Influence of women’s legal status on pregnancy outcomes and quality of care: Findings from the Pregnancy of Migrants in Switzerland (PROMISES) program

In 2020, approximately 281 million people lived in a country other than their country of birth. In Geneva, Switzerland, people born in other countries constitute 40.2% of the population. We aimed to describe the population of pregnant women delivering at the University Hospitals of Geneva (HUG) maternity department and to identify associations between legal status, migration status, and economic precarity with quality care and health outcomes. We performed an exploratory cross-sectional retrospective study including all women who delivered in HUG's maternity department in May 2019 (n=339). The group was sub-divided in three ways: by migration status (Swiss (S) or migrant (M)); by legal status (documented (D), undocumented (U), or asylum seeker (AS)); and economic precariousness (precarious (P) or non-precarious (NP)). The analysis compared the quality of care received and health outcomes across six sub-groups: Swiss non-precarious women (SNP, 25.3%), Swiss precarious women (SP, 12.2%), documented migrant non-precarious women (DMNP, 34.8%), documented migrant precarious women (DMP, 23.3%), undocumented migrants (UM, 2.4%), and asylum seekers (AS, 2.0%). Precarious patients represented 35.5% of 339 women. Economic precarity was more highly associated with poor health outcomes than legal or migration status. Due to the small samples of undocumented migrants (UM) and asylum seekers (AS), the study had limited capacity to achieve statistical significance for findings. The findings from this exploratory study suggest that, where a program exists to reach pregnant undocumented migrants, a pregnant woman's economic status is also very important in determining her experience with the healthcare system during pregnancy and delivery. More than one third of pregnant women delivering at HUG are in a situation of vulnerability, whether economic or legal. This study had few statistically significant results due to small sample sizes. However, it clearly highlights the need for further research into how best to address various vulnerability factors during pregnancy.