Enfº. Alain Pires Delgado

Maternal and Obstetric
Health Specialist Nurse

Multiculturalism in childbirth

In the gynecology & obstetrics service at HPA Gambelas - statistical data

HPA Magazine 20

The human migration aims to search for better living conditions, providing prosperity, stability, or better comfort conditions. 
In Europe, this dynamic is not new, as we remember that in the 60s and 70s, the Portuguese emigrated massively to other destinations such as France, Germany, Italy, or Luxembourg, as well as other intercontinental destinations. In those countries, thousands of Portuguese were seeking a better future, and many also experienced motherhood in sociocultural environments different from ours. 

Today, our country also attracts other peoples and has become a destination for people looking for a better quality of life for their families. 
While some seek new and advantageous social and labor opportunities, others come in search of a tourist destination with more pleasant temperatures, whose quality of life in a country is also reflected in its safety. 
This migratory flow causes the health sector to have increasingly frequent contacts with diverse cultures that were previously only punctual. 
This immigration is often done by young people, in their fertile age and in the process of forming a family. This fact provides maternity professionals with frequent contact with a variety of couples from different cultures. 
We all know that motherhood is a unique and personal experience, but immigrants have a different social and cultural experience developed by their diverse experiences. 
One of the difficulties is that they are often not in the country for a long time and do not have sufficient native language knowledge to clarify doubts or learn, in a brief period, the concepts of the society in which they find themselves. 
Their expectations were often developed in an environment opposite to what they find in Portugal. In other countries, sociocultural, religious, linguistic, and ethnic environments can vary greatly and induce very different expectations, also at the time of delivery.
At the national level, according to data from INE (National Statistics Institute) regarding births of the foreign population that occurred in 2021 (the last year presented in the official national statistics), they represented about 13.58% of the total number of births in Portugal. 
According to the same INE data, there was an increase in immigration in that year, with 51,000 entries of people. 
According to this source, there has been a positive migration balance that has been increasing since 2016, resulting from the difference between emigration and immigration. 
At Hospital de Gambelas, it is possible to compare data from 2021 with that of 2022 in terms of the evolution of births by nationality.
Fig. 1 - Percentage of births by nationality in 2021 and 2022 at Hospital Particular de Gambelas

When analyzing the data from Gambelas Hospital, it was found that in 2021, the total number of births by foreign women at the maternity ward was 15.9%. Out of this number, 59.6% were from women from European countries, with the United Kingdom having the highest representation (25.8%), followed by the Netherlands (17.7%).Births by women from South American countries accounted for 28.84%, with the vast majority being of Brazilian nationality at 93.3%.The representation of births by women from North America, Asia, and Africa was 3.8% of the total number of foreign births.In 2021, 25 foreign nationalities were identified as having given birth at the hospital, excluding Portuguese nationality.
Fig.2: Births of foreigners by continent

In 2022, the percentage of foreigners who gave birth at the maternity ward of Hospital de Gambelas was 19.5%.Within this percentage, 55.07% were from European countries, with the highest representation being from the United Kingdom at 25%, followed by France at 10.52%, and Germany at 9.2%.
From South America, we obtained a representation of 33.3%, and once again, Brazilian nationality stood out with 97.8%. From the rest of the world, North America represents 5%, Asia around 3.6%, and 2.8% have their origin on the African continent. In addition to the Portuguese nationality, the total number of identified nationalities was from another 25 countries.Based on the data obtained in 2021 and 2022, we found that there was an increase from 15.9% to 19.5% in the number of births performed for the foreign population. However, if we analyze the Portuguese population, we will see that 84% of the total births that occurred in 2021 and 80.4% of those that occurred during 2022 were of Portuguese nationality. However, this percentage may prove inconclusive, as the total number of births may also have increased.
There was an increase of 3.57% in the number of births performed in women with other nationalities. One of the biggest increases was in births with Brazilian nationality, with an increase of 4.5%. We cannot forget that knowing the exact number of total foreign births can be a difficult task, as users who possess citizenship become part of the Portuguese statistics.At the national level, the INE still does not have the 2022 data available, and it would be interesting to compare national data with the data obtained from the Gambelas Hospital maternity ward. Based on the available data, we can conclude that there is an increasingly growing trend towards immigration in the Algarve region in recent years. Consequently, there is an increase in foreign pregnant women in Portugal, particularly in the Algarve, which has increased the number of births. At HPAF, we invest in constant training of the team to improve communication mechanisms and provide the parturient with all relevant information during the peripartum, delivery, and postpartum periods. The central purpose is to provide humane and safe care and delivery, regardless of the parturient's origin.