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Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Esperanza Diaz, University of Bergen, Norway
- Second opponent: Associate Professor Soorej Jose Puthoopparambil, Uppsala University, Sweden
- Third member and chair of the evaluation committee: Professor Eline Aas, University of Oslo
Chair of the Defence
Associate Professor Randi Opheim, University of Oslo
Principal Supervisor
Associate Professor Cecilie Dahl, University of Oslo
Summary
Irregular legal status is a recognized risk factor for limited access to health care services, preterm birth and low birth weight. However, pregnant undocumented migrants are rarely included in population surveys. This thesis aims to explore the use of maternity care services by undocumented pregnant migrants in Norway and to investigate the association between legal status and severity of pregnancy-related conditions at presentation, and between legal status and perinatal health outcomes.
The population of interest were pregnant undocumented migrants aged 18-49 years living in Norway from 1999-2020. This thesis is based on collected data from medical records from non-governmental (NGO) clinics in Bergen and Oslo serving undocumented migrants and their referral hospitals from 2009-2020, medical records from the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 2009-2019, and registry data from the Medical Birth Registry of Norway (MBRN) from 1999-2020.
In total, we found 5856 undocumented migrant women giving birth from 1999-2020 representing 0.5% of all births in Norway. Undocumented migrants had six times higher risk of perinatal death in the offspring compared with non-migrants and four times higher risk compared with documented migrants. In addition, undocumented migrant women had 54% higher risk of giving preterm birth compared with non-migrants and 47% higher risk compared with documented migrants. About half of the women came to the NGO clinics for antenatal care after their first trimester and a quarter came after gestational week 22. Pregnant undocumented migrants presenting at the OAEOC had an 86% increased risk of being triaged with a high level of urgency at presentation and a 68% increased risk of being hospitalized compared with pregnant residents (migrants and non-migrants).
Based on the data, we found delayed, substandard antenatal care and an increased risk of adverse perinatal outcomes among pregnant undocumented migrants. Neither maternal origin nor maternal gestational health conditions could explain the differences in perinatal mortality, which indicates that access to health care services may still play a role, even after the 2011 legal reform, which aimed at improving access to health services for this group.
Additional information
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