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J Womens Health (Larchmt). 2019 Feb 15. doi: 10.1089/jwh.2018.7314. [Epub ahead of print]

Reproductive Health Outcomes in African Refugee Women: A Comparative Study.

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1 School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York.
2 School of Social Work, The State University of New York (SUNY), University at Buffalo, Amherst, New York.
3 Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York (SUNY), University at Buffalo, Buffalo, New York.
4 Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.



African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared: (1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between African refugee women and U.S.-born Black and White women.


A secondary data analysis of enhanced electronic birth certificate data was used. Univariate comparisons using chi-squared tests for dichotomous variables and analysis of variance and/or Kruskal-Wallis tests for continuous variables were conducted for Refugee versus Black versus White women. A p-value <0.05 was considered statistically significant.


From 2007 to 2016, 789 African refugee, 17,487 Black, and 59,615 White women in our population gave birth. African refugees experienced more favorable health outcomes than U.S.-born groups on variables examined. Compared to U.S.-born women, African refugee women had fewer prepregnancy health risks (p < 0.001), fewer preterm births (p < 0.001), fewer low birth weight infants (p < 0.001), and higher rates of vaginal deliveries (p < 0.001). These favorable outcomes occurred despite later initiation of prenatal care (p < 0.001) and lower scores of prenatal care adequacy among refugee women compared to U.S.-born groups (p < 0.001).


The healthy immigrant effect appears to extend to reproductive health outcomes in our studied population of African refugee women. However, based on our data, targeted, culturally-congruent education surrounding family planning and prenatal care is recommended. Insight from reproductive health care experiences of African refugee women can provide understanding of the protective factors contributing to the healthy immigrant effect in reproductive health outcomes, and knowledge gained can be utilized to improve outcomes in other at-risk groups.


African; immigrants and refugees; maternal health services; prenatal care; vulnerable populations


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