Philippe Wanner

Pregnancy outcome of migrant women and integration policy: A systematic review of the international literature

Immigrant mothers in developed countries often experience worse pregnancy outcomes than native women. Several epidemiological studies have described the pregnancy outcome of immigrant women in European receiving countries, with conflicting results. The present systematic review makes a quantitative synthesis of available evidence on the association between pregnancy outcomes and integration policies. We reviewed all epidemiological studies comparing the pregnancy outcome of native versus immigrant women in European countries from 1966 to 2004 and retained 65 for analysis, from 12 host countries. Overall, as compared to native women, immigrant women showed a clear disadvantage for all the outcomes considered: 43% higher risk of low birth weight, 24% of pre-term delivery, 50% of perinatal mortality, and 61% of congenital malformations. The risks were clearly and significantly reduced in countries with a strong integration policy. This trend was maintained even after adjustment for age at delivery and parity. On the basis of an analysis of naturalisation rates, five countries in our sample could be categorised as having a strong policies promoting the integration of immigrant communities. The mechanisms through which integration policies may be protective include the increased participation of immigrant communities in the life of the receiving society, and the decreased stress and discrimination they may face. The results of this study highlight a serious problem of equity in perinatal health across European countries. Immigrant women clearly need targeted attention to improve the health of their newborn, but a deep societal change is also necessary to integrate and respect immigrant communities in receiving societies.

Cancer mortality among sub-Saharan African migrants in France

Not only are there few data on sub-Saharan migrant populations, but relatively little information is available on cancer patterns in Africa. This report presents cancer mortality patterns among the 290,000 sub-Saharan African migrants in France. Risks of mortality from different cancers in migrants born in West, Central, East, and ‘Other’ parts of Africa have been compared with that observed in the local-born population, using mortality data from the period 1979–85 and population data from the 1982 French census. Relative risks were adjusted for important confounding factors such as social class and area of residence. Compared with natives, overall mortality from cancer is lower in sub-Saharan African migrants. Higher cancer mortality risks, however, are observed among males for several sites: liver in Central and West Africans; bladder in West Africans; and non-Hodgkins lymphoma in Other African migrants. For females, risks were elevated for nasopharyngeal cancers in Other African and liver in West African migrants. The results are, for the most part, consistent with the few available data on cancer patterns in Africa, and with the patterns observed in African migrants to England and Wales (UK).

Naturalisation and Socio-Economic Characteristics of Youth of Immigrant Descent in Switzerland

Many studies on the generational social mobility of immigrant populations have taken into account the socio-economic characteristics of the immigrant groups on the one hand, and the historical and economic conditions of the receiving society, including the legal framework, on the other. However, little attention has so far been paid to the juridical status of immigrant groups. This paper explores the variation in education and employment performance of young people from different immigrant origins (Italians, Portuguese, Turks, Croats, Kosovars and Serbs) and of different citizenship statuses—naturalised, non-naturalised, and Swiss-by-birth. Inter-ethnic group variations become much more muted when social origin and length of stay are controlled for; however, they do not disappear altogether. Naturalised immigrant youth perform best; indeed in many cases, where they are Swiss-born, they out-perform native Swiss. This performance, however, is overlooked by Swiss society because the acquisition of Swiss citizenship makes it statistically invisible.

The self-reported health of immigrant groups in Switzerland.

Background: More than 20% of people living in Switzerland are immigrants, defined as people with foreign nationality. This study examines health disparities between the main immigrant groups in Switzerland and the majority Swiss population. Methods: Epidemiological analysis of the 2002 Swiss Health Survey (SHS): the SHS contains health-related information about 19,706 people who were randomly sampled from among people living in Switzerland. Bi-variate and multivariate analyses of six variables on self-reported health were performed. Findings: The data from the 2002 Swiss Health Survey provide some evidence of health disparities between Swiss people and immigrants. Although the self-reported health of “Northern immigrants” (people from Germany and France) does not differ significantly from that of the majority Swiss population, “Southern immigrants” (people from Italy, Former Yugoslavia, Portugal, Spain and Turkey) report lower levels of health in several areas. Lower levels of health are particularly likely to be reported by Italian men and women. Conclusion: The self-reported health of immigrants is currently inferior to that of the Swiss. If it is the position of the Swiss health care system to ensure equal health provision for all Swiss residents, including immigrant groups, and to strive for equal health outcomes for all, self-reported ill health among immigrants is a useful basis for health policy and planning.

Pregnancy outcomes and migration in Switzerland: results from a focus group study

SummaryObjectives:To explore the issues of pregnancy and delivery in migrant women in their interaction with the Swiss healthcare system.Methods:Focus groups were conducted with women of the Turkish and Portuguese communities. Swiss women were included as the reference group. Interpreters were used when needed. Group discussions were recorded and transcribed; all communications were categorized by specific themes and subdivided as to content.Results:Eight focus groups were held: there were a total of 40 participants including 14 Turkish, 17 Portuguese, 9 Swiss. The study revealed that migrant women in Switzerland face stressful situations, which may differ according to nationality and length of stay in the country. Main factors negatively affecting pregnancy were stress due to precarious living conditions, heavy work during pregnancy, inadequate communication with healthcare providers, and feelings of racism and discrimination in society.Conclusions:Main findings of this qualitative study confirm that migrant communities need focused health attention because of numerous barriers to healthcare experienced in Switzerland. Improving the reproductive health of the migrant community is a priority that can be addressed by public health interventions, including integration of migrants into the society, strict observance of labor regulations, improved communication with healthcare providers, and better information targeting migrant communities.

Self-reported cardiovascular risk factors in immigrants and Swiss nationals

OBJECTIVE The purpose of this study was to investigate whether the prevalence of self-reported cardiovascular risk factors differs between immigrants and Swiss nationals. DESIGN AND SAMPLE This study is a secondary data analysis of the Swiss Health Survey 2002, a cross-sectional survey. In total, 19,249 individuals living in Switzerland were included. MEASURES The prevalence of hypertension, high cholesterol level, smoking, diabetes, overweight, low fruit and vegetable intake, and physical inactivity were calculated for major immigrant groups and Swiss nationals. Demographic data were used to control for age and socioeconomic status. RESULTS Major immigrant groups were people from Italy, Germany, former Yugoslavia, Spain, Portugal, France, and Turkey. Compared with Swiss women, women from former Yugoslavia were more likely to have hypertension, and women from Germany were more likely to have high cholesterol levels. Women from Italy, former Yugoslavia, Spain, Portugal, and Turkey were more likely to show physical inactivity and (except Turkish women) to be overweight. Men from these countries (except Spanish men) were more likely to be overweight than Swiss men. CONCLUSIONS Differences exist in the prevalence of modifiable cardiovascular risk factors between Swiss nationals and many of the immigrant groups. Age and socioeconomic status could only partly explain the differences.

Trends in maternal mortality in Switzerland among Swiss and foreign nationals, 1969-2006.

ObjectivesTo test whether maternal mortality was higher among immigrant women than Swiss women.MethodsAll maternal deaths and live births in Switzerland from 1969 to 2006 from official vital statistics were considered. We calculated maternal mortality ratios (MMRs) in four time intervals (1969–1979, 1980–1989, 1990–1999, 2000–2006) for both Swiss and immigrant women overall, and for Italian, Spanish and Turkish women. We also computed the odds ratios and 95% confidence intervals of maternal mortality over the four time periods, considering maternal deaths as cases, and live births as controls.ResultsFrom 1969 to 2006 there were 279 maternal deaths, 204 of Swiss women and 75 of immigrant women. Women’s age, marital status and cause of death were similar in the two groups. For immigrant women, the crude odds ratio of a pregnancy ending with maternal death, not homogeneous across the four periods, was 4.38 (95% CI 1.88–10.55) in 2000–2006.ConclusionsImmigrant women have a higher risk of maternal mortality than Swiss women. A closer scrutiny of risk factors and quality of care is necessary to identify opportunities for prevention.

La première mise en couple en Suisse : choix du type d'union et devenir de la cohabitation hors mariage

Changes in family formation behaviour are responsible for the coexistence of two forms of union in the developed countries: the fairly “flexible” extramarital cohabitation, and the more formal or official form, marriage. Cohabitation is on the increase in Switzerland, currently accounting for nearly 9 in 10 newly-formed couples, but marriage is still considered the necessary condition for starting a family and the level of extramarital births remains among the lowest in Europe. In this context, it is highly instructive to study the factors that influence decisions about the form of the first union and the duration of non-marital cohabitation. The main finding of this article based on a survey of the family is that decisions about type of union are strongly influenced by religious observance, the fact of being pregnant, and economic circumstances. While educational attainment appears not to modify the form of union chosen at the time of couple formation, it is associated with the durations of premarital cohabitation.

Mortalité des générations 1880–1980 en Suisse une relecture de l'évolution de la mortalité à partir de données longitudinales

Summary.Cohort mortality from 1880-1980 in SwitzerlandObjectives: Seek to explain the declining mortality rates observed in Switzerland using a different approach from conventional period analyses. Methods: Analysis of the mortality rates for cohorts born between 1880 and 1980 in Switzerland. Results: While the mortality transition was a constant feature of the 20th century, mortality receded most sharply among the 1900 to 1940 birth cohorts. Life expectancy gains were much lower for the pre-1900 cohorts, while early trends for the post-1940 cohorts point to a slowdown in the rate of mortality decline. These findings may be connected with the social and health conditions in which the different cohorts lived. Conclusion: In contrast to the cross-sectional analysis, the longitudinal approach shows that the decline in mortality suddenly stops with the 1940 cohort.

La nouvelle seconde génération. Introduction au numéro spécial

Le lecteur tient dans ses mains le premier numéro spécial de la Revue suisse de sociologie sur les enfants de migrants en Suisse, à presque soixante-dix ans du premier accord sur la migration que la Suisse a signé avec un Etat tiers, à savoir l’Italie (1948). En Suisse, la migration à l’enseigne du modèle du Fremdarbeiter (ou Gastarbeiter, comme on disait en Allemagne) marque les Trente glorieuses et empêche efficacement l’installation durable des arrivants (Wanner 2014). Ainsi, les premiers travaux sur les enfants de migrants et notamment sur leur présence dans l’école suisse datent des années 1970, qui ont vu émerger les familles étrangères aux origines notamment italiennes et espagnoles (avec les travaux pionniers de la sociologie zurichoise autour de Hans-Joachim Hoffmann-Nowotny sur la famille ; voir par exemple Hoffmann-Nowotny 1973 ou Wilpert 1980). Mais une confrontation systématique n’arrive que dans les années 1980 suite à des discussions politiques sur l’avenir, mais aussi sur la dangerosité sociale, de la deuxième génération (CFE 1980) qu’on soupçonne d’ailleurs particulièrement engagée dans les mouvements urbains des années 1980. Gita Steiner Khamsi pose ainsi la question politique, dans un essai de 1985 qui résume les questionnements et les peurs présents dans cette période en Suisse (seulement) : la deuxième génération (comme d’ailleurs dans d’autres pays européens) est-elle une bombe sociale ? (Steiner-Khamsi 1985). Les études se succèdent dans les années 1980 et 1990 avec comme thèmes notamment la performance scolaire et la mobilité sociale (CFE 1980 ; Gonvers et al. 1980 ; Gretler et al. 1981 ; Gurny et al. 1984 ; Fibbi et De Rham 1988) et la criminalité (Killias 1989). Le thème de l’identité s’ajoute (et s’impose) à partir des années 2000 comme l’atteste la production scientifique sur l’inscription des descendants de migrants dans la société suisse : citons à titre d’exemple les travaux de Hämmig (2000), Bolzman et al. (2003), Juhasz et Mey (2003), Bauer et Riphahn (2004), Wessendorf (2005) et Frauenfelder (2006).