Access to perinatal healthcare in minority Anglophones: Hospital type and birth outcomes

Abstract

Objectives We assessed the relationship between hospital characteristics and risk of adverse birth outcomes among minority Anglophones in Montreal, Canada. Methods The study included 124,670 births among Anglophones in metropolitan Montreal between 1998 and 2019. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between hospital characteristics, including residential proximity to hospitals and language in which medical services are provided, and risks of preterm birth and stillbirth. Models were adjusted for maternal socioeconomic status and other characteristics. Results In this study, 8% of Anglophones had a preterm birth and 0.4% a stillbirth. Anglophone women who delivered at a farther French hospital had a greater risk of stillbirth (RR 1.67, 95% CI 1.28–2.18) than preterm birth (RR 1.21, 95% CI 1.14–1.30), compared with delivery at hospitals closer to home. In contrast, delivery at a farther English hospital was associated with similar risks of stillbirth (RR 1.36, 95% CI 1.08–1.71) and preterm birth (RR 1.36, 95% CI 1.29–1.44). The greater risk of stillbirth with delivery at a farther French hospital, versus greater risk of preterm birth at a farther English hospital, remained present in analyses stratified by maternal age, education, material deprivation, and region of origin. Conclusion Minority Anglophones in Montreal who travel to a farther French hospital for delivery have a greater risk of stillbirth than Anglophones who travel to a farther English hospital. This novel observation suggests the need to determine if access to perinatal healthcare in a woman’s language may help reduce the risk of stillbirth.