Safe or Unsafe Motherhood: The Invisibility of Foreign-born Mothers in Philadelphia

Background  Globalization has changed patterns of migration with rapid feminization of the global labor force. Invisibilities among documented and  undocumented foreign-born pregnant women exist in the U.S.A..  Of particular concern are pregnant black migrants who may be at more risk for preterm birth (PTB) compared to all other migrant groups. In addition to transitioning to the US maternity care system, foreign-born black women must navigate inequities resulting from existing racial, ethnic, and socioeconomic classifications. This  study combines theoretical frameworks of stress biology with transitional theories of migration during childbearing to investigate safe or unsafe motherhood among these foreign-born mothers in Philadelphia.

Methods  Mixed-methods qualitative GIS. Geospatial analyses of linked datasets (Philadelphia birth records, census and crime data) guided expert interdisciplinary clinical experts and researchers in bimonthly meetings for 6 months to assess issues for culturally feasible and appropriate interventions to promote optimal health and decrease PTB rates.

Results  Don’t ask, don’t tell creates invisibilities. Surprising to learn, 10% of all Philadelphia resident births during 2003-2005 (n >60,000) were to foreign-born black mothers. Although city  data revealed lower rates of PTB for foreign-born black mothers compared to US-born black mothers, disaggregating data by neighborhood exposures to poverty and violence portray a different story. Meetings among experts identified areas urgently needed for all for further study. The key categories that evolved were: 1) health systems and services, 2) maternal and infant health outcomes, 3) diverse ethnic cultural expectations and practices during childbearing, and 4) transition issues related to migration and undocumentation.