Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2021 | Risk Pregnancy | Research article

The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China

Authors: Di Tang, Xiangdong Gao, Peter C. Coyte

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

China has one of the world’s largest internal migrant populations. The Chinese Hukou system is a unique household registration system that limits internal migrants in their access to basic urban public services, such as public health insurance and social assistance of their host city. In the case of female internal migrants, this may lead to high-risk pregnancies. The objective of this study is to assess the relationship between internal migrant status (Hukou) and the likelihood of high-risk pregnancies that occur in one large municipal-level obstetrics hospital in Shanghai, China.

Methods

Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to May 31, 2018, were used to analyze 133,358 live births for Shanghai natives (n = 83,872) and internal migrant women (n = 49,486). A propensity score matching approach was used in conjunction with logistic regression analysis to identify the role of internal migrant status (Hukou) on the likelihood of high-risk pregnancies.

Results

A greater likelihood of high-risk pregnancies were found among internal migrant women who moved from other parts of China to Shanghai. This effect was more obvious for women who gave birth for the first time and internal migrant women who were employed.

Conclusion

The results show the effects of internal migrant status (Hukou) and the elevated likelihood of high-risk pregnancies among internal migrant women relative to their urban counterparts in Shanghai even after accounting for self-selection by employing the propensity score matching method. China’s unique Hukou household registration system limits access to public services for internal migrant women and accordingly may account for the elevated likelihood of high-risk pregnancies.

Available only for authorised users

Batista R, Pottie K, Bouchard L, Ng E, Tanuseputro P, Tugwell P. Primary health care models addressing health equity for immigrants: a systematic scoping review. J Immigr Minor Heal. 2018;20(1):214–30. https://doi.org/10.1007/s10903-016-0531-y.CrossRef

Singh GK, Miller BA. Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health. 2004;95(3):114–21.CrossRef

Stronks K, Ravelli ACJ, Reijneveld SA. Immigrants in the Netherlands: equal access for equal needs? J Epidemiol Community Health. 2001;55(10):701–7. https://doi.org/10.1136/jech.55.10.701.CrossRefPubMedPubMedCentral

Wiking E, Johansson SE, Sundquist J. Ethnicity, acculturation, and self reported health. A population based study among immigrants from Poland, Turkey, and Iran in Sweden. J Epidemiol Community Health. 2004;58(7):574–82. https://doi.org/10.1136/jech.2003.011387.CrossRefPubMedPubMedCentral

Essén B, Bödker B, Sjöberg NO, et al. Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services? BJOG. 2002;109(6):677–82. https://doi.org/10.1016/S1470-0328(02)01077-7.CrossRefPubMed

Diani F, Zanconato G, Foschi F, Turinetto A, Franchi M. Management of the pregnant immigrant woman in the decade 1992–2001. J Obstet Gynaecol (Lahore). 2003;23(6):615–7. https://doi.org/10.1080/01443610310001604367.CrossRef

Wilcing E, Johansson SE, Sundquist J, Wiking E, Johansson SE, Sundquist J. Ethnicity, acculturation, and self reported health. A population based study among immigrants from Poland, Turkey, and Iran in Sweden. J Epidemiol Community Health. 2004;58(7):574–82. https://doi.org/10.1136/jech.2003.011387.CrossRef

Vangen S, Stoltenberg C, Skrondal A, Magnus P, Stray-Pedersen B. Cesarean section among immigrants in Norway. Acta Obstet Gynecol Scand. 2000;79(79):553–8. https://doi.org/10.1034/j.1600-0412.2000.079007553.x.CrossRefPubMed

Vangen S, Stoltenberg C, Holan S, et al. Outcome of pregnancy among immigrant women with diabetes. Diabetes Care. 2003;26(2):327–32. https://doi.org/10.2337/diacare.26.2.327.CrossRefPubMed

10.

Hu X, Cook S, Salazar MA. Internal migration and health in China. Lancet. 2008;372(9651):1717–9. https://doi.org/10.1016/S0140-6736(08)61360-4.CrossRefPubMedPubMedCentral

11.

Shaokang Z, Zhenwei SUN, Blas E. Economic transition and maternal health care for internal migrants in Shanghai, China. Health Policy Plan. 2002;17(SUPPL. 1):47–55. https://doi.org/10.1093/heapol/17.suppl_1.47.CrossRefPubMed

12.

Meng Q, Zhang J, Yan F, Hoekstra EJ, Zhuo J. One country, two worlds – The health disparity in China. Glob Public Health. 2012;2:124–36. https://doi.org/10.1080/17441692.2011.616517.CrossRef

13.

Chen J. Internal migration and health: re-examining the healthy migrant phenomenon in China. Soc Sci Med. 2011;72(8):1294–301. https://doi.org/10.1016/j.socscimed.2011.02.016.CrossRefPubMed

14.

Bureau SS. Shanghai statistical yearbook 2017. Shanghai Stat Bur; 2017.

15.

Tang D, Gao X, Rebeira M, Coyte PC. Effects of migration on infant and maternal health in China. Inquiry. 2019;56:0046958019884189. https://doi.org/10.1177/0046958019884189.CrossRefPubMedCentral

16.

Wu X, Treiman DJ. The household registration system and social stratification in China: 1955–1996. Demography. 2004;41(2):363–84. https://doi.org/10.1353/dem.2004.0010.CrossRefPubMed

17.

Chan KW. The Chinese hukou system at 50. Eurasian Geogr Econ. 2009;50(2):197–221. https://doi.org/10.2747/1539-7216.50.2.197.CrossRef

18.

Liu Z. Institution and inequality: the hukou system in China. J Comp Econ. 2005;33:133–57. https://doi.org/10.1016/j.jce.2004.11.001.CrossRef

19.

Wu X. The household registration system and rural-urban educational inequality in contemporary China. Chin Sociol Rev. 2011;44(2):31–51. https://doi.org/10.2753/CSA2162-0555440202.CrossRef

20.

Zhang L, Liu S, Zhang G, Wu S. Internal migration and the health of the returned population: a nationally representative study of China. BMC Public Health. 2015;15(1):1–9. https://doi.org/10.1186/s12889-015-2074-x.CrossRef

21.

Zhang D, Mou J, Cheng JQ, Griffiths SM. Public health services in Shenzhen: a case study. Public Health. 2011;125(1):15–9. https://doi.org/10.1016/j.puhe.2010.10.007.CrossRefPubMed

22.

Nielsen I, Nyland C, Smyth R, Zhang M, Zhu CJ. Which rural migrants receive social insurance in Chinese cities? Evidence from Jiangsu survey data. Glob Soc Policy. 2005;5(3):353–81. https://doi.org/10.1177/1468018105057416.CrossRef

23.

Tang D, Gao X, Coyte PC. The effects of compulsory health insurance on birth outcomes: evidence from China’s UEBMI scheme. BMC Health Serv Res. 2019;19(1):779. https://doi.org/10.1186/s12913-019-4657-1.CrossRefPubMedPubMedCentral

24.

Fong VL. The other side of the healthy immigrant paradox: Chinese sojourners in Ireland and Britain who return to China due to personal and familial health crises. Cult Med Psychiatry. 2008;32:627–41. https://doi.org/10.1007/s11013-008-9112-4.CrossRefPubMed

25.

McDonald JT, Kennedy S. Insights into the “healthy immigrant effect”: health status and health service use of immigrants to Canada. Soc Sci Med. 2004;59(8):1613–27. https://doi.org/10.1016/j.socscimed.2004.02.004.CrossRefPubMed

26.

Wingate MS, Alexander GR. The healthy migrant theory: variations in pregnancy outcomes among US-born migrants. Soc Sci Med. 2006;62(2):491–8. https://doi.org/10.1016/j.socscimed.2005.06.015.CrossRefPubMed

27.

Yoong W, Wagley A, Fong C, Chukwuma C, Nauta M. Obstetric performance of ethnic Kosovo Albanian asylum seekers in London: a case-control study. J Obstet Gynaecol (Lahore). 2004;24(5):510–2. https://doi.org/10.1080/01443610410001722527.CrossRef

28.

Ibison JM. Ethnicity and mode of delivery in “low-risk” first-time mothers, East London, 1988–1997. Eur J Obstet Gynecol Reprod Biol. 2005;118(2):199–205. https://doi.org/10.1016/j.ejogrb.2004.05.002.CrossRefPubMed

29.

Urquia ML, Glazier RH, Blondel B, et al. International migration and adverse birth outcomes: role of ethnicity, region of origin and destination. J Epidemiol Community Health. 2010;64(3):243–51. https://doi.org/10.1136/jech.2008.083535.CrossRefPubMed

30.

Lu Y. Test of the “healthy migrant hypothesis”: a longitudinal analysis of health selectivity of internal migration in Indonesia. Soc Sci Med. 2008;67(8):1331–9. https://doi.org/10.1016/j.socscimed.2008.06.017.CrossRefPubMed

31.

Hamilton ER, Choi KH. The mixed effects of migration: Community-level migration and birthweight in Mexico. Soc Sci Med. 2015;132:278–86. https://doi.org/10.1016/j.socscimed.2014.08.031.CrossRefPubMed

32.

Kuhn R, Everett B, Silvey R. The effects of children’s migration on Elderly Kin’s health: a counterfactual approach. Demography. 2011;48(1):183–209. https://doi.org/10.1007/s13524-010-0002-3.CrossRefPubMed

33.

Deb P, Seck P. Internal migration, selection bias and human development: evidence from Indonesia and Mexico. MPRA Pap. 2009;(19214).

34.

National Health Commission of the PRC. Overview: notice of the National Health and Family Planning Commission on strengthening the safety of mother and child. Implementation date: July 21, 2017. http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=8a786fae7e4d480c94fb0e09c89ab5fd. Accessed 31 July 2017.

35.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III L, Wenstrom KD. Williams obstetrics (22nd ed.). In: New York: McGraw-Hill; 2005. p. 761–808.

36.

Toal M, Chan C, Fallah S, et al. Usefulness of a placental profile in high-risk pregnancies. Am J Obstet Gynecol. 2007;196(4):1–7. https://doi.org/10.1016/j.ajog.2006.10.897.CrossRef

37.

Rosenbaum PR, Rubin DB. Assessing sensitivity to an unobserved binary covariate in an observational study with binary outcome. Matched Sampl Causal Eff. 1983;1959:185–92. https://doi.org/10.1017/CBO9780511810725.017.CrossRef

38.

Diaz JJ, Handa S. An assessment of propensity score matching as a non experimental impact estimator: evidence from a Mexican poverty program. J Hum Resour. 2006;41(April):319. https://doi.org/10.3368/jhr.XLI.2.319.CrossRef

39.

Xie Y, Brand JE, Jann B. Estimating heterogeneous treatment effects with observational data. Sociol Methodol. 2012;42(1):314–47. https://doi.org/10.1177/0081175012452652.CrossRefPubMedPubMedCentral

40.

Zhou M, Murphy R, Tao R. Effects of parents’ migration on the education of children left behind in rural China. Popul Dev Rev. 2014;40(2):273–92. https://doi.org/10.1111/j.1728-4457.2014.00673.x.CrossRef

41.

Abadie A, Imbens GW. Large sample properties of matching estimators. Econometrica. 2006;74(1):235–67. https://doi.org/10.1111/j.1468-0262.2006.00655.x.CrossRef

42.

Abadie A, Imbens GW. Matching on the estimated propensity score. Econometrica. 2016;84(2):781–807. https://doi.org/10.3982/ECTA11293.CrossRef

43.

Winn A, Hetherington E, Tough S. Systematic review of immigrant women’s experiences with perinatal care in North America. J Obstet Gynecol Neonatal Nurs. 2017;46(5):764–75. https://doi.org/10.1016/j.jogn.2017.05.002.CrossRefPubMed

44.

Kawar M. Gender and migration: why are women more vulnerable? Femmes en Mouv. 2017;2004(2004):71–87. https://doi.org/10.1016/j.jclepro.2007.08.009.CrossRef

45.

Hou Z, Wang Q, Zhang D. No health insurance and multiple insurance among internal migrants in China: a national cross-sectional study. Lancet. 2017;390:S97. https://doi.org/10.1016/S0140-6736(17)33235-X.CrossRef

46.

Zhao DH, Rao KQ, Zhang ZR. Coverage and utilization of the health insurance among migrant workers in Shanghai, China. Chin Med J (Engl). 2011;124(15):2328–34. https://doi.org/10.3760/cma.j.issn.0366-6999.2011.15.015.CrossRef

47.

Dole N, Savitz DA, Siega-riz AM, Hertz-picciotto I, Mcmahon MJ. Psychosocial factors and preterm birth among African American and White women in central North Carolina. Am J Public Health. 2004;94(8):1358–65.CrossRef

48.

Mustillo S, Krieger N, Erica P. Self-reported experiences of racial discrimination and Black – White differences in preterm and low-birthweight deliveries: the CARDIA study. Am J Public Health. 2004;94(12):2125–31.CrossRef

49.

Chan KW, Buckingham W. Is China abolishing the hukuo system? China Q. 2008;195(195):582–606. https://doi.org/10.1017/S0305741008000787.CrossRef

50.

Zhao Q, Kulane A, Gao Y, Xu B. Knowledge and attitude on maternal health care among rural-to-urban migrant women in Shanghai, China. BMC Womens Health. 2009;9:1–8. https://doi.org/10.1186/1472-6874-9-5.CrossRef

51.

Mou J, Cheng J, Zhang D, Jiang H, Lin L, Griffiths SM. Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference? BMC Health Serv Res. 2009;9:1–9. https://doi.org/10.1186/1472-6963-9-214.CrossRef

52.

Sun HM, Wu SY. Analysis of the high-risk pregnancy factors of the floating population with early and middle pregnancy. 2012:10–13. https://doi.org/10.16571/j.cnki.1008-8199.2012.12.004.

53.

Laopaiboon M, Lumbiganon P, Intarut N, et al. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG. 2014;121:49–56. https://doi.org/10.1111/1471-0528.12659.CrossRefPubMed

54.

Hsieh TT, Liou JD, Hsu JJ, Lo LM, Chen SF, Hung TH. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol. 2010;148(1):21–6. https://doi.org/10.1016/j.ejogrb.2009.08.022.CrossRefPubMed

55.

The World Bank. Overview: mortality rate, neonatal (per 1,000 live births) - China. https://data.worldbank.org/indicator/SH.DYN.NMRT?view=chart&locations=CN. Accessed 24 Mar 2021.

56.

Shanghai Municipal Health Commission. Overview: Shanghai held a meeting on maternal and child health in 2021 (in Chinese). https://wsjkw.sh.gov.cn/gzdt1/20210319/118016199f824a3ea7c063d69a3cfb6a.html. Accessed 19 Mar 2021.

Title: The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China
Authors: Di Tang
Xiangdong Gao
Peter C. Coyte
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Risk Pregnancy
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03958-4

2024 ASCO Annual Meeting

Springer Medicine

The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound

Incorporating Aboriginal women’s voices in improving care and reducing risk for women with diabetes in pregnancy - A phenomenological study

Partner’s emotional reaction to pregnancy mediates the relationship between pregnancy planning and prenatal mental health

Increased risk of preeclampsia after use of paracetamol during pregnancy – causal or coincidence?

Prevalence of suicidal ideation and associated factors among HIV positive perinatal women on follow-up at Gondar town health institutions, Northwest Ethiopia: a cross-sectional study

Fetal weight estimation by automated three-dimensional limb volume model in late third trimester compared to two-dimensional model: a cross-sectional prospective observational study