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[Potentials of elderly migrants].

Re-migration and immigration are the causes for the continual fluctuation within the migrant population. It is, however, currently foreseeable that the elderly migrant population living in Germany will steadily increase. Because of the large degree of heterogeneity among the elderly migrant population in Germany, the following report will be limited to a discussion of those groups of migrant workers, who originate from former recruiting countries. These groups will constitute the majority of elderly migrants in the coming years. Among the first generation of migrants, some groups have extensive ethnic social networks. This is mostly the case with respect to the migrants from Turkey. These have access to their own ethnic infrastructure, and, due to this fact, there is little need for the initiation of social contacts outside their own ethnic context. Generally, they prefer, as do other elderly foreign workers, to remain in their cultural niches with their own religious institutions and migrant organizations. In comparison to the German population, the families of the first generation of migrants have more children and live more often in multigenerational households. Under the conditions of migration and in a foreign cultural context, the family fulfills a function of social-emotional support. Migrants possess a high potential for mobility. They commute between their homeland and the land of immigration. For some, this is a transitional strategy in order to reach a final decision, either to return to their homeland or to stay in Germany. For others, it is a long-term solution that enables them to make use of each country's respective advantages.

Age Distribution↗

Urban and rural suicide differentials in migrants and the Australian-born, New South Wales, Australia 1985--1994.

We estimated risk of suicide in adults in New South Wales (NSW) by sex, country of birth and rural/urban residence, after adjusting for age; we also examined youth suicide (age 15-24 years). The study population was the entire population of NSW, Australia, aged > or =15 years during the period 1985-1994. Poisson regression was used to examine the relationship between predictor variables and the risk of suicide, with the focus on migrant status and area of residence. A significantly higher risk of suicide was found in male migrants from Northern Europe and Eastern Europe/former USSR, compared to Australian-born males; a significantly lower suicide risk occurred in males from Southern Europe, the Middle East and Asia. In female migrants, those from UK/Eire, Northern Europe, Eastern Europe/former USSR and New Zealand exhibited a significantly higher risk of suicide compared to Australian-born females. A significantly lower risk of suicide occurred in females from the Middle East. Male migrants overall were at significantly lower risk of suicide than the Australian-born, while female migrants overall had a significantly higher risk of suicide than Australian-born females. Among migrant males overall, the rural-urban suicide risk differential was significantly higher for those living in non-metropolitan areas (RR = 1.9; 95% CI: 1.7-2.1). Suicide risk was significantly higher in non-metropolitan male immigrants from the UK/Eire (RR = 1.4; 95% CI: 1.1-1.7), Southern Europe (RR = 1.7; 95% CI: 1.2-2.4), Northern/Western Europe (1.5; 95% CI: 1.2-1.9), the Middle East (RR = 3.8; 95% CI: 1.9-7.8), New Zealand (RR = 1.4; 95% CI: 1.0-1.8) and 'other' (RR = 2.6; 95% CI: 1.9-3.5), when compared to their urban counterparts. There was no statistically significant difference in suicide risk between rural and urban Australian-born males. For female suicide, significantly lower risk was found in female immigrants living in non-metropolitan areas who were from Northern/Western Europe (RR = 0.7; 95% CI: 0.4-0.96), as well as the Australian-born (RR = 0.7; 95% CI: 0.6-0.8), when compared to their urban counterparts. The non-metropolitan/metropolitan relative risk for suicide in female migrants overall was not significantly different from one. Among male youth there was a significantly higher suicide risk in non-metropolitan areas, with a relative risk estimate of 1.4 for Australian-born youth (95% CI: 1.2-1.5) and 1.7 for migrant youth (95% CI: 1.2-2.4), when compared with metropolitan counterparts. We conclude that suicide among migrant males living in non-metropolitan areas accounts for most of the excess of male suicide in rural NSW, and the significantly lower risk of suicide for non-metropolitan Australian-born women does not apply to migrant women.

Adolescent↗

Women migrant workers' vulnerability to HIV infection in Hong Kong.

Research on population mobility and HIV/AIDS risk among migrant populations is quite limited, and research on migrant women workers' vulnerability is further limited. Hong Kong, the Special Administrative Region of China, has currently about 200,000 women migrant workers working as domestic helps. This paper reports migrant women worker's access to AIDS-related health information and health care facilities, perceptions about vulnerability, and risk behaviour profile. Data was collected through a pre-tested questionnaire from a random sample of 2,010 women migrant workers. A majority of the migrant women workers (63.6%) have been living and working in Hong Kong for between 4-10 years. Fifty-four per cent of the respondents felt that being a female they were vulnerable to HIV infection. Overall, the knowledge regarding HIV/AIDS and its route of transmission is inadequate amongst the migrant women workers in Hong Kong. It appears that AIDS-related information education and communication needs of women migrants workers are not met by the current HIV prevention and care activities in Hong Kong. The study indicates that migrant women workers who experienced sexual violence (9%) in Hong Kong perceive themselves to be 'at risk' of HIV infection. Seventy per cent of the respondents reported that they have felt discriminated against in Hong Kong, of which 42% felt discriminated against in Hong Kong hospitals. Addressing discrimination in health care settings is an essential element of AIDS prevention. The discussion urges researchers and policy makers to pay more attention to the vulnerability of migrant women workers.

Adolescent↗

Health and mortality of migrant farm children.

This research examines preventive medical care, morbidity and mortality among children of migrant agricultural workers using a representative sample of migrant families in Wisconsin. Our findings support the view that this group is at substantially greater risk of health problems and early mortality than the general population. Fewer than half of migrant children under age 16 received the recommended annual physical checkup. Only one-third of migrant children under age 16 had received an annual dental checkup compared to 50% of children in the total population. A rough comparison between levels of chronic health conditions for migrant children and those reported for children in a national survey suggest that the incidence of chronic conditions is several times greater among migrant children. Childhood mortality appears to be 1.6 times higher than in the U.S. population. In analyzing variation in preventive care for migrant children, younger children are more likely to receive checkups, while older children are more likely to receive immunizations. In interpreting this finding, we suggest distinguishing between two types of preventive care: one under the direct control of the family, and the other controlled by the schools. Since immunizations are given to migrant children in schools, the older or school-age children are more likely to be immunized. In assessing reports of chronic conditions, we noted that mothers who spoke English were more likely to report that a child had a chronic condition. One possible interpretation is that women who do not speak English may not label various childhood conditions as chronic illnesses. Since a large proportion of women spoke only Spanish, the chronic conditions may be substantially under-reported among migrant children. The analysis of childhood mortality shows the level of mortality to be proportionally lower among women who spoke English, and higher among those who gave birth to a low birth weight child. But surprisingly, the most important characteristic related to loss of children was whether or not a mother smoked. Using smoking as one example of high risk behavior, we suggest that future studies should give closer attention to the impact of parental risk-taking behaviors on childhood morbidity and mortality experiences.

Adolescent↗

HIV/AIDS prevention for migrants and ethnic minorities: three phases of evaluation.

There are now a number of HIV/AIDS prevention programmes for migrant and ethnic minority communities throughout the world, both 'top down' programmes organised, for example, by governments and large NGOs, and 'bottom up' programmes, organised by migrant groups themselves. Evaluation of such programmes, however, is in most cases sorely lacking. The Swiss 'Migrants Project' is, to the authors' knowledge, the only such programme to have been systematically accompanied by evaluation throughout. This paper describes three phases of evaluation of the Migrants Project (exploratory studies, process, and outcome evaluations). The evaluations have highlighted the need for culturally and linguistically appropriate prevention efforts which use already-existing community structures, as well as the need to identify and train people from within communities to carry out local prevention efforts. Outcome evaluation has shown that: a government sponsored HIV/AIDS prevention programme can meet with acceptance by migrant communities; considerable engagement in prevention activities can be mobilised; and AIDS prevention among such communities can be effective. Such efforts can create levels of sensitivity to HIV issues and of protective behaviour that are equal to those of the host country population. The strategy adopted by the programme is thus supported. Key elements are to avoid potential for stigmatising by: (1) placing HIV/AIDS prevention efforts for migrant populations within an overall national HIV/AIDS prevention strategy; (2) informing and sensitising general populations within migrant communities before initiating more targeted prevention with migrant IDUs, MSM, and CSWs; (3) encouraging, facilitating and guiding health promotion efforts which emerge from within migrant communities themselves.

Acquired Immunodeficiency Syndrome↗

Delivery of medical care for migrants in Germany: delay of diagnosis and treatment.

BACKGROUND: Migrants form 9% of Germany's population and 13% of its capital Berlin. Only limited data are available regarding general health status and prevalence of tropical diseases among migrants in Germany. This study was conducted to investigate the spectrum and frequency of tropical diseases among migrants in Berlin and to evaluate the quality of the medical care provided. The necessity of a routine screening for tropical diseases among migrants was assessed. METHODS: Anonymized data of migrants presenting to the Berlin Institute of Tropical Medicine between 1999 and 2004 with a stay in Germany below 1 year (n= 153) were analyzed. RESULTS: Of all examined migrants, 48% needed immediate medical treatment and 38% carried an infectious disease, mainly nematodes and intestinal protozoa. 19% suffered from a noninfectious disease, mainly anemia, and 12% were transferred to other specialists for further investigation. These figures were similar among asymptomatic and symptomatic patients. The median duration of stay in Germany until presentation was 42 days. While 40% of the migrants were examined within the first 4 weeks of their stay, 20% had not received a medical examination after 6 months. Of this population, 50% required treatment upon presentation. CONCLUSIONS: The high proportion of delayed diagnosis and treatment indicates a lack of medical service for migrants. While this clearly translates into increased health risks for the individual patient, it also indicates a potential risk for transmission of communicable diseases in the community. The lack of a correlation between symptoms and detected infectious disease indicates the need for a standardized routine screening examination in all migrants.

Adolescent↗

HIV infection in mobile populations: the case of Mexican migrants to the United States.

OBJECTIVE: Previous studies have indicated varying rates of HIV infection among labor migrants to the United States of America. Most of these studies have been conducted with convenience samples of farmworkers, thus presenting limited external validity. This study sought to estimate the prevalence of HIV infection and risk factors among Mexican migrants traveling through the border region of Tijuana, Baja California, Mexico, and San Diego, California, United States. This region handles 37% of the migrant flow between Mexico and the United States and represents the natural port of entry for Mexican migrants to California. METHODS: From April to December 2002 a probability survey was conducted at key migrant crossing points in Tijuana. Mexican migrants, including ones with a history of illegal migration to the United States, completed an interview on HIV risk factors (n = 1 429) and an oral HIV antibody test (n = 1,041). RESULTS: Despite reporting risk factors for HIV infection, none of the migrants tested positive for HIV. CONCLUSIONS: Our findings contrast with previous estimates of HIV among labor migrants in the United States that were based on nonprobability samples. Our findings also underline the need for early HIV prevention interventions targeting this population of Mexican migrants.

Adult↗

[Social psychiatry of migrant workers (author's transl)].

A review of literature about psychic illness in migrant workers (with special reference to the situation in Europe) is presented, including the problems of incidence and prevalence, course of the illness, typical syndromes and treatment. Results concerning incidence and prevalence of psychic disease in migrant workers are contradictory and partly--for methodological reasons--of questionable quality. It cannot be take for granted, that migrant workers suffer more often from psychiatric disturbances than either of the two possible control groups: the populations of the emigration or immigration countries respectively. There are two high risk periods for migrants: shortly after the migration and after a longer period in the guest country. Differences between the migrant's culture and that of the immigration context (language, mythical beliefs, illness behavior) influence the manifestations of psychiatric syndromes. The following syndromes are typical for migrant workers: paranoid reactions, hypochondric-depressive syndromes, psychosomatic conditions and sexual neurosis. Special attention requests the treatment of migrant workers with psychiatric problems; the aspects of psychotherapy, accompanying social measures and the return as therapeutic measure are discussed. In the second part, a general frame of reference for the sociological analysis of the problem of migrant workers is presented. Reasons for the mass immigration of foreign workers to the industrialized countries of central Europe were the demand of labor force and the large gap in socio-economic development between the countries. In the immigration context, the foreign workers find themselves in the lowest social strata and numerous problems accumulate there. Empirical evidence for different sociological explanations of mental illnes of migrant workers ist presented: hypotheses of social selection vs. social causation (low socio-economic status, goal-striving-stress, culture-shock theory, theory of culture change and isolation hypothesis).

Adjustment Disorders↗

Local understandings of, and responses to, HIV: rural-urban migrants in Tanzania.

Migration is an important process of change for rural populations in developing countries. Migration is a primary cause of behaviour change-by their very act of migrating, migrants are different from those who do not migrate. The focus of the current study is male rural-urban migration in Tanzania and its interaction with sexual behaviour. The analysis presents results from a comparison with individual-level analyses of two populations, one (composed of recent rural-urban migrants) in an urban area and one made up of residents in a rural area. Detailed migration histories (n=96 rural-urban migrants) and in-depth interviews form the basis of the analysis. Three key research questions are addressed: How does the sexual behaviour of migrants differ from that of rural residents? How do HIV knowledge levels vary between rural-urban migrants and rural residents? What factors are associated with either intentions of behaviour change or reported behaviour? The results are counter-intuitive: rural-urban migrants-both married and unmarried-are not having sex in town. Despite limited understanding of the nature of HIV, the migrant population studied here regulates its behaviour in a way that reflects local understandings of the disease. This finding is important, not least because it challenges the view that HIV in sub-Saharan Africa is largely transmitted to rural areas by return migrants. Maasai rural-urban migrants in Tanzania-both married and unmarried-are not having sex in town. The policy and service provision implications of the results are explored.

Adult↗

Modes of transmission and evidence for viral latency from studies of human T-cell lymphotrophic virus type I in Japanese migrant populations in Hawaii.

Human T-cell lymphotrophic virus type I (HTLV-I) seroprevalence was 20% among Hawaiian Japanese migrants (issei) and their offspring (nisei) from Okinawa compared to 35% in similarly aged men who were lifetime residents of Okinawa. A control group of migrants from a nonendemic area of Japan, Niigata, had low rates of HTLV-I antibodies, suggesting that Hawaii per se is not an endemic area for HTLV-I. Factors that were significantly associated with seropositivity in the Okinawa migrant groups were years of residence in Japan before migration (issei) and age for offspring of Okinawa migrants (nisei). Antibody titer was highest in Okinawa lifetime residents, intermediate in migrants (issei), and significantly lower in offspring of Okinawa migrants (nisei), with increasing titer observed with advancing age in the offspring of the migrant group. Based on these data, infection within the household occurring early in life appears to be a major route of HTLV-I transmission and may help to explain the curious geographic clustering of this virus in certain locales. As yet to be defined cofactors, including sexual transmission and/or environmental exposures (e.g., particularly before age 20), also may contribute to HTLV-I seropositivity. The pattern of rising seroprevalence and titer with age in the offspring of migrants who resided all of their lives in Hawaii raises the possibility that HTLV-I infection acquired early in life may become dormant and reexpressed with reactivation of latently infected T cells. The importance of this model in the process of viral leukemogenesis is supported by recent reports of adult T-cell leukemia in offspring (nisei) of Okinawa migrants.

Age Factors↗

[Mortality among non-western migrants in The Netherlands].

Mortality among 10 groups of non-western migrants to The Netherlands, observed in the period 1995-2000, is compared with mortality among people who were born in and whose parents were born in The Netherlands. The migrant groups concerned consisted of people who were born in, or whose parents were born in Turkey, Morocco, Surinam, The Netherlands Antilles, Ghana, Somalia, Iraq, Iran, Afghanistan and Vietnam. Differences in mortality were adjusted for age, marital status, region, degree of urbanization, and socioeconomic status. Despite the fact that most migrants originate from countries with a substantially higher mortality rate than The Netherlands, most groups had similar or more favourable total mortality rates than native Dutch people. Men from Turkey and Surinam had slightly elevated mortality rates and men and women from Somalia had a notably higher mortality rate than native Dutch people. The generally favourable mortality rates among migrants are the result of two compensating phenomena: higher mortality among young migrants than among young native Dutch people, and lower mortality among elderly migrants than among elderly native Dutch people. An analysis of cause-of-death patterns revealed relatively low mortality from cardiovascular diseases, cancer and respiratory diseases in most migrant groups, and relatively high mortality from infectious diseases and injuries. These findings are unlikely to have been influenced by incomplete registration of mortality. Selective migration may play a role--some migrant groups have a relatively high level of education for example. Also some of the findings may be explained by a difference in timing between the health benefits and the health risks of migration. Migrant health could be benefiting from the favourable socioeconomic, public health and health-care conditions in The Netherlands, but not yet be affected by the higher risks of cancer and cardiovascular disease associated with prosperity.

Adolescent↗

Cancer incidence in Estonian migrants to Sweden.

Cancer incidence in Estonians who took refuge in Sweden in 1944-1945 has been compared with that in the total Swedish population and that among Estonians in Estonia in 1974-1985 using data from the Swedish and the Estonian countrywide population-based cancer registries. The vast majority of the Estonian immigrants studied had been living in Sweden for 30 years when the follow-up with respect to cancer incidence started in this investigation. In spite of the long residence in Sweden, differences in cancer incidence could be observed between these immigrants and the total Swedish population. The age-standardized incidence of stomach cancer was higher in the Estonian migrants than in the total Swedish population (SIR = 1.6 and 2.1 for males and females, respectively). Breast cancer incidence was lower in the migrant women (SIR = 0.75) and lung cancer incidence higher in migrant men (SIR = 1.5). An increased incidence of colorectal cancer was also found for both sexes in the migrant population (SIR = 1.4 for both males and females). A comparison between Estonians in Estonia and the total Swedish population revealed that the cancer incidence for the Estonians was lower than expected at age 70 and over. Male lung cancer and stomach cancer showed a higher incidence in the Estonian population than in the Swedish and in the migrant populations. The migrant population showed an intermediate incidence relative to Estonians in Estonia and the entire Swedish population. The colon-cancer risk in Estonian migrants to Sweden was higher than the risk for Estonians in Estonia and for the Swedish population. This contrasts with most findings in the present and other studies on intermediate risks of migrants compared to the risks in the country of origin and in the new country of residence.

Adult↗

Cancer in Mediterranean migrants--based on studies in France and Australia.

Whether non-European Mediterranean populations also benefit from the protective effect on health of the so-called Mediterranean diet is not know yet, as national mortality statistics are available in neither North Africa nor the Near East. This article investigates the cancer profile of Maghrebian and Near Eastern migrants, by gathering and discussing data from recent studies on cancer mortality in Mediterranean migrants of various origins in France and Australia. In France, the migrants originating from Morocco, and in Australia, the migrants originating from the Near East, have a lower mortality from all cancers than their host countries and than Italian migrants. Concerning specific sites, Moroccan and Near Eastern migrants have a cancer profile which is quite similar to that of the Italian migrants, with relatively low risks compared with the local-born for certain cancers typical of affluent societies (colon and rectum, breast, ovary, and prostate). In addition, the non-European Mediterranean migrants are protected even more than the Italians in the same host country from esophagus cancer, and Moroccans in France have a much lower risk than the local-born for lung cancer. Lastly, they tend to have a relatively high risk for some cancers which are likely to have a viral etiology: e.g., nasopharynx (Italians and Near Easterners), liver (Near Eastern males), and possibly cervix (Moroccans).

Africa, Northern↗

[Epidemiological research on migrant health in Germany. An overview].

In recent years, Germany has become an important immigration country. Health services in Germany thus have to face the needs of a growing migrant population. The health of migrants is affected by the process of migration in various--positive as well as negative--ways. Epidemiological research can help to reveal health inequalities between migrants and the majority population as well as to identify causes of disease. Standard epidemiological study designs may have to be adapted for migrant health research so they can be employed in migrant studies. While a large number of descriptive studies on migrant health have been conducted in Germany based on routinely available data sources, analytical migrant studies are still scarce. This paper presents an overview of methods and findings of epidemiological studies related to migrants in Germany. It also describes needs and challenges for future research.

Adolescent↗

Health and well-being among 70-year-old migrants living in Sweden--results from the H 70 gerontological and geriatric population studies in Göteborg.

BACKGROUND: Comparative epidemiological studies in migrants in Sweden have shown increased prevalence of psychosocial morbidity in young adults, but there is paucity of information on health in people aged 65 years and over. AIMS: We aim to compare prevalence of mental, physical and social health problems, rates of hospital admission, and mortality in Swedish and non-Swedish born people aged 70 years living in Göteborg, Sweden, and examine associations between social factors, physical health, mood and life satisfaction in the ethnic groups. In addition, we aim to test for the hypothesis that differences in mental health between migrants and natives are explained by social disadvantages rather than ethnicity. METHOD: Semi-structured interviews were administered to 84 migrants (47 women and 37 men randomly selected) with the help of bilingual interpreters, and 409 Swedes (183 males and 226 females) used as "controls". Complementary health and social data obtained from official sources on the total sample (N = 764, including non-participants in overall medical interviews) were used in comparative analyses of in-patient care and mortality and to check for the possibility of sampling bias. RESULTS: Migrants--originating mainly from Estonia, Poland, Yugoslavia, Germany, Italy and Nordic countries other than Sweden--reported more dizziness, poor vision and urinary problems, and fewer gall bladder problems than indigenous people (p < 0.05). Migrants also had higher levels of anxiety and depression and bodily pain, and lower levels of general health, social and emotional functioning, satisfaction with physical health status, family contacts, housing conditions and economic status than natives (p <0.05). Satisfaction with physical health seemed to be one of the strongest factors related to a lower prevalence of anxiety and depression together with family support and time spent in leisure pursuits. No significant differences in inpatient care in several ICD categories and all-cause mortality were found between overall migrants and the control group notwithstanding differences in self-reported health. CONCLUSION: The results indicate poorer subjective health in older migrants than natives in Göteborg, and also point to a "healthy migrant" effect on survival.

Activities of Daily Living↗

Reproductive health status, knowledge, and access to health care among female migrants in Shanghai, China.

As the largest labour flow in human history, the recent rise in migration in China has opened up unprecedented opportunities for millions of Chinese to rearrange their lives. At the same time, this process has also posed great challenges to Chinese migrants, especially female migrants, who not only face a bias against 'outsiders' but also have a greater need for reproductive health-related services in their migratory destinations. Based on data collected via multiple sources in Shanghai, China's largest metropolis, this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants' access to health care in urban China. Results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to STD. Both self-reported health status and knowledge of reproductive health are related to migrants' educational attainment and length of stay in the urban destination. This study also finds ample evidence that female migrants' access to urban health care is limited by a number of institutional barriers.

Adolescent↗

Cancer incidence in migrants to New South Wales from England, Wales, Scotland and Ireland.

Cancer incidence in migrants to New South Wales (NSW) from individual countries within the British Isles has been compared with that in the Australian-born population using data from the NSW Central Cancer Registry for the period 1972-84. Indirectly age-standardised incidence ratios (SIR) showed that, for cancer at all sites combined, Scottish migrants had a significantly higher, and English migrants a lower, incidence than the native-born Australians. Melanoma of skin was less common in migrants from all four countries while lung cancer was more common. In all except the Irish migrants, stomach cancer was more frequent than in the Australian-born. Raised SIRs for bladder cancer were found in men from all the countries and for breast cancer in all except the Irish women but only in the English migrants were these ratios significant. English migrants differed from those from Wales, Scotland and Ireland in that, compared with the Australian-born, they had significantly lower SIRs for cancer of the colon (both sexes), head and neck, larynx and prostate (men), gallbladder and kidney (women), and a higher SIR for ovarian cancer. Bone cancer was relatively more common in men born in Wales. 'Other genital' cancers (penis and scrotum; vulva and vagina) tended to be more frequent in migrants from each country than in the Australian-born.

England↗

Maternal care coordination for migrant farmworker women: program structure and evaluation of effects on use of prenatal care and birth outcome.

Nearly three fourths of the migrant farmworkers in the U.S. are Hispanic. Cultural and social barriers, along with constant travel, make coordination of care a significant concern for migrant health centers providing perinatal services to female farmworkers. As part of a demonstration project, a migrant-specific maternal care coordination program was developed that used bilingual staff, outreach services, lay health advisers, and a multistate tracking system. Following the initiation of the project, first-trimester entry into prenatal care and number of prenatal visits increased over a five-year period among the target population. Successful tracking methods provided outcome data on more than 80 percent of participants during the project period. The results of this study suggest that migrant health centers should focus on employing public health-oriented bilingual or bicultural health professionals and that an outreach strategy must be an integral part of a health care delivery system serving migrant farmworkers. Without these key ingredients, health care services will not be accessible or acceptable for this hard-to-reach population. Collaboration among the National Migrant Resource Program, the Migrant Clinicians Network, and the National Perinatal Association can facilitate development of a regionwide perinatal service system for female migrant farmworkers.

Communication Barriers↗