ArticleBMJ open2017
Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Maternal and neonatal outcomes of second-generation mothers in Europe: a systematic review.Globalization and health · 2025Pooled it
- "Morbus Mediterraneus" and its impact on medical care in Germany: the intersection of pain and racism.BMC medical ethics · 2025Review
- Disparities in Obstetric and Anaesthetic Care Between Migrant and Native Populations in High-Income Countries: A Narrative Review.Acta medica academica · 2025Review
- Changes in the choice of anaesthetic techniques for caesarean sections among Turkish citizens and migrants during the COVID-19 pandemic: an interrupted time series analysis.BMC pregnancy and childbirth · 2025Observational
- Review
- Cultural Framing and the Impact On Acute Pain and Pain Services.Current pain and headache reports · 2023Review
- Medical students' perspectives on racism in medicine and healthcare in Germany: Identified problems and learning needs for medical education.GMS journal for medical education · 2023Article
- Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2022Article
- Cultural influence on the expression of labour-associated pain.BMC pregnancy and childbirth · 2022Article
- Use of pain management in childbirth among migrant women in Iceland: A population-based cohort study.Birth (Berkeley, Calif.) · 2022Article
- Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study.International journal of environmental research and public health · 2020Article
- Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study.BMC pregnancy and childbirth · 2020Article
- Do social factors and country of origin contribute towards explaining a "Latina paradox" among immigrant women giving birth in Germany?BMC public health · 2019Article
- Differences in pregnancy outcomes and obstetric care between asylum seeking and resident women: a cross-sectional study in a German federal state, 2010-2016.BMC pregnancy and childbirth · 2018Article
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveResearch on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness).
designCross-sectional study.
settingThree obstetric hospitals in Berlin, Germany.
methodsQuestionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters.
resultsThe chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94).
conclusionsWe found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery).
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