New study from Finland: Undocumented women receive inadequate pregnancy care

Undocumented women in Finland access pregnancy care later than others. Yet, screening of infectious diseases at the early stages of pregnancy would be particularly important to these women, a new study carried out in Helsinki, Finland, shows. Conducted by the University of Eastern Finland and the University of Helsinki, the study on undocumented women’s pregnancy care and childbirth was published in BMC Pregnancy and Childbirth.

Undocumented pregnant women constitute a vulnerable group of people who lack equal access to pregnancy care. Previous research has shown that undocumented migrants encounter difficulties in accessing health services, the onset of their prenatal care is delayed, and women have an increased risk for infectious diseases. Yet, with continuous prenatal care throughout pregnancy, it is possible to prevent pregnancy complications and arrange proper medical care and guidance when needed.

The new study examined the outcomes of pregnancy and childbirth of undocumented women attending the public maternity care in Helsinki, Finland, in 2014–2018. The study population consisted of 62 individual pregnancies. The majority, 61%, of undocumented women gained or sought access to pregnancy care only during their second or third pregnancy trimester. For the majority, 71%, pregnancy care was inadequate. Undocumented women had an average of five prenatal care visits, whereas other women had an average of 13 visits. In Finland, the national recommendation is 8–10 prenatal care visits during pregnancy.

Screening for infectious diseases during pregnancy was fairly successful in Helsinki. Almost all undocumented pregnant women were screened for HIV, hepatitis B, and syphilis. However, 57% of women were not screened for hepatitis C antibodies as recommended. HIV and hepatitis B were more common among undocumented pregnant women than other women in Finland.

“It would be very important to screen all undocumented women for infections at the early stages of pregnancy, so that possible antiviral medication can be initiated in time to prevent mother-to-child-transmission. This would be best safeguarded by guaranteeing undocumented people a legal right to health care,” Infectious Diseases Physician Ville Holmberg says.

In Finland, undocumented people do not have a statutory right to health care and, consequently, to pregnancy care. However, Helsinki and a few other Finnish municipalities are providing undocumented women access to pregnancy care.

“We also need new innovative ways of promoting undocumented women’s seeking of, and access to, care. Information should be made available extensively and not only in different languages, but also in plain language. Health care professionals should be provided with up-to-date information on the types of services available to undocumented women and children, and on the special characteristics associated with the treatment of undocumented people,” Midwife Janita Tasa, MHS, says.

“By providing timely and adequate prenatal care to undocumented women, we can prevent pregnancy complications and the transmission of infectious diseases from mothers to children. Timely care is equitable, and it also reduces the costs of health care,” Tasa says.

“Overall, the service users of Finnish maternity care are changing, as families with immigrant backgrounds are a rapidly growing group. So far however, we have very little research evidence on the impact of this change on traditional maternity care,” says Professor Katri Vehviläinen-Julkunen.

For further information, please contact:

Janita Tasa, Midwife, Master of Health Sciences, University of Eastern Finland, tel. +358445577515, janitatasa@gmail.com

Ville Holmberg, Infectious Diseases Physician, University of Helsinki and Helsinki University Hospital, tel. +358 50 4271630, ville.holmberg@hus.fi

Katri Vehviläinen-Julkunen, Professor, University of Eastern Finland, tel. +358 50 338 1957, katri.vehvilainenjulkunen@uef.fi

Research article:
Maternal health care utilization and the obstetric outcomes of undocumented women in Finland – a retrospective register-based study. Tasa J, Holmberg V, Sainio S, Kankkunen P & Vehviläinen-Julkunen K. BMC Pregnancy Childbirth 21, 191 (2021). https://doi.org/10.1186/s12884-021-03642-7