Receipt of adequate prenatal care for privately sponsored versus government-assisted refugees in Ontario, Canada: a population-based cohort study

Background: Canada has 2 main streams of resettlement: government-assisted refugees and privately sponsored refugees, whereby citizens can privately sponsor refugees and provide resettlement services, including health care navigation. Our objective was to compare receipt of adequate prenatal care among privately sponsored and government-assisted refugees.Methods: This population-based study used linked health administrative and demographic databases. We included all resettled refugees classified as female who landed in Ontario, Canada, between April 2002 and May 2017, and who had a live birth or stillbirth conceived at least 365 days after their landing date. Our primary outcome - adequacy of prenatal care - was a composite that comprised receipt of a first-trimester prenatal visit, the number of prenatal care visits recommended by the Society of Obstetricians and Gynaecologists of Canada and a prenatal fetal anatomy ultrasound. We accounted for potential confounding with inverse probability of treatment weighting, using a propensity score.Results: We included 2775 government-assisted and 2374 privately sponsored refugees. Compared with privately sponsored refugees (62.3% v. 69.3%), government-assisted refugees received adequate prenatal care less often, with a weighted relative risk of 0.93 (95% confidence interval 0.88-0.95).Interpretation: Among refugees resettled to Canada, a government-assisted resettlement model was associated with receiving less adequate prenatal care than a private sponsorship model. Government-assisted refugees may benefit from additional support in navigating health care beyond the first year after arrival.