Are some perinatal deaths in immigrant groups linked to sub-optimal perinatal care services? Perinatal audit of infants to women from Africa’s Horn delivered in Sweden 1990-96

Research output: Contribution to journalArticle


Objective: To test the hypothesis that sub-optimal factors in perinatal care services resulting in perinatal deaths were more common among immigrant mothers from the Horn of Africa, as compared to Swedish mothers.

Design: A perinatal audit, comparing cases of perinatal deaths among children of African immigrants residing in Sweden, with a stratified sample of cases among native Swedish women.

Setting: Sixty-three cases of perinatal deaths among immigrant east African women delivered in Swedish hospitals in 1990–1996, and 126 cases of perinatal deaths among native Swedish women. Time of death and type of hospital were stratified.

Main outcome measures: Sub-optimal factors in perinatal care services, categorised as maternal, medical care, and communication.

Results: The rate of sub-optimal factors likely to result in potentially avoidable perinatal death was significantly higher among African immigrants. In the group of antenatal deaths, the OR was 6.2 (CI 1.9-20); the OR for intrapartal deaths was 13 (CI 1.1-166); and the OR for neonatal deaths was 18 (CI 3.3-100), when compared with Swedish mothers. The most common factors were delay in seeking health care, mothers refusing caesarean sections, insufficient surveillance of IUGR (intrauterine growth restriction), inadequate medication, misinterpretation of CTG (cardiotocography), and interpersonal miscommunication.

Conclusions: Sub-optimal factors in perinatal care likely to result in perinatal death were significantly more common among east African than native Swedish mothers, affording insight into socio-cultural differences in pregnancy strategies, but also the sub-optimal performance of certain health-care routines in the Swedish perinatal care system.


Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine


  • Quality of Health Care, Risk Factors, Emigration and Immigration, Cohort Studies, Adult, Africa : ethnology, Sweden : epidemiology, Non-U.S. Gov't, Support, Perinatal Care : standards, Medical Audit, Newborn, Infant, Infant Mortality, Female, Human
Original languageEnglish
Pages (from-to)677-682
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Issue number6
Publication statusPublished - 2002
Publication categoryResearch

Bibliographic note

The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Division of Social Medicine and Global Health (013241820), Pediatrics/Urology/Gynecology/Endocrinology (013240400)

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Related research output

Essén, B., 2001, Department of Obstetrics and Gynecology, Lund University. 163 p.

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