Pre-conception health and contraception among migrant women in the UK: a mixed methods study

点击翻译按钮获取中文摘要

BackgroundNearly a third of women who gave birth in England and Wales in 2019 were migrants (born outside the UK). Compared with women born in the UK, migrant women are more likely to have poor health during pregnancy and after giving birth. Studies from other European countries have found that migrant women are also more likely to become pregnant unexpectedly and have an abortion than non-migrant women. A woman's health before getting pregnant affects her wellbeing during and after pregnancy, as well as the health of her baby. Pre-conception care provides the opportunity to improve a woman's health before becoming pregnant. This includes providing women with the option to use contraception to prevent unintended pregnancies. Pre-conception care is usually provided by a general practitioner (GP), so is free for all women in the UK. Little is known about migrant women's health before they get pregnant, what pre-conception care they receive (if any) and what kind of care they might want. Not knowing these things means opportunities are missed to improve the health of migrant women and their babies. ObjectivesMy first objective is to find out how migrant women access and use support before becoming pregnant, and how their health differs from that of UK-born women around the time they become pregnant. I also want to find out how migrant women access and use contraception, compared to UK-born women. My second objective is to find out the views of migrant women (and professionals working with them) on what helps or hinders them accessing contraception as needed, and what helps or hinders them improving their health before pregnancy.My third objective is to use the findings from my first and second objectives to develop a programme (or 'intervention') to support migrant women to improve their health before they get pregnant and to help them access contraception when needed.Research planI will use electronic GP patient records to study what care migrant women receive before pregnancy and if this is different from UK-born women. I will also use these records to find out how migrant women's health differs around the time of getting pregnant and what contraception they use, compared to UK-born women. Patient records will be anonymous, so I will not be able to recognise individuals.I will then undertake individual and group interviews with migrant women and professionals working with them. The interviews will provide a deeper understanding of the barriers migrant women might face in accessing their preferred contraception and seeking support and advice before pregnancy. I will use interpreters where necessary. Based on my findings from the GP patient records and interviews, I will develop and test a programme to support migrant women to improve their pre-pregnancy health and access their preferred contraception (if needed). This programme will be developed in partnership with a Community Advisory Group (a group of migrant women, volunteers and staff at GP surgeries and charities).Patient and public involvementThe Community Advisory Group will help to shape the development of this study through regular meetings. Together, we will consider which groups of migrant women to include in the study, what to ask them about in interviews and how to interpret the study findings. DisseminationI will hold information sessions for policy-makers, charities, and healthcare professionals. I will publish findings in scientific journals and present them at conferences. With help from the Community Advisory Group, I will create posters, blogs and social media posts to inform other migrant women about the study findings. This will not only benefit migrant women, but also help GPs and policy-makers to understand the important issues for this group and how they might be overcome.