This scoping review synthesized existing interventions and policy measures aimed at improving access to perinatal care for pregnant migrant women without medical insurance (PMWMI). Interventions described across the included literature were typically comprehensive maternal–newborn packages that spanned pregnancy testing, routine prenatal care and follow-up, screening for pregnancy-related diseases, prenatal education, vaccination, and assistance during childbirth. Immediate obstetric and neonatal support during labor, delivery, and the first two hours postpartum, as well as postpartum and newborn care, were recurring components. Several studies also described policy-level actions intended to sustain or expand service delivery for uninsured migrants.
The review used the Arksey and O’Malley framework to map the scope and nature of available evidence. An electronic search covered 11 databases and gray literature for publications dated from 2000 through 2025. Only studies in English or French were eligible. After screening, 14 studies met inclusion criteria. The review aimed to extract and chart data on intervention characteristics, implementation strengths and weaknesses, and any reported costs.
Of the 14 included studies, four were conducted in Canada, eight in the United States, one in Iran and one in Thailand. The geographic distribution reflects a predominance of North American research on interventions for uninsured pregnant migrants in high-income settings, with limited evidence from other regions. The populations targeted were migrant women aged 12 years and older who were pregnant, in labor, or postpartum and lacked public or private medical insurance.
Across the included studies, intervention packages shared core elements:
Pregnancy testing and early identification of pregnant women.
Routine prenatal care and scheduled follow-up visits to monitor maternal and fetal health.
Screening for conditions and infections relevant to pregnancy.
Prenatal education addressing pregnancy, childbirth and postpartum topics.
Vaccination where clinically appropriate.
Support during labor and delivery, including immediate obstetric and neonatal interventions for the first two hours postpartum.
Postpartum and newborn care to ensure continuity after birth.
Several programs emphasized culturally sensitive approaches, multidisciplinary collaboration, and integration with community resources to improve geographic and financial accessibility. Policy mechanisms—such as funding arrangements, program eligibility rules and regulatory protections—were described as critical to maintain these services over time.
The review highlights notable policy influences on service availability. In some settings, policy changes that reduced coverage or services created gaps that affected PMWMI. Authors report that such reductions can produce apparent short-term savings but often generate higher costs in the medium to long term. In federated systems, the financial burden of reduced federal support frequently shifts to provinces or states, which must respond to increased local needs. The review notes that many restrictive measures—mandatory waiting periods, exclusion of temporary residents, and denial of services to undocumented individuals—limit access to essential maternal healthcare and may be driven by political considerations rather than clear economic benefit.
Limited access to perinatal care among uninsured migrant women is associated with later initiation of prenatal services and higher rates of obstetric complications at delivery. The literature cited in the review connects inadequate prenatal monitoring to increased emergency caesarean sections and other adverse outcomes. Migrant women without insurance consistently show higher risks for stillbirth, fetal growth restriction, preterm birth and disproportionate perinatal mortality in the broader literature cited by the authors. Nonobstetric burdens documented among PMWMI include higher prevalence of postpartum depression, parasitic infections and communicable diseases such as hepatitis and HIV in some reports. Fear of detection, deportation or other immigration consequences also contributes to avoidance of preventive and routine care.
Strengths of the scoping review include use of a structured, transparent methodology (Arksey and O’Malley) and searches across multiple databases plus gray literature. The body of included studies, however, is geographically concentrated in Canada and the United States, limiting generalizability. Detailed cost information for interventions was not uniformly reported across studies; where economic data existed, the review emphasized how short-term policy savings may mask downstream expenditures. The authors identify a gap in synthesized evidence specifically focused on interventions for PMWMI and call for more evaluation of intervention effectiveness, cost analyses and context-specific implementation studies.
This scoping review catalogs intervention components that aim to facilitate access to perinatal care for migrant women without medical insurance and underscores the essential role of supportive policy to sustain those services. Findings indicate that restrictive policy changes jeopardize health benefits for undocumented immigrants and asylum seekers and contribute to health disparities. The review highlights the need for context-appropriate, culturally sensitive, multidisciplinary interventions and for economic data to inform decision-makers about the costs and potential long-term savings of providing perinatal services to PMWMI. Further primary research and implementation evaluations are needed to guide policy and practice in diverse settings.