Which of the following statements is/are true relating to maternal mortality and morbidity?

• a)
  

  Maternal mortality and severe morbidity have been shown to be elevated across all migrant groups in all host countries where studies have been conducted.

  
  
• b)
  

  Risk factors for maternal complications, such as anaemia and obesity are higher in migrants compared to native women.

  
  
• c)
  

  Risk factors for maternal complications, such as HIV are higher in migrants compared to native women.

  
  
• d)
  

  Evidence indicates that the ‘healthy migrant hypothesis’ should be refuted as a general statement.

  
  
• e)
  

  Substandard care is always due to health worker delays, often compounded by communication barriers.

Which of the following statements is true?

• a)
  

  In the Netherlands, women from Turkey have increased risks of severe acute maternal morbidity.

  
  
• b)
  

  In the Netherlands, women from Morocco have increased risks of severe acute maternal morbidity.

  
  
• c)
  

  Black women in the United States are at the highest risk of maternal mortality, regardless of whether they are born in or outside the country.

  
  
• d)
  

  Protocols for diagnosis and treatment should be applied in the exact same manner to each individual patient, regardless of their ethnic background.

  
  
• e)
  

  Confidential enquiries and other methods of maternal audit do not require additional political effort.

Which of the following are known to affect birthweight?

• a)
  

  Infant sex

  
  
• b)
  

  Gestation

  
  
• c)
  

  Altitude above sea level

  
  
• d)
  

  Maternal smoking

  
  
• e)
  

  Maternal BMI

The following statement(s) is/are true regarding ethnic and migrant disparities in birthweight

• a)
  

  The birthweight of an infant is affected by numerous determinants, thus the clinical significance of birth weight disparities between population groups is unclear.

  
  
• b)
  

  Birth weight charts accurately predict adverse neonatal outcomes, such as perinatal death.

  
  
• c)
  

  Birth weight charts that are based on entire populations are well-suited to accurately describe normal fetal growth and newborn size.

  
  
• d)
  

  When using birth weight charts based on a healthy population, a certain proportion of healthy babies will nevertheless be categorized as SGA.

  
  
• e)
  

  Babies above the 10 ^th centile for growth are by definition not SGA.

The following statement(s) is/are true regarding the “Black-White gap” (non-Hispanic Black women versus non-Hispanic White women) in preterm delivery rates in the United States?

• a)
  

  Differences in genetics explain the gap in preterm delivery rates

  
  
• b)
  

  Differences in maternal smoking and drug use partly explain the disparities in preterm delivery rates

  
  
• c)
  

  Immigrant Black women have the same high risk of preterm delivery as Black women that are native-born

  
  
• d)
  

  The “healthy immigrant effect” has been largely discredited more recently in the US

  
  
• e)
  

  Exposures such as differentials in socioeconomic position and discrimination are likely to explain the gap

The following statement(s) is/are also true regarding the “Black-White gap” (non-Hispanic Black women versus non-Hispanic White women) in preterm delivery rates in the United States?

• a)
  

  Pregnancy dating based on the last menstrual period have been shown to inflate preterm delivery rates among Black women compared to ultrasound-based methods

  
  
• b)
  

  Pregnancy dating based on the last menstrual period have been shown to deflate preterm delivery rates among Black women compared to ultrasound-based methods

  
  
• c)
  

  Data based on ultrasound-determined gestational length should be preferred when comparing rates

  
  
• d)
  

  Spontaneous preterm deliveries are more common among Black women compared to White women

  
  
• e)
  

  Medically indicated preterm deliveries are more common among Black women compared to White women

Which of the following statement(s) about the link between migrant status and perinatal outcomes in the UK is/are true?

• a)
  

  Overall migrant women tend to have less favourable maternal outcomes compared to White British women

  
  
• b)
  

  Overall migrant women tend to have less favourable fetal outcomes compared to White British women

  
  
• c)
  

  Migrant women always tend to have worse perinatal outcomes than UK-born women of the same ethnicity

  
  
• d)
  

  Low birth weight for babies of South Asian mothers in the UK do not seem to improve over generations

  
  
• e)
  

  Congenital malformations are a major cause of infant mortality among babies born to Pakistani mothers

The following statement(s) about migrant women’s access and utilization of maternity services in the UK is/are true?

• a)
  

  Migrant mothers are likely to initiate antenatal care late compared to UK-born mothers

  
  
• b)
  

  Migrant mothers are likely to get fewer antenatal visits compared to UK-born mothers

  
  
• c)
  

  As there is a statutory obligation in the UK to provide interpretation services for patients who are unable to speak English, migrant mothers face relatively few language difficulties when they access health services

  
  
• d)
  

  Overall migrant mothers tend to face difficulties in their contact with health services in the UK

  
  
• e)
  

  Effective communication between health care professionals and parents is not a prerequisite for quality in maternity care

Which migration indicators are important to consider in a migrant woman’s overall risk of requiring a Caesarean birth?

• a)
  

  Country of birth

  
  
• b)
  

  Migration classification

  
  
• c)
  

  Receiving-country language fluency

  
  
• d)
  

  Length of residence in the receiving-country

  
  
• e)
  

  No clear pattern of migration indicators have been identified

Efforts towards reducing Caesarean rates among migrant women should include which of the following?

• a)
  

  Reducing the rate of primary Caesareans and increasing the rate of vaginal births after Caesarean (VBACs)

  
  
• b)
  

  Instituting clinical audits and feedback systems to standardize and improve the accuracy in diagnosing labour complications including failure to progress (FTP), fetal heart rate abnormalities and cephalo-pelvic disproportion (CPD)

  
  
• c)
  

  Ensuring women have adequate support with communication during labour

  
  
• d)
  

  Removing legal pressures that contribute to care-providers to practice more “defensively”

  
  
• e)
  

  Educating women and care-providers and promoting “normal childbirth”

The following statement(s) is/are true regarding the care for childbearing migrant women who have experienced genital cutting:

• a)
  

  Genital cutting is an indication for a Caesarean birth for women who have experienced the most severe form of cutting

  
  
• b)
  

  An episiotomy should be done to ensure labour is not obstructed

  
  
• c)
  

  If a woman requests re-infibulation it may be carried out during the perineal repair after birth

  
  
• d)
  

  Women who have experienced genital cutting usually prefer a Caesarean to avoid de-infibulation

  
  
• e)
  

  All migrant women from Sub-Saharan Africa should be screened for genital-cutting

The following statement(s) is/are true regarding research on Caesarean births in migrants in high-income countries:

• a)
  

  The consistently higher rates of Caesarean between migrant women from Sub-Saharan Africa and non-migrant women are most likely due to higher rates of HIV in women from Sub-Saharan Africa

  
  
• b)
  

  Migrant women tend to show higher rates of planned Caesareans compared to non-migrant women

  
  
• c)
  

  Several studies have confirmed a link between experiences of care during labour and risk for Caesarean among migrants

  
  
• d)
  

  Medical conditions including pre-eclampsia and placental conditions are the major driving factors of the high Caesarean rates among migrants

  
  
• e)
  

  Research regarding women’s views and experiences of Caesarean births is limited

The following factor(s) is/are considered important to consider in reproductive healthcare of devout Muslims:

• a)
  

  Always ensure that Muslim women are treated by a female physician

  
  
• b)
  

  Childless Muslim couples inevitably face restrictions to their reproductive possibilities as Islam discourages third-party donation

  
  
• c)
  

  Clinicians must acknowledge religious heterogeneity and variability in order to provide good level of care of Muslim patients

  
  
• d)
  

  Contraceptive counselling should foremost be directed to married Muslims

  
  
• e)
  

  Unmarried Muslim women and men are less likely to have sexual intercourse due to their beliefs

What statement(s) is/are true regarding cultural competence and person-centered care in reproductive healthcare for Muslim patients?

• a)
  

  Cultural competence models have shown to increase providers’ knowledge base, but there is no evidence that patients’ health is improved

  
  
• b)
  

  Person-centered care models increase both providers’ knowledge base and improve patients’ health outcomes

  
  
• c)
  

  Cultural competence models have proven to lead to overall positive reproductive health outcomes in the Muslim patient group

  
  
• d)
  

  Cultural competence models have proven to lead to reductions in health disparities

  
  
• e)
  

  Person-centered care models have shown to be effective in contraceptive counselling of Muslim patients

The following is/are true regarding migrant-related policies and laws:

• a)
  

  They help to control migrants from having any negative impact on the locals

  
  
• b)
  

  They fully protect migrants from labour trafficking and sexual abuse

  
  
• c)
  

  They requires various agencies to implement them

  
  
• d)
  

  They are important to ensure migrant have access to their sexual and reproductive health and rights

  
  
• e)
  

  They vary from one country to another

Efforts to ensure all migrants receive proper sexual and reproductive health and rights should include which of the following?

• a)
  

  Public awareness on the plight of female and undocumented migrants

  
  
• b)
  

  Increased access to health care among migrants in terms of cost and quality of service

  
  
• c)
  

  To ensure migrant-related laws and policies enable low-skilled migrants and domestic workers to exercise their SRHR

  
  
• d)
  

  To increase the frequency of mandatory health screening among migrants

  
  
• e)
  

  For government to be more committed and takes actions in upholding the SRHR of migrants.

Which of the following factors contribute to attendance at ante-natal clinics (ANC) for migrant women?

• a)
  

  Lack of knowledge of the health system

  
  
• b)
  

  They need less care

  
  
• c)
  

  Poor language proficiency

  
  
• d)
  

  Indirect discrimination

  
  
• e)
  

  Migrant women have actually been shown to attend as much as non-migrant women for ANC

The quality of care for pregnant and delivering migrant women are challenged by which of the following?

• a)
  

  Migrant women expect something different from health care providers compared to non-migrant women

  
  
• b)
  

  Delays in the health system management of pregnancy complications

  
  
• c)
  

  Low use of interpreters

  
  
• d)
  

  Poor cross-cultural communication

  
  
• e)
  

  Mutual broken trust between health care provider and migrant woman

Which of the following is/are relevant to the use of a participatory approach to intervention development for improving the health of pregnant and delivering migrant women?

• a)
  

  A participatory approach will ensure ownership

  
  
• b)
  

  A participatory approach will ease implementation

  
  
• c)
  

  Participatory approaches struggle to be effective as they cannot be combined with evidence based medicine

  
  
• d)
  

  They try and fit the needs and perceptions of migrant women

  
  
• e)
  

  It is ethically important