16th European Public Health Conference 2023 ii603

Abstract citation ID: ckad160.1511 Germany, this study answered the research question: ‘‘How
The social gradient in adolescent mental health do midwives deal with women’s preferences during birth?’’.
problems and the role of physical activity Methods:
Johan Dahlstrand 11 semi-structured face-to-face interviews were conducted
with active midwives. The sample showed a high variance in
J Dahlstrand1, P Friberg1, M Petzold1, Y Chen1
1
School of Public Health and Community Medicine, University of
terms of obstetric settings (clinics, birth centers, home births),
Gothenburg, Gothenburg, Sweden regions, and participants’ characteristics (e. g. experience, age).
Contact: johan.dahlstrand@gu.se All interviews were recorded, transcribed, anonymized, and
analyzed using the Grounded Theory Methodology (Strauss/
Background:
Corbin, 1994).
In Sweden, the share of 13 and 15-year-old students reporting
Results:
 2 psychosomatic symptoms (PSS) more than once a week
A model consisting of 7 steps was developed: 1) Interpret the
doubled between 1985/1986 and 2017/2018, during which
situation; 2) Prioritize relevant parameters; 3) Determine a
there were increases in both income inequalities and
frame of possibilities; 4) Match the preference(s) to the frame

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adolescents with insufficient physical activity (PA). PA
of possibilities; 5) Negotiate preference(s); 6) Continuously
during non-school time has been shown to be negatively
monitor contextual/situational changes; 7) Adjust the frame of
associated with stress and PSS among adolescents. We aimed
possibilities. The actions are related to contextual conditions
to explore whether there is a socioeconomic status (SES)-
(structural; interpersonal; personal; health situation; course of
related gradient in adolescent mental health problems, and if
birth; understanding of birth). The model shows how
so, whether non-school sedentary time (SED) and PA mediate
midwives can promote SD even if prior preferences are
this social gradient.
discarded or modified at birth.
Methods:
Conclusions:
We used data from STARS, a prospective and observational
The model describes how midwives in Germany deal with
cohort study of 2283 7th grade students in Västra Götaland,
women’s preferences during birth, which factors they consider
Sweden. A total of 1235 participants (mean age 13.60.394
decisive in doing so, and how SD may be promoted despite of
years, 59% females) returned with valid accelerometer data (
discarded or modified preferences. Further research should
10 hours per day for  4 days), answered questionnaires
examine the role of relationship building, test the model with
regarding stress and PSS, and had parents’ earned income
regard to its generalizability, and use it to analyze and support
registry data. Ordinary least square for linear regressions and
person-centered midwifery care.
bootstrapping for mediation analysis were used with 95% CI,
Key messages:
repeated for males and females separately.  The model describes how midwives in different obstetric
Results:
settings in Germany deal with women’s preferences during
We found that higher income was associated (a = 5%) with
birth and, thereby, influence self-determination.
less stress (-0.1108, p  0.001 and PSS (-0.1315, p  0.001). For  Midwives can promote self-determination also if prior
stress, we found that non-school PA partly mediated this
preferences are discarded, modified, or redeveloped at
association. This was true for light PA (LPA) (-0.0040,
birth.
[-0.0093-0.0003]), moderate to vigorous PA (MVPA)
(-0.0077, [-0.0152-0.0023]) and vigorous PA (VPA) (-0.0090,
[-0.0166, -0.0031]). When separated by sex, mediation via PA
was found only in females. For PSS, mediation effect was Abstract citation ID: ckad160.1513
found for MVPA (-0.0071, [-0.0137, -0.0018]) and VPA Association between language barrier and
(-0.0103, [-0.0182, -0.0039]), but not when separated by sex. inadequate prenatal care utilization among migrant
Conclusions: women
There is a social gradient in both stress and psychosomatic Elie Azria
symptoms among adolescents, mediated by physical activity
M Eslier1, C Deneux-Tharaux1, T Schmitz2, D Luton3, L Mandelbrot4,
although to a relatively small part. This shows the relevance to C Estellat5, R Radjack6, E Azria7
inform policy on the need to enable extracurricular sports 1
Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric
activities for adolescents. Epidemiology Research Team, Paris, France
2
Key messages: Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP,
 Physical activity partly explains the social gradient in Paris, France
3
Department of Obstetrics and Gynaecology, Beaujon-Bichat Hospital, AP,
adolescent mental health. Paris, France
 Supporting extracurricular sports activities may help to 4
Department of Obstetrics and Gynaecology, Louis Mourier Hospital, AP-H,
reduce the social gradient in adolescent mental health. Colombes, France
5
Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de
Santé Publiquet, Paris, France
6
Paris University Hospital, University Hospital Cochin, Maison des Adol,
Villejuif, France
7
Abstract citation ID: ckad160.1512 Maternity Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
How do midwives deal with women’s preferences Contact: eazria@ghpsj.fr
during childbirth in Germany? An action model Background:
Marie Tallarek Language barriers may limit access to care and thus be
associated with increased risk of adverse maternal and
M Tallarek1, A Jost2, J Spallek1
1
Department of Public Health, Brandenburg University of Technology perinatal outcomes. Our objective is to assess the association
Cottbus-Senftenberg, Senftenberg, Germany between this language barrier and inadequate prenatal care
2
Department of Social Psychiatry, Brandenburg University of Technology utilization among migrant women.
Cottbus-Senftenberg, Cottbus, Germany Methods:
Contact: tallarek@b-tu.de
The analysis took place in the French multicentre prospective
Background: PreCARE cohort, conducted in four university hospital
Midwifery care is increasingly discussed in terms of its ability maternity units in the northern Paris area, having a
to promote a self-determined childbirth. The degree of self- professional interpreting service. This cohort included 4803
determination (SD) depends on the extent to which women’s migrant women registered and giving birth between 2010 and
preferences are negotiated and implemented. From the 2012. Migrants’ language barrier was categorized in three
perspective of midwives in different obstetric settings in groups: no, partial or total. Inadequate prenatal care utilization
ii604 European Journal of Public Health, Volume 33 Supplement 2, 2023

was assessed according to the modified Adequacy of Prenatal Conclusions:

Care Utilization Index through multivariable logistic regres- The differential risk of severe maternal outcomes in migrant
sion models. versus native women in high income countries varies by host
Results: country and by women’s region of origin. Our findings
Among the 4803 migrant women included, 16.3% had a partial provide insight into the mechanisms of these inequalities.
and 3.8% a total language barrier. Migrants with language Key messages:
barrier had resided less time in France, experienced social  In high income countries, the differential risk of severe
deprivation and undocumented status more frequently than maternal outcomes in migrants (born outside the host
those with no language barrier. Compared to migrants with no country) compared to natives, varies by the host country
language barrier, those with partial (RR 1.23, 95%CI 1.13- and the region of birth.
1.33) and total (RR 1.28, 95%CI 1.10-1.50) language barrier  Our findings strengthens the evidence supporting the need
were at higher risk of inadequate PCU. Adjustment for to fight migrant’s health inequalities and to customise
maternal age, parity, and region of birth did not modify related health policies in each context.
these association, which were noted particularly among socially

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deprived women.
Conclusions: Abstract citation ID: ckad160.1515
Migrant women with language barrier have a higher risk of Evolution of infant mortality in the Paris region over
inadequate prenatal care utilization than those without. These the past two decades
findings underscore the importance of targeted efforts to bring
Bobette Matulonga Diakiese
women with language barrier to prenatal care.
Key messages: B Matulonga Diakiese1,2
1
 Compared with migrant women with no language barrier, Paris Region Health Observatory, Paris, France
2
Médecine, Université Protestante au Congo, Kinshasa, Democratic Republic
those with such barrier, either total or partial, have a higher of the Congo
risk of inadequate prenatal care utilization. Contact: bobette.matulonga@institutparisregion.fr
 These findings underscore the importance of targeted
efforts to bring women with language barrier to prenatal Background:
care. Infant mortality is one of the major health indicators to
appreciate the population health and the organization of the
health system. Since the 1990s, the infant mortality rate (IMR)
declines less rapidly in France as compared to other Western
Abstract citation ID: ckad160.1514 countries, taking the country from 7th to 27th place in 2017.
Migration and severe maternal outcomes in high As the Paris region recorded a quarter of the under one French
income countries: systematic review and meta- mortality, we aimed to analyze the evolution of the regional
analysis IMR over the last two decades.
Elie Azria Methods:
M Eslier1, E Azria2, K Chatzistergiou2, Z Stewart1, A Dechartres3, Using 2000 to 2019 data from the National Institute of Statistic
C Deneux-Tharaux1 and Economic Study on births and deaths, we ran joinpoint
1
Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric regressions model to analyze the evolution of mortality of
Epidemiology Research Team, Paris, France infant under one. We also examined IMR by age at death
2
Maternity Unit, Paris Saint Joseph Hospital, FHU PREMA, Paris, France
3
Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de subgroups (early neonatal [Day 0-D6], late neonatal [D7-27],
Santé Publiquet, Paris, France and post-neonatal[D28-364]). We also analyzed territorial
Contact: eazria@ghpsj.fr disparities.
Background: Results:
Literature focusing on migration and maternal health inequal- Over 20 years, 13,401 deaths and 3,389,048 live births were
ities is inconclusive. This is potentially explained by hetero- recorded among children under one in the Paris region, IMR:
geneous definitions and settings. Our objective was to assess 3.,93 deaths per 1000 live births, an average of 18% higher than
migrants’ risk of severe maternal outcomes compared to native the national IMR. Data from evolution shows that Paris
women in high income countries overall, according to host region’ IMR was 4.51ø in 2001 and reached its lowest level in
country, and by the migrant’s region of birth. 2013 with 3.65ø before rising to 3.99ø in 2019. The joinpoint
Methods: regression model shows a decline in the IMR between 2000 and
Systematic literature review and meta-analysis using 2003 (-3.78% annually), followed by a slow and steady decline
MEDLINE/Pubmed and EMBASE databases between 1990 between 2003 and 2011 (-1.57%). However, from 2011 to 2019
and 25 March, 2022. Observational studies comparing the risk a significant increase was observed in IMR (+1.48% annually).
of maternal mortality or all-cause or cause-specific severe The analysis of deaths by age-group shows that the IMR
maternal morbidity in high income countries between increase was mainly driven by the increase in early neonatal
migrant, defined by birth outside the host country, and mortality and a little less by late neonatal deaths while the
native women, were included. Case-control and case studies post-neonatal mortality continued to decrease. Additional
were excluded. We performed random-effects meta-analyses analyses showed territorial disparities in global and subgroups
when possible. Subgroup analyses were planned by host IMR with higher IMR in poorer areas.
country and migrant’s region of birth. Conclusions:
Results: These results are of a higher importance and should alert
From 2010 unique references, 36 studies reporting data from French authorities. Further studies, considering risk factors of
32 databases were included. In Europe, migrants had a higher infant mortality are needed to understand the reason of such
risk of maternal mortality than native women (RR 1.4;95%CI increase.
1.1-1.6), but not in USA and Australia. Migrants born in sub- Key messages:
 We showed anhistoric and worrying increase in infant
Saharan Africa (RR 3.3;95%CI 2.5-4.4), Latin America and the
Caribbean (RR 2.8;95%CI 1.2-6.9), and Asia (RR 1.8;95%CI mortality in the Paris region.
 We showed territorial disparities in global and subgroups
1.3-2.4) were at higher risk of maternal mortality than natives,
but not those born in Europe or the Middle East and North IMR with higher IMR in poorer of the Paris region areas.
Africa. Patterns were similar for all-cause severe maternal
morbidity.