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Objectives: We compared severe maternal morbidity (SMM) and SMM subtypes, including HIV, of refugee women with those of nonrefugee immigrant and nonimmigrant women., Methods: We linked 1,154,421 Ontario hospital deliveries (2002-2011) to immigration records (1985-2010) to determine the incidence of an SMM composite indicator and its subtypes. We determined SMM incidence according to immigration periods, which were characterized by lifting restrictions for all HIV-positive immigrants (in 1991) and refugees who may place "excessive demand" on government services (in 2002)., Results: Refugees had a higher risk of SMM (17.1 per 1000 deliveries) than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among SMM subtypes, refugees had a much higher risk of HIV than did immigrants (risk ratio [RR] = 7.94; 95% confidence interval [CI] = 5.64, 11.18) and nonimmigrants (RR = 17.37; 95% CI = 12.83, 23.53). SMM disparities were greatest after the 2002 policy came into effect. After exclusion of HIV cases, SMM disparities disappeared., Conclusions: An apparent higher risk of SMM among refugee women in Ontario, Canada is explained by their high prevalence of HIV, which increased over time parallel to admission policy changes favoring humanitarian protection.

Objectives: We examined the joint associations of marital status and duration of cohabitation on self-reported intimate partner violence, substance use, and postpartum depression among childbearing women., Methods: We analyzed data from the 2006-2007 Canadian Maternity Experiences Survey, a cross-sectional nationwide sample of 6421 childbearing women. Cohabiting women were married or nonmarried women living with a partner; noncohabiters were single, divorced, or separated women. We further categorized cohabiters by their duration of cohabitation (≤ 2, 3-5, or > 5 years). We used logistic regression to generate adjusted odds ratios and 95% confidence intervals., Results: About 92% of women were cohabiters. Compared with married women living with a husband more than 5 years, unmarried women cohabiting for 2 years or less were at higher odds of intimate partner violence (adjusted odds ratio [AOR] = 4.64; 95% confidence interval [CI] = 2.85, 7.56), substance use (AOR = 5.36; 95% CI = 3.06, 9.39), and postpartum depression (AOR = 1.87; 95% CI = 1.25, 2.80); these risk estimates declined with duration of cohabitation., Conclusions: Research on maternal and child health would benefit from distinguishing between married and unmarried cohabiting women, and their duration of cohabitation.

Objectives: We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers., Methods: We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76,500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006-2007)., Results: Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers., Conclusions: Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse.

Objectives: We compared the influence of the residential environment and maternal country of origin on birthweight and low birthweight of infants born to recent immigrants to urban Ontario., Methods: We linked delivery records (1993-2000) to an immigration database (1993-1995) and small-area census data (1996). The data were analyzed with cross-classified random-effects models and standard multilevel methods. Higher-level predictors included 4 independent measures of neighborhood context constructed by factor analysis and maternal world regions of origin., Results: Births (N = 22 189) were distributed across 1396 census tracts and 155 countries of origin. The associations between neighborhood indices and birthweight disappeared after we controlled for the maternal country of origin in a cross-classified multilevel model. Significant associations between world regions and birthweight and low birthweight persisted after we controlled for neighborhood context and individual characteristics., Conclusions: The residential environment has little, if any, influence on birthweight among recent immigrants to Ontario. Country of origin appears to be a much more important factor in low birthweight among children of recent immigrants than current neighborhood. Findings of neighborhood influences among recent immigrants should be interpreted with caution.