Caesarean sections and breastfeeding initiation among migrants in Switzerland
Caesarean sections and breastfeeding initiation among migrants in Switzerland
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DOI：
10.1007/s00038-007-6035-8
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发表时间：
2007-08-01
影响因子：
4.6
通讯作者：
Ackermann-Liebrich, Ursula
中科院分区：
文献类型：
--
作者：
Merten, Sonja;Wyss, Corinne;Ackermann-Liebrich, Ursula
目标：在瑞士分娩的所有妇女中，26%是非瑞士国籍的。调查了不同民族母子对在早产、剖腹产、母乳喂养等生殖健康结局方面的差异，并评估了受教育程度的影响。为了确定跨国差异，对22个国家的母乳喂养率和24个国家的剖腹产率与瑞士医院的剖腹产率进行了比较。研究样本：利用常规收集的监测数据，2000年至2002年在瑞士爱婴医院分娩的37332对来自不同民族的母婴纳入研究范围。结果：撒哈拉以南非洲、拉丁美洲和亚洲母亲的剖宫产率高于瑞士母亲(OR=1.77，95%CI 1.49~2.22；OR=1.80，1.51~2.17；OR=1.37，1.18.1.59)。非洲和亚洲儿童被转移到新生儿监护病房的风险增加(OR=1.48，95%CI 1.19~1.83；OR=1.45，1.21~1.73；)。此外，来自巴尔干国家的婴儿剖腹产率最低，也更有可能被转移到ICU(OR=1.30，95%CI 1.12-1.52)。除了原籍国或地区，母亲的教育水平是一个重要的影响因素，并改变了母亲的民族性的影响。除西欧以外，所有地区的母亲在出院后更有可能用母乳喂养孩子。已确定的母乳喂养持续时间的决定因素，包括在产科病房完全用母乳喂养、早期开始母乳喂养、同住一室和使用奶嘴，因民族而异。剖腹产率和母乳喂养率与母亲原籍国的比率的比较还调查了瑞士移民妇女与其原籍国之间的生殖健康结果之间的关系。在这两种情况下，瑞士医院的发病率和母亲原籍国的发病率之间都存在显著的等级相关(P<；0.001，P=0.04)。结论：我们的数据证实了瑞士移民妇女在生殖健康结果和对健康促进计划的反应方面的不平等。这些差异取决于教育水平和母亲的国籍。这种巨大的差异表明，不同的跨国经历在与卫生相关的决策和获得卫生保健方面发挥了一定作用。在规划瑞士的健康促进计划和孕妇的个别咨询时，应考虑这一点。
Objectives: Twenty-six percent of all women giving birth in Switzerland are of non-Swiss nationality. Differences in reproductive health outcomes such as preterm deliveries, Caesarean sections, and breastfeeding initiation for mother-child pairs of various nationalities are investigated, and the influence of the educational level was assessed. In order to identify trans-national differences, national breastfeeding rates from 22 countries and Caesarean section rates from 24 countries were compared to the rates in Swiss hospitals.Study-sample: Drawing on routinely collected monitoring data, 37 332 mother-child pairs from various nationalities, who delivered in Swiss Baby-Friendly hospitals between 2000 and 2002, were included in the study. All nationalities with at least 150 deliveries were coded individually, while the remaining were summarised in regional groups.Results: Sub-Saharan African, Latin American and Asian mothers had higher rates of Caesarean sections compared to Swiss mothers (OR = 1.77, 95 % CI 1.49-2.22; OR = 1.80, 1.51-2.17; OR = 1.37, 1.18.1.59). African and Asian children were at an increased risk of being transferred to neonatal care units (OR = 1.48, 95 % CI 1.19-1.83; OR = 1.45, 1.21-1.73;). In addition, infants from Balkan countries, who showed lowest Caesarean section rates, were also more likely to be transferred to an ICU (OR = 1.30, 95 % CI 1.12-1.52). Apart from the country or region of origin, the maternal educational level was an important influence and modified the effect of the mother's nationality.Mothers from all regions, apart from Western Europe, were significantly more likely to breastfeed their children after being discharged. Established determinants for breastfeeding duration, including feeding exclusively with breast milk in maternity wards, early initiation of breastfeeding, rooming-in and pacifier use, varied according to nationality.The comparison of Caesarean section and breastfeeding rates with the rates in the mother's country of origin additionally investigates the relation between reproductive health outcomes of migrant women in Switzerland compared to their country of origin. In both cases, a significant rank correlation (Spearman) could be established between the rate in Swiss hospitals and the rate in the mother's country of origin (P < 0.001, P = 0.04).Conclusions: Our data confirms inequalities in reproductive health outcomes and responses to health promotion programmes among migrant women in Switzerland. These differences are dependent on educational level and on the mothers' nationality. The large variation suggests that different trans-national experiences play some role in health-related decision-making and access to health care. This should be considered when planning health promotion programs and the individual counselling of pregnant mothers in Switzerland.