Infant Health Among Indochinese Refugees: Patterns of Infant Mortality, Birthweight and Prenatal Care in Comparative Perspective.

Abstract

This article presents detailed comparative analyses of infant health outcomes and risk factors among refugee groups from Vietnam, Laos and Cambodia, compared to all other major racial-ethnic groups in San Diego County, California (Hispanics, non-Hispanic whites and blacks, Filipinos, Chinese, Japanese, and American Indians). Data are drawn from (1) a complete list of all linked live births (N=269,252) and infant deaths (N=2,610) recorded in San Diego County from 1978 to 1985; (2) longitudinal survey data from refugee respondents in the Indochinese Health and Adaptation Research Project (IHARP), matched to the vital statistics data; and (3) in-depth qualitative interviews which were conducted with a subsample of refugee mothers about their pregnancies since their arrival in the United States. Findings measure early neonatal and post-early neonatal infant mortality rates for all groups, as well as birth weight (in grams), low-birthweight births, late onset of prenatal care, and other risk factors. Multivariate analyses of the vital statistics and the longitudinal survey data identify the determinants of infant health outcomes, while four detailed case histories of Hmong and Vietnamese refugee mothers are sketched from the qualitative data. Despite severe economic and cultural handicaps and traumatic migration histories, Indochinese refugees were found to exhibit significantly lower infant mortality rates than more advantaged groups, another instance of the, “epidemiological paradox,” also observed among Mexican immigrants. Theoretical and policy implications of these findings are discussed.

Keywords: Infant health, early neonatal and post-early neonatal mortality, low-birthweight births, prenatal care, refugees from Vietnam, Laos and Cambodia, immigration, adaptation, IHARP study, San Diego County, public health policy