Zohra Lassi, Negin Mirzaei Damabi, Abela Mahimbo
Since 1945, Australia has welcomed close to a million refugees. However, when a pregnant refugee woman walks into a hospital, her experience rarely leaves a trace in our health records. Her name might appear on a patient chart, but her migration background, language, health needs, and barriers to care often go unrecorded. We have not made it a priority.
Without data, we can’t see patterns and lived experiences, nor design tailored solutions. We are left with a health system that works well for some women but leaves others struggling.
Migrants and refugees face distinct challenges. Refugee women often experience multiple barriers related to pre-migration trauma, forced displacement, and post-resettlement pressures.
International evidence
Access to timely and adequate antenatal care is another concern. Immigrant women, particularly asylum-seekers, often go for antenatal care later than the recommended first 10 weeks. Among migrant women in Europe, 65% were not able to go to antenatal care and 42% received care only after 12 weeks of pregnancy. For women from refugee backgrounds specifically, delayed pregnancy care is common.
These delays lead to other health risks. Across the globe, migrant and refugee women face more risks of pregnancy complications compared to host populations. Studies show that foreign-born women have a 32% higher risk of gestational diabetes compared to women born in the United States, with the risk increasing with longer residence—women residing in the US for 6-10 years face nearly double the risk. Women with refugee backgrounds from Central and East Africa show significantly higher risks of gestational diabetes. Additionally, migrant women experience higher rates of stillbirth, low-birthweight infants, early neonatal mortality, and preterm birth.
But in Australia, we do not know if migrant women in general face the same struggles. We assume the system works for everyone, but we have never systematically checked. Each year, about 515,000 migrants arrive in Australia. They have babies, navigate our healthcare system and join our communities. Yet, in national health data, they remain largely invisible.
Research across 100 countries found that even where governments report equal access to health services for migrants, health outcomes tell a different story. The gap between policy and lived reality stays hidden. What we do not measure, we cannot improve.
Why this matters now
The evidence challenging old assumptions is growing. For years, we have relied on the so-called ‘healthy migrant effect’ – the belief that people who migrate are generally healthier than the host population. But newer research shows the opposite. Immigrants often experience faster health decline than non-immigrants, even when they have higher levels of education or socioeconomic stability.
Without tracking pregnant migrant women’s health, we cannot identify when and why their health declines. We cannot pinpoint which pregnancy complications are increasing, which antenatal interventions are reaching women, or whether the risks of gestational diabetes, hypertension, and adverse birth outcomes were present throughout the time they were settling in the new country.
Without tracking their health, we can’t intervene early. We can’t identify reasons for their health decline or whether interventions work. We continue operating on outdated assumptions while the evidence shifts under our feet.
When we can’t track health outcomes, we can’t hold our systems accountable. Disparities that should be seen and addressed, stay hidden. Resources that could be targeted, stay generic. Progress that should be measured, stays assumed.
What needs to change
Australia needs to routinely collect and report migrants’ health data across all national health information systems as standard practice.
International examples show this is achievable. Sweden and Denmark have successfully integrated the migration status into their population registers. These registers record the country of birth and date of immigration, and are linked across national health databases. This has helped identify issues regarding maternal health, including higher rates of gestational diabetes, inadequate antenatal care, and stillbirth among certain migrant groups. It provides complete, valid, and timely information for interventions.
We need to strengthen how mainstream services function. Cultural humility and responsiveness, effective communication, including the use of interpreters, understanding of migration health, and trauma-informed approaches can’t be optional extras. They need to be core competencies that are taught, practised, assessed, and expected.
Migrant and refugee women need to be involved when designing services. They aren’t passive recipients of care but people with insight, lived experiences, preferences, and agency. Their current exclusion is our gap to close, not their problem to solve.
We can close this gap by committing to building data systems that make everyone visible, co-create services that work for everyone, and recognise that ‘women’s health’ can’t mean ‘some women’s health’.
Image credit: Nandhu Kumar – Pexels
Associate Professor Zohra Lassi and Dr Abela Mahimbo are PHAA Women’s Health SIG co-convenors. Negin Mirzaei Damabi is a PHAA Diversity, Equity and Inclusion SIG member.
Prof Lassi and Negin are affiliated with the School of Public Health and Robinson Research Institute at the University of Adelaide. Dr Mahimbo is with the School of Public Health at the University of Technology Sydney.
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