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

2019年在英格兰和威尔士分娩的女性中，近三分之一是移民（出生在英国境外）。与在英国出生的妇女相比，移民妇女在怀孕期间和分娩后更有可能健康状况不佳。其他欧洲国家的研究发现，移民妇女也比非移民妇女更有可能意外怀孕和堕胎。妇女在怀孕前的健康状况会影响她在怀孕期间和之后的健康，以及她婴儿的健康。孕前保健提供了在怀孕前改善妇女健康的机会。这包括为妇女提供使用避孕药具的选择，以防止意外怀孕。孕前保健通常由全科医生（GP）提供，因此对英国所有女性免费。人们对移民妇女怀孕前的健康状况、她们接受了什么样的孕前护理（如果有的话）以及她们可能需要什么样的护理知之甚少。不了解这些事情意味着错过了改善移民妇女及其婴儿健康的机会。我的第一个目标是了解移民妇女在怀孕前如何获得和使用支持，以及她们的健康与英国出生的妇女在怀孕前后的健康有何不同。我还想了解与英国出生的妇女相比，移民妇女如何获得和使用避孕药具。我的第二个目标是了解移民妇女的看法（以及与他们一起工作的专业人员）了解什么有助于或阻碍他们根据需要获得避孕药具，我的第三个目标是利用我的第一个和第二个目标的发现来制定一个计划，（或“干预”）支持移民妇女在怀孕前改善健康状况，并在需要时帮助她们获得避孕药具。研究计划I将使用电子全科医生病历来研究移民妇女在怀孕前接受的护理怀孕，如果这是不同于英国出生的妇女。我还将利用这些记录来了解移民妇女在怀孕前后的健康状况以及与英国出生的妇女相比，她们使用的避孕措施有何不同。病人的记录是匿名的，所以我无法识别个人，然后我将与移民妇女和与她们一起工作的专业人员进行个人和集体访谈。这些访谈将使人们更深入地了解移徙妇女在怀孕前获得其首选避孕药具和寻求支持和建议时可能面临的障碍。必要时我将使用口译员。根据我从全科医生患者记录和访谈中的发现，我将制定和测试一项计划，以支持移民妇女改善其孕前健康并获得其首选的避孕措施（如果需要）。该计划将与社区咨询小组（由移民妇女、志愿者和全科医生手术和慈善机构的工作人员组成的小组）合作开发。患者和公众参与社区咨询小组将通过定期会议帮助制定本研究的发展。我们将共同考虑将哪些移民妇女群体纳入研究，在访谈中向她们询问什么以及如何解释研究结果。我将为政策制定者、慈善机构和医疗保健专业人员举行信息会议。我将在科学期刊上发表研究结果，并在会议上发表。在社区咨询小组的帮助下，我将制作海报、博客和社交媒体帖子，向其他移民妇女通报研究结果。这不仅有利于移民妇女，也有助于全科医生和决策者了解这一群体的重要问题以及如何克服这些问题。

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.