Migrants and perinatal health: access to health services

Inequities 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.