric interventions among native and migrant women: the (over)use of episiotomy in Portugal

Publication . Lorthe, Elsa; Severo, Milton; Hamwi, Sousan; Rodrigues, Teresa; Teixeira, Cristina; Barros, Henrique

Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association.Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy.Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics.Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

2024Journal article

Open access

Equitable migrant-friendly perinatal healthcare access and quality in public maternity units in Portugal

Publication . Doetsch, Julia; Almendra, Ricardo; Carrapatoso, Mariana; Teixeira, Cristina; Barros, Henrique

Migrant women are at higher risk to face access barriers to perinatal care services and to experience worse pregnancy outcomes compared to native. Assessing the perception of migrant women and health providers discloses a multifaceted view on migrant-friendly care, a multidimensional concept in itself. This study aims to compare self-perceived assessments of migrant women and directors of obstetrics and gynaecology (GYN/OBS) departments on equitable migrant-friendly perinatal healthcare quality and access during the intrapartum and postpartum period at public maternities in Portugal. Methods: In this cross-sectional study, two indicators on Healthcare access and Quality of care were developed to compare how adult migrant women who gave birth between April 2017 and March 2019 and GYN/OBS department directors assessed offered care. The one-sample Wilcoxon test was used to compare directors' with migrants' assessments and the Kruskal-Wallis one-way analysis of variance to test for country regional differences. A stratified analysis by sex, spoken language, and country of birth tested for potential effect modifiers. Results: Migrants rated Healthcare access significantly better (P<0.05), but perceived Quality of care worse (P<0.01) than GYN/OBS department directors. Migrants' and directors' perceptions differed significantly according to directors' gender (P<0.05). Migrants' and directors' assessments on Healthcare access (P<0.05) and Quality (P<0.01) changed significantly across regions. Conclusions: Migrants' and directors' self-perceived appraisal of Healthcare access and Quality of care significantly varied. Identifying these discordances allows to deliver insights into existing barriers in access and provision of care and raises awareness to improve quality assurance, essential to inform practice and policies.

2021Journal article

Open access