Our study shows that the constellation of background characteristics which describe DC mothers, combined with their mental health profiles, suggest that they are an extremely high-risk group warranting case finding and additional support and care. Their mental health profile is poorer than other migrant mothers and is not explained by being in a precarious immigration class. The mental health issues they experience include symptoms of PPD risk for clinical depression and anxiety related to trauma. And these challenges are often experienced in the context of low formal education, low household income, food insecurity, single parenthood, lack of social support, limited time in Canada, limited host language ability, absence of health insurance, and having experienced a surgical birth.
Previous research has studied the impact of separation on the mother [11
], however to our knowledge, none has investigated the health or well-being of women who subsequently gave birth in a new country. The rates of harmful background psychosocial experiences and mental health outcomes of DC mothers we found in our study are greater than those found in studies of other populations. For example, as regards food insecurity, 4.1% of Canadian households with children have ever had to cut the size of meals or skipped meals [28
], compared to the nearly four times greater rate of the DC mothers in our study. Canadian studies have estimated the prevalence of physical abuse during pregnancy in the general population to be about 6% [29
]. Our estimates for non-DC mothers are close to this rate (5.2%), while DC mothers were more than twice the rate (14.8%).
DC mothers are at higher risk of PPD at 4-month postbirth than non-DC mothers (28.3% versus 18.6%), although both groups have higher rates than other studies which report an average prevalence of 13% [31
]. Our findings that DC mothers exhibit symptoms over twice this rate may speak to the constellation of factors making up their background. DC mothers exhibited nearly twice the rate of signs of clinical depression than non-DC mothers (23.1% versus 13.5%) and more experienced anxiety (16.5% versus 9.4%). More of the DC mothers had past experiences of violence and trauma, and these past traumatic experiences could contribute to the observed higher rates of depression and anxiety in addition to separation from their children. Previous research has shown both that “…having children who lived elsewhere predicted the likelihood of major depression” [12
] and that being with one's family can have a protective effect on trauma victims [7
]. Anxiety is likely further exacerbated, since one or more of her children remain in the country where she experienced violence, and from where she has sought refuge. Reducing the lengthy immigration application processing time, financial requirements, and narrow definitions of family may reduce the long separation periods between family members. Finally, asylum-seeking women who give birth may further fear that their applications for asylum may be rejected while their infant is permitted to stay as a Canadian citizen, leaving them to be forced to choose to remain illegally in Canada, return with the infant to an unsafe environment, or leave the infant in Canada with other caregivers.
Our study is not exempt from limitations. The relatively small number of DC mothers in our study prevented us from being able to perform multivariate analyses; however, analyses restricted to the combined asylum-seeking and refugee group did offer evidence that the difference in the two groups by immigration class was not responsible for the differences in mental health outcomes. The tools used for mental health risk do not constitute diagnostic tools on their own, and referral and followup with community mental health practitioners are warranted.
Care providers working with migrant women in the perinatal period may wish to do screening to determine if the woman is (or is soon to be) a DC mother, knowing that she is more likely to experience poor mental health than non-DC mothers. Referral to mental health workers and relevant community agencies may be appropriate. Home visits and community activities may help to address isolation and minimize harmful mental health symptomatology. Assistance in reducing lengthy immigration application processing times through letter writing in support of a woman's case for family reunification could help to reduce the long separation periods between family members who could offer needed social support. This may be particularly beneficial for those who were victims of trauma since the literature shows that being with one's family can have a protective effect [7
Research to further examine the causes of food insecurity such as isolation, inaccessibility to food programs (e.g., food banks), or insufficient income is warranted to develop targeted policies and interventions. Future research on how separation from children affects mothers' health and mental wellbeing with a subsequent birth in a new country is also needed.