Temporary childbirth migration: understanding the magnitude and implications for maternal and infant health

项目摘要 南亚妇女在怀孕期间经常返回不同社区的纳塔尔分娩， 和产后。我们的团队在印度的两个邦对这一现象进行了首次可靠的测量 （创造了“临时分娩移民（TCM）”一词），发现大约三分之一的妇女回到 围产期的纳塔尔地点。鉴于印度对社区妇幼保健的依赖 医疗保健提供，TCM可能会破坏护理的连续性，对医疗保健的获得和健康产生负面影响 结果。相反，考虑到妇女在婚姻家庭中的地位较低， 移徙者的健康结果，使那些“留守”的人面临更高的健康风险。更好地了解中医， 它的影响和相关机制是重要的投入，可为政策和做法提供信息， 印度的新生儿健康然而，尽管有传闻证据表明中医在不同的国家和地区广泛流行， 印度的情况及其对健康的潜在影响，它没有很好地定义或量化的文献。客观 这项研究的目的是描述印度中医的特点，描述其对围产期结局的影响，并探讨印度人的健康状况。 护理连续性和社会支持作为这些关系的潜在调解人。首先，我们将收集交叉- 来自印度8个健康和人口监测点的约6000名妇女的截面数据 界定和描述临时分娩移徙的特点，包括规模、时间、驱动因素， 社会人口和地理异质性。家庭成员的三重定性访谈， 研究中心将进一步阐明TCM的选择和驱动因素。然后，我们将选择三个站点， 地理分布和中医水平的纵向研究。我们将招募1000名妇女在每个 研究中心（共3000人），这些人处于怀孕早期，并对其进行随访，直到产后一年，其中一些人将 有些人迁移，有些人不迁移。我们将收集每月一次的电话调查和五次来自妇女的更长时间的深入调查 关于移民模式、卫生保健使用、孕产妇和儿童健康结果、社会支持和社会- 人口统计学我们将要求女性用她们的移动的手机（提供给那些没有手机的人）拍照。 卫生记录数据的质量更高，产妇和婴儿的结果数据。我们将估计 中医对早产影响及高危孕妇的识别然后，我们将研究 持续的围产期护理和社会支持作为临时分娩移徙之间的潜在中介 与健康这些发现将帮助我们了解可能导致贫困孕产妇和儿童的因素。 印度的健康结果，可能还有南亚其他地区和其他地区。更好地了解 中医药的影响可以帮助项目和政策更好地支持妇女获得他们需要的照顾和支持， 怀孕和产后需要。

PROJECT SUMMARY Women in South Asia often return to their natal homes in different communities during pregnancy, for childbirth, and postpartum. Our team conducted the first robust measurement of this phenomenon in two states of India (coining the term “temporary childbirth migration (TCM)”) and found that about one-third of women returned to the natal home point during the perinatal period. Given India’s reliance on community-based maternal and child health care delivery, TCM may disrupt care continuity, negatively impacting health care access and health outcomes. Conversely, given the lower status of women in their marital homes, TCM could potentially improve health outcomes for migrants, leaving those “left behind” at higher health risk. A greater understanding of TCM, its impact, and associated mechanisms are critical inputs to inform policy and practice to improve maternal and neonatal health in India. However, despite anecdotal evidence of TCM’s widespread prevalence across diverse Indian contexts and its potential impact on health, it is not well defined or quantified in the literature. The objective of this study is to characterize TCM in India, describe its impact on perinatal outcomes, and explore the health care continuity and social support as potential mediators of these relationships. First, we will collect cross- sectional data from roughly 6000 women at eight Health and Demographic Surveillance Sites throughout India to define and characterize temporary childbirth migration, including magnitude, timing, drivers, and sociodemographic and geographic heterogeneity. Triadic qualitative interviews with household members in 2 sites will shed additional light on selection and drivers of TCM. Then, we will select three sites based on geographical distribution and differing levels of TCM for a longitudinal study. We will recruit 1000 women in each site (3000 total) who are early in pregnancy and follow them until one year postpartum, some of whom will migrate and some not. We will collect monthly telephone surveys and five longer in-depth surveys from women about migration patterns, health care use, maternal and child health outcomes, social support, and socio- demographics. We will ask women to take photographs on their mobile phones (provided to those without phones) of health record data to have higher quality maternal and infant outcome data. We will estimate the impact of TCM on preterm birth and identify women most at risk. We will then examine disruptions in the continuum of perinatal care and social support as potential mediators between temporary childbirth migration and health. These findings will help us understand factors that may be contributing to poor maternal and child health outcomes in India, and potentially other parts of South Asia and other regions. A better understanding of the impact of TCM can help programs and policies better support women to obtain the care and support they need in pregnancy and postpartum.