Health and Citizenship: Gaps and Needs in Intercultural Health Care to Immigrant Mothers

Funding
Funded by FEDER funds through the Operational Programme for Competitiveness Factors - COMPETE and National Funds through FCT - Foundation for Science andTechnology within the project PTDC/CS-SOC/113384/2009

 

Reference
PTDC/CS-SOC/113384/2009

 

Project Coordinator
Elsa Beatriz Padilla (CIES/ISCTE-IUL)

 

Partner institutions
CIES/ISCTE-IUL - Center for Investigation and Sociology Studies, University Institute of Lisbon [Proponent institution]
CIIE/FPCE/UP - Center for Research and Intervention in Education, Faculty of Psychology and Education Science, University of Porto

 

Team
José Caldas (CIIE/FPCE/UP)
Erika Masanet Ripoll
Sonia Hernández Plaza
Alejandra Ortiz
Maria Cristina Santinho
Cláudia de Freitas
Elsa Rodrigues

 

Duration
15.03.2011 - 14.02.2014

 

Database

 

Abstract
Migration trends are an opportunity for the EU as migrants counteract population ageing, meet the demands of labor markets and make contributions to economic development and socio-cultural enrichment of host societies. However, migration is also a challenge: new needs emerge as the population becomes more heterogeneous and mobile, creating a need for host societies to adapt for coexistence. One important challenge concerns the provision of adequate, accessible, appropriate and quality healthcare to all the population, independently of their gender, ethnicity and country of origin (Fernandes & Pereira 2009), assuming that health and healthcare access are a matter of human rights. 

The Human Development Report of the United Nations pointed out that Portugal has shown commitment to improving the integration and living conditions of migrants. As health play an essential role in the integration of migrants, access to good quality care is key aspect for social inclusion/exclusion (Ingleby et al. 2005). Recent migration trends illustrate the feminization of migration and the increasing contribution of migrant women to the EU demography. While European women are having fewer children, migrant women are helping to keep up the fertility and fecundity rates. Thus, the good state of health of migrant women and their children is fundamental for the future. 
Studies showed that migrant women, who suffer the healthy migrant effect in the beginning, present worse health indicators: higher levels of maternal mortality, neo-natal and child mortality, malnutrition and under-weight babies, problems with delivery, lower rates of perinatal controls, more miscarriages, abortions or pre-term delivery, worse mental health status with higher risks of postpartum depression, among others (Bartlett et al. 2002; Carballo & Nerukar 2001; Machado et al. 2007). Other studies showed positive aspects of pregnant migrant women that could be reinforced, such as higher level of breastfeeding, healthier diets and less tobacco consumption during pregnancy (Machado et al. 2007). Research in this field has received much attention in other contexts. However, in Portugal is recent and less developed. There have been some new developments associated to increasing migration, but still little is known about the maternal health of migrant women. All these factors indicate the urgent need for this research. This project focuses on health citizenship of migrant pregnant women, as a first step to enact citizenship rights. Citizenship is an old concept associated with rights and duties granted to the members of certain community. With the emergence and development of modern Nation States, national governments became the central in granting citizenship, establishing distinctions between nationals (citizens) and foreigners (non-citizens) (Aleinikoff & Klusmeyer 2002). Health citizenship emphasizes that health as a matter of human rights, implying the “growing involvement of the citizen in assuming more responsibilities in health and making informed health decisions (Padilla 2008). Portugal recognizes the right of migrants to access the National Health System. The law ensures access to health care for all citizens regardless of their legal status, however, in practice, several obstacles are identified (language and cultural miscommunication, lack of information, lack of cultural competence of health professionals, administrative resistance). Looking at health and access implies the consideration of the interplay between culture, social inequalities and social exclusion. Lack of economic resources, poor housing and precarious working conditions are associated with poorer health due to insufficient and inadequate nutrition, overcrowded and inadequately housing, risky working conditions, and unhealthy behaviors such as smoking, alcohol consumption and poor exercise. The presence of these risk factors in pregnant women could have a negative impact not only on themselves but also on their children’s development and health. The project looks at the experience of pregnant migrant (and national women) with maternal health services, focusing on the impact of culture & social inequalities on health output, involving all interested actors: pregnant women and health/social support professional, and community organizations, enlarging its potential. The target population is two-folded: 1) pregnant immigrant women from the most significant countries of origin (PALOP countries, Brazil and Ukraine), together with Portuguese pregnant women as control and comparison group; and 2) health professionals/staff, as key actors in the provision of maternal health care. The geographical contexts compare the metropolitan areas of Lisbon and Porto. Other important aspects are the empowerment of immigrant women and the promotion of cultural competence, emphasizing the interconnection between theory & practice and paying attention to “good practices” in the field of maternal health care, and developing a multi-method needs assessment to identify and tackle existing health needs.