Refugees and asylum seekers

Abstract

Migrants commonly maintain transnational ties with their home country including identities, attachments, and
social, cultural, economic and service/care interactions. Significant gaps remain regarding care-providers’ perspectives on migrants’ transnational ties and whether and how these ties are addressed in the context of care. La
Maison Bleue (LMB) is a community-based social perinatal care service with four sites in Montreal, Canada,
providing health and social care to families in vulnerable contexts from pregnancy up until age five. We conducted a small, qualitative descriptive study and interviewed 7 care-providers (nursing, social work, family
medicine, psycho-education) and 3 administrators/support personnel from LMB to gather data on their experiences and perspectives on “transnationalism” in care with vulnerable-status migrant women and their families.
Transnational identity (language, culture, attachment to the home country), and ongoing connections with back
home, including communication with children and extended family, remittent sending, and the receipt of childrearing and health advice, commonly arise within care interactions. Fostering transnational relationships and
cultural identity are strategies used by LMB care-providers to strengthen migrant families’ sense of belonging and
to help them cope with losses, while addressing transnational tensions and stresses are used to promote families’
well-being and integration. This involves a combination of listening, humility, remaining open, providing information and delivering care that is respectful of culture and sensitive to families’ situations. Cultural negotiation, directly with migrant families or via local peers, is sometimes used to overcome transnational cultural
barriers related to health decisions and child-rearing. At times, care-providers also engage directly with family
back home to mediate cross-border stresses and cultural tensions and/or to draw on them as a source of information and support. Care-providers view transnational cultural ties and relationships as both positive and
negative for the well-being of families and with respect to its impact on interventions with families. Although not
always feasible, care-providers believe it’s important to know about families’ transnational contexts, in order to
provide responsive, supportive care.

Abstract In Quebec, employment assistance centres offer social and professional integration (SPI) programs for refugees and asylum seekers, whose backgrounds are often marked by a winding path that may include traumatic experiences. This path can complicate integration into their host society and expose them to situations of social vulnerability. This article seeks to understand how a learning pathway in a group-based SPI program can open up a range of real opportunities and promote social justice from the standpoint of a capability approach. Our processual qualitative analysis of the learning pathways of these individuals addresses the resources that the program makes available in order to expand participants’ actual SPI opportunities. We also analyze barriers to the conversion of provided resources into instruments for learning. Keywords refugees, social and professional integration, capability approach, social justice, learning pathway, group

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O’Malley in Int J Soc Res Methodol 8:19–32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS’ accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.

Background

Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants.

Nos membres Naïma Bentayeb et Lara Gautier sont les responsables du dernier numéro de la revue Alterstice sous le thème “Expérience des réfugiés, demandeurs d’asile et migrants sans statut et offre de services de santé et sociaux pendant la pandémie au Québec”. 

Plusieurs autres membres de SHERPA ont contribué à ce numéro dont Janet Cleveland, Jill Hanley, Patrick Cloos, Mélanie M. Gagnon et  Andréanne Dufour, membre de notre équipe.

Abstract

Background

Refugees, asylum seekers, and migrants without status experience precarious living and working conditions which disproportionately expose them to COVID-19. In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, as well as educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants.

Methods

This theory-informed participatory research is co-created with socio-culturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane’s framework on health systems’ responsiveness to guide the 4-phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include, 1) building an inventory of intersectoral initiatives developed during the pandemic, 2) organizing a deliberative workshop with representatives of the study population, community and public sectors respondents to select and validate the intersectoral initiatives, 3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers and employees of philanthropic foundations 4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers.

Discussion

This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach – particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.

Health care personnel attitudes toward refugee claimant entitlement to health care are influenced by multilevel factors including institutional and societal culture. Although individual attitudes may be modified through training, macro- and meso-issues require system-level interventions. This paper analyzes the role of individual-, institutional-, and city-level factors in shaping attitudes toward refugee claimants’ access to health care among Canadian health care personnel. A total of 4207 health care personnel in 16 institutions located in Montreal and Toronto completed an online survey on attitudes regarding health care access for refugee claimants. We used multilevel logistic regression analysis to identify individual-, institutional-, and city-level predictors of endorsing access to care. Participants who had prior contact with refugee claimants had greater odds of endorsing access to care than those who did not (OR 1.13; 95% CI 1.05, 1.21). Attitudes varied with occupation: social workers had the highest probability of endorsing equal access to health care (.83; 95% CI .77, .89) followed by physicians (.77; 95% CI .71, .82). An estimated 7.97% of the individual variation in endorsement of equal access to health care was attributable to differences between institutions, but this association was no longer statistically significant after adjusting for city residence. Results indicate that the contexts in which health care professionals live and work are important when understanding opinions on access to health care for vulnerable populations. They suggest that institutional interventions promoting a collective mission to care for vulnerable populations may improve access to health care for precarious status migrants.

For the last three decades, Western host countries have been implementing restrictive immigration measures toward asylum seekers aiming to keep them out, to contain them in their country of origin or to toughen their living conditions in the host country. These measures have deeply affected the civil and political rights of asylum seekers as well as their social and economic well-being. Using an exploratory approach, this study explored how social workers dealt with situations of social and economic human rights violations experienced by asylum seekers in Canada. Findings revealed that many factors shaped social workers’ conceptions of human rights and their decisions to engage in human rights–based practice. These factors were academic training, social workers’ personal stance toward human rights, and social workers’ approach to structural disadvantage carried out in public institutions toward asylum seekers. Findings suggested social workers developed different understanding of inland immigration measures and the effect of structural disadvantages in asylum seekers’ host countries. Findings also illustrated interventions centered around human rights that followed from empowerment, such as consciousness-raising, critical thinking and actions of mobilization.

This article introduces a thematic issue of Transcultural Psychiatry that presents recent work that deepens our understanding of the refugee experience—from the forces of displacement, through the trajectory of migration, to the challenges of resettlement. Mental health research on refugees and asylum seekers has burgeoned over the past two decades with epidemiological studies, accounts of the lived experience, new conceptual frameworks, and advances in understanding of effective treatment and intervention. However, there are substantial gaps in available research, and important ethical and methodological challenges. These include: the need to adopt decolonizing, participatory methods that amplify refugee voices; the further development of frameworks for studying the broad impacts of forced migration that go beyond posttraumatic stress disorder; and more translational research informed by longitudinal studies of the course of refugee adaptation. Keeping a human rights advocacy perspective front and center will allow researchers to work in collaborative ways with both refugee communities and receiving societies to develop innovative mental health policy and practice to meet the urgent need for a global response to the challenge of forced migration, which is likely to grow dramatically in the coming years as a result of the impacts of climate change.

This brief report explored trends of cigarette smoking among Syrian newcomers in the first two years of resettlement in Canada. 1794 adult Syrian refugees were surveyed about their physical and mental health, and smoking behaviours. Results were analyzed using descriptive statistics, Wilcoxon signed-rank tests, and logistic regressions. Almost 27% of the sample reported cigarette smoking (50% light smokers and 50% moderate/heavy smokers). Light smokers increased and moderate/heavy smokers decreased in the number of cigarettes smoked from year 1 to year 2. Moderate/heavy smokers were more likely to be male and reported higher post-traumatic stress scores, while light smokers reported higher depression scores. Only 14.3% of smokers recalled receiving advice from health care providers in Canada regarding their smoking habits. Healthcare providers should provide tailored advice to everyone who is an active smoker with a specific emphasis on those who have concurrent health issues.

The objectives of this paper are to explore the impact of psychological trauma and migration on a mother’s ambivalence regarding her relationship with her child and to explore the effect on the child’s “continuity of being.”

En France, les mineurs non accompagnés (mna) rencontrent de multiples obstacles qui peuvent avoir des effets négatifs sur leur santé mentale. Les professionnels de la santé et du social qui participent à leur prise en charge doivent développer et mettre en œuvre des approches et outils adaptés aux réalités des mna et qui leur offrent un espace d’interactions le plus ouvert possible. À partir d’une revue de littérature, nous proposons dans cet article de dresser un état des lieux de la santé mentale des mna et d’identifier les approches ainsi que les outils développés et mis en œuvre par les professionnels qui visent à favoriser la communication et l’expression des mna (notamment l’approche interculturelle, le travail en interdisciplinarité, l’art-thérapie). Nous formulons en conclusion plusieurs pistes de réflexion à l’endroit des professionnels et des pouvoirs publics qui travaillent avec ce jeune public migrant.

In 2019, 30,615 asylum claims were made in Quebec, representing almost half of the claims made in Canada. Asylum-seeking families with young children (0 to 5 years) represent a significant proportion of this population. Canada, as well as Quebec, have a responsibility to protect asylum seekers and to ensure that public policies promote health and well-being, especially among children. However, certain existing public policies exclude asylum seekers and are negatively affecting families. This commentary seeks to raise awareness among all those involved in policymaking, especially decision-makers, regarding asylum-seekers and three policy domains that are contributing to poverty, social isolation, and reduced access to care among asylum-seeking families with young children. These include the lack of eligibility for child benefits, the limited access to affordable daycare, and barriers to accessing family doctors. Consequently, both parents and children suffer impacts to their health and well-being. We are calling on our governments to assume their responsibilities and eliminate these inequities, and to ensure that the health of asylum seekers is considered in all policies.

The field of refugee family research and intervention forms a growing field of scientific study, focussing on the refugee family as the central niche of coping with, and giving meaning to, trauma, cultural uprooting, and exile. This important new book develops an understanding of the role of refugee family relationships in post-trauma healing and provides an in-depth analysis of central clinical-therapeutic themes in refugee family psychosocial interventions. Expert contributions from across transcultural psychiatry, psychology, psychotherapy and social work have provided chapters on post-trauma reconstruction in refugee family relationships, trauma care for refugee families, and intersectorial psychosocial interventions with refugee families. This exploration of refugee family systems in both research and clinical practice aims to promote a systemic perspective in health and social services working with families in refugee mental health care.

The number of refugee youth worldwide receives international attention and is a top priority in both academic and political agendas. This article adopts a critical eye in summarizing current epidemiological knowledge of refugee youth mental health as well as interventions aimed to prevent or reduce mental health problems among children and adolescents in both high- and low-to-middle-income countries. We highlight current challenges and limitations of extant literature and present potential opportunities and recommendations in refugee child psychiatric epidemiology and mental health services research for moving forward. In light of the mounting xenophobic sentiments we are presently witnessing across societies, we argue that, as a first step, all epidemiological and intervention research should advocate for social justice to guarantee the safety of and respect for the basic human rights of all refugee populations during their journey and resettlement. A constructive dialogue between scholars and policy makers is warranted.

Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/− 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (p-value = .02). Refugees with secondary migration were 68% more likely to have HIV than refugees with primary migration (PR = 1.68, 95% CI 1.06, 2.68; APR = 1.68, 95% 1.04, 2.71) with a stronger effect in the matched model. There was no difference among non-refugee immigrants. Secondary migration may amplify HIV risk among refugee but not non-refugee immigrant mothers.

Dans le contexte d’arrivées importantes de demandeurs d’asile au Québec depuis l’été 2017, le CERDA, en collaboration avec le Centre de recherche SHERPA, a développé une trousse d’outils afin de :

1. Sensibiliser les professionnels aux réalités vécues par les demandeurs d’asile et aux particularités de l’intervention auprès de cette clientèle ;
2. Faciliter le travail des professionnels en rendant accessible des informations sur les ressources d’accueil et d’intégration auxquelles les demandeurs d’asile ont accès

La trousse inclut un guide, 7 capsules vidéos et des fiches synthèses

Around the world, armed conflicts force people to leave their homes, families, and communities in search of protection from collective violence, and seek to regain a meaningful perspective on their lives within the borders of their Western host societies. As the dynamics of organized violence and forced displacement continue to impact and disrupt relationships in refugee communities, scholars in the field of refugee trauma care have increasingly argued for the need to understand spaces that are able to restore safety, meaning, and connectedness in the process of post-trauma reconstruction within those disrupted communities. This is reflected in the growing interest in community-based psychosocial interventions. In this article, we focus on applied theatre interventions with refugee communities. In doing so, we aim to understand the restorative role of within-group interactions in applied theatre. We performed a case study of a community-based applied theatre project with Syrian refugees who were recently resettled in Belgium. The qualitative analysis that was the result of this case study allows us to develop an understanding of the various processes of coping with trauma and exile that are at play in within-group interactions between Syrian community members in applied theatre, against a background of authoritarian rule, collective violence, and forced displacement.

Highlights
Within-group interactions in applied theatre can play a r5restorative role in coping with trauma and exile in refugee communities.
The group in applied theatre provides participants a temporary safe haven.
Within-group interactions reinstall a sense of personal continuity.
Within-group interactions install a sense of hope for political and social change.
Within-group interactions enable participants to reshape cultural belonging.

Camp Cosmos was founded in 1971 in Montreal to provide children from diverse social, economic and cultural backgrounds with a safe and fun environment to play, learn and grow. The summer camp is grounded on an anti-oppression philosophy that drives its enriching intercultural, accessibility, environmental, youth leadership and athletic programs. After 47 summers of empowering children, building communities with families, and fostering support networks with partner organizations, Camp Cosmos continues to be a vehicle of social transformation in Montreal. Since 1971, more than 2000 children have participated in the Camp Cosmos summer camp program. In response to the Syrian refugee crises, Camp Cosmos expanded in 2016 to create a second camp on Montreal’s West Island. That year, 23 Syrian children were welcomed at both the West Island and Downtown locations. In summer 2017, numbers rose, with 28 Syrian children and 12 children whose families had recently crossed the Canadian/USA border for a total of 40 (camp fees waived). The total number of campers in 2017 was 121 (up from 50 in 2014). In addition to welcoming Syrian campers, there were also 3 young Syrian counselors-in- training who had their first Canadian job experience. In 2018, with the aim to continue adapting to the Montreal society’s needs, Camp Cosmos welcomed 158 campers from diverse backgrounds, introduced a sliding scale payment system to welcome a greater diversity of campers, and extended the hours of care to improve access to camp. The camp adapted their 5-day staff training to include a greater focus on their anti- oppression mandate and a focus on accessibility by collaborating with Montreal-based organizations. For the first time, the camp welcomed 12 and 13-year-old campers, filling the previously existing age gap, to participate in a new program that included both activities with the whole camp as well as volunteer opportunities at community organizations.

Research has shown that lesbian, gay, bisexual, and transgender (LGBT) children are likely to experience chronic victimization and that these experiences
correlate with numerous mental health problems. However, there is little understanding of the abuse experiences of LGBT children living in countries where rights for sexual and gender minorities are limited or nonexistent. In this chapter, we explore the child abuse experiences that contribute to LGBT individuals’ decision
to flee their countries of origin in search of protection. In addition, we examine the impact of these abuse experiences on their pre-migration mental health. We conducted 26 interviews with individuals who obtained refugee or asylee status in the United States or Canada on the basis of sexual orientation or gender identity.
Participants originated from countries in Asia, Africa, the Caribbean, Eastern Europe, Latin America, and the Middle East. We identified the following themes: abuse by parents and caregivers, abuse by peers and school personnel, having nowhere to turn, and dealing with psychological distress. Findings demonstrate that
participants experienced severe verbal, physical, and sexual abuse throughout childhood and adolescence and that this abuse occurred at home, in school, and in the community. Furthermore, there were no resources or sources of protection available to them. Participants linked their abuse to subjective experiences of depression, anxiety, and traumatic stress, as well as suicidal ideation and suicide attempts. We provide implications for clinical practice as well as international policies that protect the well-being of children

There is little longitudinal research that directly compares the effectiveness of Canada’s Government-Assisted Refugee
(GAR) and Privately Sponsored Refugee (PSR) Programs that takes into account possible socio-demographic differences between them. This article reports findings from 1,921 newly arrived adult Syrian refugees in British Columbia, Ontario, and Quebec. GARs and PSRs differed widely on several demographic characteristics, including length of time displaced. Furthermore, PSRs sponsored by Groups of 5 resembled GARs more than other PSR sponsorship types on many of these characteristics. PSRs also had broader social networks than GARs. Sociodemographic differences and city of residence influenced integration outcomes, emphasizing the importance of considering differences between refugee groups when comparing the impact of these programs.

Il existe peu de recherches longitudinales comparant directement l’efficacité des programmes gouvernemental (RPG) et privé (PPR) de parrainage des réfugiés au Canada qui tiennent compte de possibles différences socio-démographique entre eux. Cet article rend compte des résultats de 1921 nouveaux arrivants syriens adultes en Colombie-Britannique, en Ontario et au Québec. Les RPG et PPR diffèrent largement sur plusieurs caractéristiques démographiques, dont le temps du déplacement. De plus, les PPR parrainés par groupes de cinq ressemblaient davantage aux RPG que les autres types de parrainage PPR sur plusieurs de ces caractéristiques. Les PPR avaient aussi des réseaux sociaux plus larges que les RPG. Les différences sociodémographiques et la ville de résidence influent sur l’intégration, ce qui fait ressortir l’importance de tenir compte des différences entre les groupes de réfugiés dans la comparaison de l’impact de ces programmes.

Background: Considering the growing number of asylum-seeking children worldwide, research
on interventions which may buffer the effects of early resettlement conditions on asylum-seeking
children’s adjustment is warranted. In Canada, creative expressive workshops for asylum-seeking
children and adolescents were implemented as a Psychological First Aid (PFA) intervention in
temporary shelters. The present exploratory study aims to describe the implementation of
these workshops to assess whether the intervention met core elements of PFA and explore its
potential in supporting the diverse needs of asylum-seeking youth in temporary shelters, adopting
a process-evaluation research approach.
Method: The intervention was evaluated via a qualitative thematic analysis of extensive field and
supervision notes and focus groups with facilitators.
Results: Preliminary results suggest that the intervention contributed to fostering emotional safety
and a sense of normalcy in children and supported the creation of connections among both children
and parents. Children’s expression of past and present experiences during the workshops was seen
as a way to promote self-efficacy in children and was reported as a potential way to provide some
comfort and hope in a time of high instability. However, the high needs of children and the lack of
resources in the temporary shelters represented significant challenges and barriers.
Conclusions: PFA using creative expression may be a promising youth mental health prevention
intervention in temporary shelters

With the sharp increase of refugees’ arrival and resettlement in western communities, adequate mental health care forms a pivotal dimension in host societies’ responses to those individuals and communities seeking protection within their borders. Here, clinical literature shows a growing interest in the development of family therapy approaches with refugees, in which therapeutic practice engages with the pivotal role of refugee family dynamics in posttrauma reconstruction and adaptation in resettlement and aims at supporting posttrauma reconstruction through strengthening capacities to restore safety, meaning and connectedness within family relationships. In this article, we focus on the narrative restoration of meaning as central mode of posttrauma reparation and explore its specific dynamics and relational complexities in the context of therapeutic practice with refugee families. Hereto, we integrate theoretical and clinical scholarly work on trauma narration and its intersection with empirical findings on trauma communication in refugee families. Furthermore, we develop case reflections to illustrate different processes of engaging with trauma narration in refugee family therapy. This analysis develops an understanding of the multivoiced ways in which refugee families engage with traumatic suffering through different modes of expression that may entail both narration and silence and explores how family therapeutic practices can engage and mobilize voices of narration and silence as relational stories of restoration.

In this article, we question the unilateral discourse of benefit of participation in participatory refugee theatre in the context of a growing socio-political climate of polarisation and stigmatisation of refugees in European countries of resettlement. By integrating critical voices from the fields of applied theatre and refugee research, we analyse the micro and macro dramaturgy of a Berlin-based participatory refugee theatre project. Through this analysis, we explore how refugees’ participation entails opportunities for empowerment, agency and giving voice, but also risks disempowerment and silencing in the interconnected relations between the participant, theatre maker, audience and the broader socio-political context.

Beginning in 2015, Canada undertook an exceptional undertaking of sponsoring of more than40,000 Syrian refugees to resettle in Canada. As the excitement of their initial arrivals dissipates,it is important to consider their longer-term settlement and integration in their new communities.This article offers a portrait and analysis of how Syrian refugees sponsored to Montreal are able tocreate social networks and access social support in order to build social capital for employmentand housing purposes. Part of a larger, three-province, 4-year longitudinal study, here we report onthe first wave of survey data collected from 626 Privately-Sponsored Refugees living in Quebec.We report on their family support and friendships, as well as the ways that these social connectionshelped them in terms of employment and housing. Differences in terms of age, gender and time inCanada are analyzed. We find strong evidence of bonding social capital among recently resettledSyrians in Montreal, and growing bridging capital.

Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes.

Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data.

Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014.

Primary outcomes Numerous adverse maternal and perinatal health outcomes.

Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers.

Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further

Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’s stomach pains, this paper questions how ways of dealing with medical uncertainty has bearing on pathways to care. These pathways are enacted within and beyond the family space as well as in medical settings. While acknowledging that group practices call for nuance, non-migrant children lead a greater quest for legitimacy of their pain while most migrant families place stomach aches in the range of normality.