We compared severe maternal morbidity (SMM) and SMM
subtypes, including HIV, of refugee women with those of nonrefugee immigrant
and nonimmigrant women.
We linked 1 154 421 Ontario hospital deliveries (2002-2011)
to immigration records (1985-2010) to determine the incidence of an SMM
composite indicator and its subtypes. We determined SMM incidence according to
immigration periods, which were characterized by lifting restrictions for all
HIV-positive immigrants (in 1991) and refugees who may place "excessive
demand" on government services (in 2002).
Refugees had a higher risk of SMM (17.1 per 1000 deliveries)
than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among
SMM subtypes, refugees had a much higher risk of HIV than did immigrants and
nonimmigrants. SMM disparities were
greatest after the 2002 policy came into effect. After exclusion of HIV cases,
SMM disparities disappeared.
An apparent higher risk of SMM among refugee women in
Ontario, Canada is explained by their high prevalence of HIV, which increased
over time parallel to admission policy changes favoring humanitarian
protection.
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- 1At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
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