Understanding excess maternal mortality among immigrant women in France: an analysis of access to quality care based on the conceptual framework of the three delays
In France, as in other European countries, immigrant women face an increased risk of maternal mortality, particularly those born in sub-Saharan Africa (SSA). While it has already been reported that the quality of care provided to these women is lower than that provided to native-born women, previous analyses have focused primarily on the quality of care once the woman has made contact with healthcare providers. The World Health Organization’s (WHO) “three delays” framework allows for a more detailed analysis by distinguishing delays in (or lack of): deciding to seek care (type 1), reaching the health facility (type 2), and receiving appropriate treatment (type 3). The objective was to analyze care pathways deemed generally suboptimal in the French Confidential National Survey on Maternal Deaths among native-born women, immigrant women born in Sub-Saharan Africa (SSA), and women born outside Africa and Europe (“Elsewhere”). This would allow for the identification of potential type 1 and 2 delays and their comparison across the three groups. Among the 254 women who died of maternal causes in France between 2010 and 2012, the analysis focused on 110 women who received care that was generally suboptimal according to the National Confidential Survey on Maternal Deaths (ENCMM), comprising 72 native-born women, 17 women born in Sub-Saharan Africa (SSA), and 21 women born “Elsewhere.” Each care pathway was analyzed by a group of experts through consensus judgment regarding the presence of each of the three delays and their role in the occurrence of death. The frequency of delays 1 or 2 was 29% among native-born women, 41% among those born in ASS, and 29% among women born “Elsewhere” (p=0.33). These delays were implicated in the occurrence of death in 24%, 41%, and 10% of women in these three groups, respectively (p=0.14). Type 3 delay was, by definition, present in all three groups, since it is due to a lack of care typically characterized by ENCMM. Beyond the quality of care provided, and although statistical significance was not reached in our study, the higher frequency of Type 1 and 2 delays among women from ASS and those born “Elsewhere” suggests the involvement of specific barriers to access to care for them. This study could lead to a better understanding of these barriers, particularly by applying this analytical framework to women who experienced a severe non-fatal complication during the perinatal period.
Author(s): Sauvegrain Priscille, Perbellini Maria, Tessier Véronique, Saucedo Monica, Azria Elie, Deneux-Tharaux Catherine
Publishing year: 2023
Pages: 61-68
Weekly Epidemiological Bulletin, 2023, n° 3-4, p. 61-68
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