It’s time for a new healthcare policy in Italy to improve prognosis of newborns of immigrant parents.
4 April 2010
Hertzman and collegues argue that a good start in life is the key to reducing health and social inequalities and that governments should invest more in programmes to support early child development (1). Besides this desirable plan, even in some developed countries such as Italy, interventions are needed also before birth to reduce neonatal mortality and morbidity. This would facilitate prenatal care especially for pregnant immigrant women who, more frequently than Italians, face poor social, economic and cultural conditions (higher rate of minor and/or unwed mothers, low family income, heavier and irregular employment, unsuitable dietary habits, poor living and hygienic conditions, late or inadequate obstetrical and gynaecological care). In Italy there is a rising number of children born to citizens coming from abroad. According to ISTAT, the national statistics bureau, in 2008 there were 72472 children born to immigrant women, equal to 12.6% of all Italian births (2).
As the Policlinico Umberto I in Rome is a referral centre for high risk pregnancies, a research study was carried on the 16821 children born in the last 10 years (2000-2009) at this hospital. As many as 22.5% were born to immigrant mothers; compared to children born to Italians, these newborns had higher rate of 1) delivery before 37 weeks’ gestation (15.9 vs 14%; OR: 1.12; IC 95%: 1.01-1.24), 2) incidence of birth weight below 1000 g (1.6% vs 1.2%; OR: 1.37; IC 95% :1.01-1.84), 3) gestational age below 28 weeks (1.7 % vs 1.0 %; OR:1.70; IC 95%: 1.25-2.31) and 4) a series of pathological conditions (birth trauma, newborn depression, metabolic disorders, Rh alloimmunisation, and malformations) requiring more often NICU stays (7.1 vs 5.8%; OR:1.20; IC 95%: 1.04-1.39). Newborns to foreigners also had higher hospital mortality rate than those born to Italians (0.7 vs 0.4 %; OR=1.83; IC 95% 1.13-2.99). The worst prognosis was related to the more severe conditions of newborns of foreigners; in fact, when the data were corrected for variables such as gestational age or birth weight, the differences in mortality rates completely levelled out. This implies that children born to foreigners received the same medical care as those born to Italians, but had more often lower birth weight and, being more often premature, experienced higher complications rate.
Although the immigrant women in our population sample were on average younger than Italians (28.9 vs 32.4 yrs; p<_0.001 more="more" often="often" they="they" gave="gave" birth="birth" to="to" high="high" risk="risk" newborns.="newborns." p="p"/>Improved mother and child health among immigrants can be achieved in Italy by facilitating access to health services and prenatal care for pregnant immigrant women, and by reconsidering the crime of illegal immigration recently introduced by the Security Act of the current Italian government, which has led many irregular immigrants to avoid hospitals out of fear of being reported to the police and consequently expelled. According to Italian legislation, all pregnant women—whatever their legal status—are entitled to free access to all medical services and to a six-moth residency permit after delivery. This regulation has now lost its value because women fear that once their permit has expired they can be identified and expelled. This could translate into a much lower number of examinations during gestation and, consequently, a higher risk of perinatal mortality.
Mario De Curtis, Renato Lucchini
Dipartimento di Pediatria, Sapienza-Università di Roma
1)Hertzman C, Siddiqi A, Hertzman E, Irwin LG, Vaghri Z, Houweling TA, Bell R, Tinajero A, Marmot M. Bucking the inequality gradient through early child development. BMJ. 2010 Feb 9;340:c468. doi: 10.1136/bmj.c468.
2) http://www.istat.it/salastampa/comunicati/non_calendario/20091008_00/tes... accessed 2 April 2010
Competing interests: None declared
Competing interests: None declared
Department of Paediatrics, University of Rome La Sapienza
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