---
title: "Interventions to Improve Perinatal Care Access for Migrant Women Without Medical Insurance"
id: "plos-one-18-interventions-facilitating-access-to-perinatal-care-for-migrant-women-without"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-18-interventions-facilitating-access-to-perinatal-care-for-migrant-women-without"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357487"
published_at: "2026-09-10T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Interventions to Improve Perinatal Care Access for Migrant Women Without Medical Insurance
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-18-interventions-facilitating-access-to-perinatal-care-for-migrant-women-without
- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357487)
- **Published At:** 2026-09-10T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This scoping review mapped interventions and policies designed to improve access to **perinatal care** for pregnant migrant women without medical insurance (PMWMI). It used the Arksey and O’Malley framework and searched 11 databases plus grey literature for 2000–2025 publications in English or French. - Fourteen studies met inclusion criteria: 4 from Canada, 8 from the United States, 1 from Iran and 1 from Thailand. The review synthesized intervention components, policy contexts, strengths and weaknesses, and reported costs when available. - Interventions typically offered a comprehensive maternal–newborn package: pregnancy testing, prenatal care and follow-up, disease screening during pregnancy, prenatal education, vaccination, assistance at childbirth, and postpartum and newborn care. Immediate obstetric and neonatal support during labor, delivery and the first two hours postpartum was commonly included. - Policy-level measures were identified as necessary to support and sustain service delivery; the review highlights how restrictive policy changes can reduce services and create gaps in care for PMWMI. - The authors reported that policy-driven reductions in services produce apparent short-term savings but frequently shift costs to subnational governments and increase medium- to long-term health expenditures. Such policy shifts often appear politically motivated rather than economically justified. - Consequences of limited access include late initiation of prenatal care, greater maternal complications at delivery, higher emergency caesarean rates, and adverse neonatal outcomes; uninsured migrant women are at higher risk of stillbirth, preterm birth, fetal growth restriction and perinatal mortality. - Nonclinical burdens documented among PMWMI include higher prevalence of postpartum depression, parasitic infections and certain communicable diseases. Fear of detection and deportation contributes to avoidance of preventive care and routine check-ups. - The review underscores the need for context-appropriate, multidisciplinary, culturally sensitive interventions and for economic data to inform policymakers about the financial benefits of providing perinatal services to PMWMI. - The included literature shows geographic variation in coverage (for example, Canada’s Interim Federal Health Program covers refugee claimants but many temporary or undocumented migrants remain excluded), reinforcing heterogeneity in access across settings.
## Clinical Analysis & Structured Key Points
Interventions facilitating access to perinatal care for migrant women without medical insurance: a scoping review | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Peer Review Reader Comments Figures Figures Abstract Introduction Poor antenatal monitoring is associated with higher rates of maternal complications at delivery and serious threats to neonatal well-being. This scoping review intended to explore existing interventions and policies addressing access to perinatal care among pregnant migrant women without medical insurance (PMWMI). Additionally, it will highlight the strengths and weaknesses of these interventions, as well as their associated costs. Materials and Methods Using the Arksey and O'Malley (2005) framework – selected for its structured and widely used approach to mapping the breadth and nature of available evidence -, an electronic search was conducted across 11 databases for studies published between 2000 and 2025 in English or French. Grey literature was also examined. A total of 14 studies were included: 4 from Canada, 8 from the United States, 1 from Iran, and 1 from Thailand. Results The gaps created by policy changes, such as the reduction of services, create a misleading perception of economic efficiency. While short-term savings may be evident, they often lead to greater expenses in the medium to long term. In a federal system of government, the financial burden is shifted to the states (or provinces), which are compelled to address the resulting shortfall. The findings indicate that these changes appear to be politically motivated rather than economically beneficial. Conclusion This scoping review highlighted interventions that facilitate access to perinatal care for migrant women without medical insurance. As the first of its kind, the findings reveal significant policy shifts that jeopardize the health benefits of undocumented immigrants and asylum seekers, contributing to profound health disparities. Further, these individuals may forgo necessary medical treatment, preventive care, and routine check-ups due to fear of detection and deportation. Citation: Sia D, Beogo I, Ntanda GM, Tchouaket Nguemeleu E, Bationo NJ-C, Séguin C, et al. (2026) Interventions facilitating access to perinatal care for migrant women without medical insurance: a scoping review. PLoS One 21(9): e0357487. https://doi.org/10.1371/journal.pone.0357487 Editor: Sharada P. Wasti, University of Greenwich, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Received: November 2, 2025; Accepted: August 18, 2026; Published: September 10, 2026 Copyright: © 2026 Sia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All data underlying the findings of this scoping review are fully available within the manuscript and its supplementary information files. Appendix 3 presents the charted data extracted from the included studies. Funding: SHERPA University Institute and the Social Sciences and Humanities Research Council (SSHRC) have funded this project. Competing interests: The authors have declared that no competing interests exist. Introduction Across high‑income countries, uninsured migrant women face substantial barriers to accessing adequate prenatal care [ 1 ]. In Toronto, Canada, for example, 80% of uninsured pregnant women received inadequate prenatal care, with more than half receiving clearly inadequate care and 6.5% receiving none at all [ 2 ]. Insurance status has been linked to differences in the type of healthcare provider seen, indications for caesarean section, neonatal resuscitation rates, and the length of maternal hospital stay among uninsured migrant, refugee, asylum‑seeking, and undocumented women [ 2 – 5 ]. Similar patterns have been documented internationally, where immigrant women frequently encounter inadequate prenatal care [ 6 – 9 ], contributing to higher stillbirth rates [ 10 ]. Those lacking medical insurance often initiate care late in pregnancy and facing more severe delivery complications [ 11 ], including more emergency caesarean sections, which can result in lasting trauma for both mother and child [ 11 ]. In both Canada and the United States, many migrant women receive care that falls below recommended standards because they are excluded from public health insurance coverage [ 2 ]. This review focus on migrant women aged 12 years and older who lack health insurance and are either pregnant, in labor, or postpartum. According to the glossary of the International Organization for Migration, the term “migrant” refers to “a person who is compelled to move, whether within a country or across an international border, temporarily or permanently, for a variety of reasons, to improve his or her material and social conditions, as well as those of his or her family [ 12 ]. In Canada, refugee claimants have coverage through the Interim Federal Health Program (IFHP) for medical and hospital services that is virtually identical to those afforded citizens, as well as full coverage of prescription medications and partial coverage of other services, including midwives. However, this is not always observed in practice in other contexts, as highlighted in the literature [ 13 , 14 ]. Certain categories of migrants with temporary visas, as well as undocumented migrants, receive no health coverage at all [ 15 ]. Migrants are also disproportionately affected by financial vulnerability [ 16 ]. In many countries, restrictive immigration policies, such as mandatory waiting periods for public insurance, exclusion of temporary residents from health coverage, and the denial of services to undocumented individuals, further limit access to essential maternal healthcare [ 17 – 19 ]. As a result, migrant women frequently face inadequate prenatal care [ 9 , 20 ], which contributes to higher rates of stillbirth, fetal growth restriction, preterm birth, and disproportionate perinatal mortality [ 21 – 23 ]. Migrants without medical insurance are particularly vulnerable populations [ 10 , 11 ]. They often begin their prenatal consultations late in pregnancy [ 1 ] what leads to medical complications during labor [ 11 ]. Additionally, they have a higher incidence of emergency caesarean sections, contended to be traumatic for both the mother and the future child [ 10 ]. One systematic review and meta-analysis, comparing pregnant women with an immigration background to native origin, showed that the former had significantly higher risks of emergency caesarean section (OR = 1.1, 95% CI = 1.0–1.2), shoulder dystocia (OR = 1.1, 95% CI = 1.0–1.3), gestational diabetes mellitus (OR = 1.4, 95% CI = 1.2–1.6), small for gestational age (OR = 1.3, 95% CI = 1.1–1.4), low 5-min Apgar score (<7) (OR = 1.2, 95% CI = 1.0–1.3), and oligohydramnios (OR = 1.8, 95% CI = 1.0–3.3) [ 24 ]. A substantial burden of postpartum depression [ 25 ], parasitic infections [ 26 ], and other communicable diseases (e.g., hepatitis B, hepatitis C, and HIV/AIDS) [ 27 ] has also been reported among this population. The combination of their precarious status and the challenges they face in accessing perinatal care [ 28 ] multiplies the burden for them. The matter of pregnant migrant women without medical insurance (PMWMI) is complex. To improve perinatal care, interventions have focused on providing early and routine services, delivering culturally sensitive programs, enhancing geographic accessibility, fostering multidisciplinary collaboration, and integrating care with affordable community resources [ 29 , 30 ]. Previous reviews have examined migrant maternal health more broadly [ 31 ] or focused on outcomes among asylum seekers and undocumented migrants [ 32 , 33 ], but none have specifically synthesized interventions aimed at improving access to perinatal care for migrant women without medical insurance or with precarious migration status. No knowledge synthesis has yet examined interventions aimed at improving access to perinatal care for PMWMIs. Given the growing concerns surrounding healthcare access for PMWMIs, conducting a comprehensive review to catalogue existing interventions that facilitate perinatal care is both timely and essential. That is, we run a scoping review of interventions and policies to synthesize the available evidence, assess their strengths and weaknesses, and evaluate their financial costs. This understanding will facilitate the implementation of context-appropriate interventions to improve access to perinatal care for PMWMIs. Interventions comprised a comprehensive package of maternal and newborn health services, including pregnancy testing, prenatal care and follow-up, and screening for diseases during pregnancy. It provided immediate obstetric and neonatal support during labor, delivery, and the first two hours postpartum, as well as postpartum and newborn care. Additional components included prenatal education, vaccination, and assistance during childbirth, ensuring continuity of care across the maternal and neonatal period. Policy-level interventions were incorporated to support and sustain these services. Additionally, knowledge of the costs associated with these interventions will assist decision-makers in recognizing the financial benefits of investing in their establishment. This scoping review addresses a gap in the literature and aims to identify interventions that have been utilized to enhance access to perinatal care for PMWMIs. It also emphasizes the strengths, weaknesses, and costs of these interventions. Research questions This review examines interventions and policies that enhance PMWMIs’ access to perinatal care and addresses two key research questions. What are the interventions that facilitate access to perinatal care for PMWMI women? What are the interventions impacts on PMWMI perinatal health What are the strengths and weaknesses of the interventions, and what is the cost of implementation? Materials and Methods Methodological framework The protocol of this review has been published [ 34 ]. This study utilized the Arksey and O’Malley framework [ 35 ]. It provides six fundamental steps for carrying out a thorough scoping review: (i) defining the research question; (ii) identifying relevant studies; (iii) selecting studies; (iv) extracting data; (v) analyzing and aggregating results; and (vi) conducting a consultation exercise (optional). As the consultation phase is optional, it was not undertaken in this review. Data sources and research strategy The study was registered in Research Registry (#6864 https://www.researchregistry.com/browse-the-registry/#home/?view_2_search=6864&view_2_page=1 ) and followed PRISMA-ScR recommendations [ 36 ] (see S1 Checklist ). Eleven electronic databases for studies published between 2000 and 2024 were queried, including CINHAL, Web of Science, Medline-Ovid, Embase, Cochrane Library, Scopus, ScienceDirect, Hinari, Lilacs, Cairn and Banque de Données Santé Publique (BDSP). Additionally, we performed search in other sources including 1) reference tracking from reference lists; 2) key journals in the field of immigration (Revue Migrations Forcées; Migrations Société); and 3) Grey literature, including websites of non-governmental organizations (NGOs) such as Médecins du Monde, Médecins Sans Frontières (MSF), and the United Nations High Commissioner for Refugees (UNHCR). A working meeting with the research team, which included an experienced librarian (CS), facilitated the development of the search strategy (presented in Table 3 published elsewhere [ 34 ]. An expanded version, including the complete search strategies for all databases consulted, is presented in Table 3 of the present review. This strategy was formulated using descriptors or thesaurus along with the logical operators “AND” and “OR” to identify relevant studies published in French or English. An updated screening was conducted in December 2024. The year 2000 was chosen as a reference point with the launch of eight Millennium Development Goals (MDGs), addressing gender equality (MDG 3), and child mortality reduction (MDG 4) [ 37 ]. Study selection Inclusion Criteria. Inclusion and exclusion criteria were based on the Population, Interventions, Comparators, and Design and Outcomes, or Anticipated Outcomes (PICO), as summarized in Table 1 in the published protocol [ 34 ]. Download: PNG larger image TIFF original image Table 1. Summary of studies included in the review (n = 14). https://doi.org/10.1371/journal.pone.0357487.t001 Population (P). Articles addressing the perinatal period of uninsured migrant women were also considered. It is important to note that migrants are not a homogeneous population [ 12 ]. Migrants originate from diverse countries and cultures and fall roughly into two groups: (i) those in a regular situation, whose entry and stay in the host country comply with applicable laws; and (ii) those in not regular situation vis-à-vis of the regulations of the host country by the way they get in or because they stay beyond the validity of their residence permit [ 12 , 38 ]. This review also considers internally displaced persons, as well as refugees and asylum seekers without health insurance. Interventions (I). This review examines care for uninsured migrants during the perinatal period and the policies that facilitate access. For the purposes of this review, the perinatal period is defined as extending from the onset of pregnancy to the early months of life, thereby expanding beyond the World Health Organization definition [ 39 ]. It encompasses pregnancy testing; prenatal care (antenatal follow-up); immediate obstetric and neonatal care (during labor, delivery, and within two hours postpartum); postpartum care (up to 42 days after delivery); and newborn care (up to 28 days of life) [ 40 ]. Care, including prenatal education, labor, delivery, and postpartum services, was considered per the MdM framework [ 41 ] [summarized in Table 2 of [ 34 ]]. Were excluded, intervention falling out of the perinatal period. Comparator and design (C). As for the design, we considered all empirical scientific studies, of any design, conducted in French or English from any country [ 42 ]. This inclusive approach was chosen to capture the full range of interventions and policies implemented to support uninsured migrant women during the perinatal period, acknowledging that the evidence base is limited and methodologically diverse. Media articles, editorial comments, and studies focusing solely on the profiles of PMWMIs were excluded because they do not provide empirical data on interventions or policy measures relevant to our research question. No comparison was anticipated. Outcomes or intended results (O). Studies were included if they reported the impacts, strengths, limitations, and implementation costs of interventions aimed at improving perinatal care access for PMWMIs. Studies Screening In collaboration with the librarian (CS) of the Université du Québec en Outaouais and co-authors (I.B. and D.S.) designed the selection of articles and their extraction strategy. To begin selection, data were exported to EndNote for electronic and manual duplicate removal, then transferred to Rayyan [ 43 ]. Article selection proceeded in four steps: first, the team adapted a screening algorithm —develop by the team and used in previous reviews [ 44 – 47 ] — ( Fig 1 of the protocol [ 34 ]); second, 10% of articles were jointly reviewed to harmonize the process (D.S., I.B., N.J.-C.B., E.T., G.M.N.); third, three authors (D.S., I.B., N.J.-C.B.) independently screened titles and abstracts and abstracts, and an article was retained if at least two reviewers deemed it eligible. Across this stage, 2.32% of screening decisions resulted in a conflict, all of which were resolved through discussion after re‑examining the record. This corresponds to an agreement rate of 97.68%, reflecting strong consistency in the application of eligibility criteria. Over the process, disagreements were resolved through discussion after reviewing the title and the abstract; if consensus was not reached, the fourth author (E.T.) made the final decision. Download: PNG larger image TIFF original image Fig 1. Prisma flow diagram illustrating the search strategy. https://doi.org/10.1371/journal.pone.0357487.g001 At the final step, eligible articles have been read in their entirety by two independent reviewers (D.S. and I.B.). At the end of this step, all authors met and summarised the reasons for exclusion of articles to prepare the flow diagram of the study. Data extraction The data extraction grid [ S2 Appendix of [ 34 ]] was adopted from Cameron et al. [ 48 ], to capture study details (authors, year, country, title, design, population, sample size, interventions (antenatal, obstetric/neonatal, postpartum, newborn care, and related policies), impact, strengths, weaknesses, and implementation costs. To ensure consistency, three authors (D.S., I.B., N.J.-C.B.) collaboratively extracted data from two of the 13 included articles, after which N.J.-C.B. completed the remaining extractions. All extracted data were validated by D.S. and I.B. Data analysis Data analysis was conducted using a narrative synthesis informed by thematic analysis. Following data extraction, study findings were systematically coded and compared across study objectives, intervention types, and settings. A thematic synthesis was then undertaken to identify recurring patterns and relationships across the included studies, with themes generated through iterative review and discussion among members of the research team. While themes emerged inductively from the data, the organisation of the Results section was guided by key outcome domains relevant to the review objectives, including intervention impacts, strengths, weaknesses, and costs. This combined analytical approach enabled a structured comparison of interventions and facilitated the identification of effective strategies for improving access to perinatal care among PMWMI women. The synthesis also informed implications for future research, practice, and policy development. The study was approved by the Research Ethics Committee of the Université du Québec en Outaouais (Project #2021-1490, March 11, 2021). No informed consent was required, as no individual data were collected. Results Study characteristics We identified 16,593 records and removed 3,915 duplicates (last update in April 16, 2026). After screening titles and abstracts, an additional 12, 563 records were excluded (see Flowchart). A total of 14 studies met the inclusion criteria and were included in this review ( Table 1 ). These studies were published between 2000 and 2025. The studies were conducted in four countries: the United States (n = 8) [ 49 – 56 ], Canada (n = 4) [ 2 , 21 , 57 , 58 ], Thailand (n = 1) [ 59 ], and Iran (n = 1) [ 14 ]. Study designs varied and included cohort (longitudinal) studies (n = 6) [ 2 , 49 , 52 , 53 , 55 , 57 ], quasi-experimental studies (n = 2) [ 21 , 56 ], qualitative studies (n = 1) [ 14 ], cross-sectional descriptive studies (n = 1) [ 50 ], grounded theory studies (n = 1) [ 59 ], Retrospective and decision-analytic models (n = 1) [ 51 ]. Sample sizes ranged from fewer than 100 participants (n = 2) [ 14 , 59 ], 100–999 participants (n = 3) [ 2 , 21 , 52 ], 1,000–1,999 participants (n = 3) [ 56 , 58 , 60 ], to 2,000 or more participants (n = 6) [ 49 – 51 , 54 , 55 , 57 ]. Across publication periods, one study was published between 2000–2005 [ 52 ], two between 2006–2010 [ 50 , 60 ], three between 2011–2015 [ 2 , 21 , 59 ], seven between 2016–2020 [ 14 , 49 , 54 – 58 ], and one in 2025 [ 51
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