Elsevier

Social Science & Medicine

Volume 57, Issue 8, October 2003, Pages 1443-1454
Social Science & Medicine

Fertility and perinatal health among Finnish immigrants in sweden

https://doi.org/10.1016/S0277-9536(02)00402-1Get rights and content

Abstract

Several studies have reported poorer infant outcome among immigrants, but contrary evidence also exists. Between 1940 and 1999 more than a half million Finns emigrated to Sweden, which made Finns the largest minority group in Sweden. Our aim was to investigate fertility trends, parturients’ background and pregnancy outcomes among Finns in Sweden, and to compare the findings with those obtained among Swedes in Sweden and Finns in Finland. The data came from the Finnish and Swedish Medical Birth Registers for the years 1987–1998. All deliveries by women born in Finland and having given birth in Sweden (N=33 874) were compared with a 10% sample of all deliveries by Swedish parturients in Sweden (N=108 549) and of all Finnish deliveries (n=75 133). Among Finns in Sweden, the number of live births per 1000 women aged 15–49 years declined significantly in the late 1990s. The change in the total fertility rate was less dramatic: the rate for Finns in Sweden followed the total Swedish rate although it remained from 5% to 10% higher up to the mid-1990s. Finns who had given birth in Sweden were older, had a higher parity and a higher prevalence of previous miscarriages, and smoked more often than did Swedes in Sweden or Finns in Finland. The crude infant outcomes of Finns having given birth in Sweden were equal to those among Swedes in Sweden (except for the incidence of small for gestational age), but poorer than in Finland. Biological factors explained the differences between Finns in Sweden and Finland in being small for gestational age, and biological factors and smoking explained the difference in prematurity. The difference in low birth weight remained statistically significant (3.9% versus 3.6% among singletons). In conclusion, fertility trends followed the pattern prevailing in the resident country. The relatively good outcome of children whose mothers were born in Finland but who had given birth in Sweden can partly be explained by the healthy migrant effect.

Introduction

Sweden experienced a lack of workers in the 1960s and 1970s, which caused extensive immigration to Sweden, mostly from other European countries (Statistics Sweden, 1999a). Since Finland and Sweden are neighbouring countries, migration between them has been intensive. Between 1940 and 1999, more than 545 000 Finns emigrated to Sweden. Although 308 000 Finns returned from Sweden to Finland during the same period, there is still a relatively large Finnish minority in Sweden. In all 70% of the net immigration surplus (for Sweden) occurred in the 1960s and 1970s. The peak was reached in 1969–1970, when more than 80 000 Finns emigrated to Sweden (Fig. 1), mostly due to increasing unemployment in Finland and the 30% devaluation of the Finnish currency in 1967, which increased the attractiveness of Swedish salaries (Leiniö, 1984). In addition, the general standard of living was high in Sweden after the World War II, since the country was not involved in the war.

Between 1970 and 1999, 47% of all immigrants from Finland to Sweden were women (annual variation range between 44% and 55%), and 94% (between 86% and 96%) were under 50 years of age (Statistics Finland, 1999). Slightly more than 50% of immigrating women as compared with slightly less than 50% of immigrating men were married in the 1960s and 1970s. Swedish-speaking Finns and Gypsies have been overrepresented among Finnish people immigrating to Sweden (Leiniö, 1984).

The health of immigrants living in Sweden has been investigated ever since the 1960s. In general, there seems to be a greater risk of longstanding illness as well as of increased mortality and morbidity among immigrants as compared with the general Swedish population (Emami, 1997; Sundquist & Johansson, 1998).

There are, however, fewer studies that focus on health and social conditions among Finns living in Sweden. Large interview studies conducted in 1968, 1974 and 1981 revealed that Finns had less secure work conditions (although in general the same average wages), poorer dwelling standards, and poorer physical, mental and oral health than Swedes. Despite the greater need for health-care services, the utilisation of services was at the same level among Finns and Swedes in Sweden (Leiniö, 1984). The 1986–1991 Swedish living condition survey showed that Finns have poorer general health and a higher incidence of long-term illness, musculo-skeletal disorders, sleeping disorders and oral problems, and that they use more long-term medication and have a reduced working capacity as compared with Swedes in general (Leiniö, 1994). As expected, the biological risk factors—such as high cholesterol values among 25–54 year-old-immigrants (Tomson & Åberg, 1994) — have been reported to be equal to those of Finns living in Finland.

Studies on reproductive health among immigrants have yielded contradictory results. In the US, for example, some studies have reported an increased risk of problems during pregnancy and delivery as well as poorer infant outcomes (e.g. Mor, Alexander, Kieffer, & Baruffi, 1993; Carballo, Grocutt, & Hadzihasanovic, 1996), while some other studies have reported a decreased risk and better infant outcomes (e.g. Alexander, Mor, Kogan, Leland, & Kieffer, 1996) as compared with the general population.

A previous analysis of the Swedish Medical Birth Register along with more detailed information on maternal background from other national administrative registers showed that the country of origin has a significant effect on infant outcome. For Finns, a decreased risk of prematurity and of being small for gestational age but an increased perinatal mortality risk was observed in 1983–1993 (National Board of Health and Welfare, 1998). However, this study did not compare the outcome to parturients and their children in Finland, and it remained unclear, if the observed differences were caused by genetic and biological factors, by socio-economic and life-style factors, or by both.

The aim of this study was to investigate the fertility, parturients’ background factors and their infant outcomes among the Finnish-born population in Sweden. Comparisons were made with the general population of the Swedish-born population in Sweden and with the total population in Finland. All data came from the National Medical Birth Registers of the two countries.

Section snippets

Material and methods

The national statistical offices provided basic information on migration and populations between 1940 and 1999 (Statistics Finland, 2000; Statistics Sweden, 2000a).

Both countries maintain a nation-wide Medical Birth Register (MBR). Reporting to the registers is obligatory. The Swedish MBR was started in 1973 and the Finnish MBR in 1987. Both registers collect data on maternal background, on care and interventions during pregnancy and birth, and on short-term infant outcome. Both MBRs contain

Fertility

The general fertility rate among Finns in Sweden was stable until 1992, varying within the same range as the Finnish fertility rate (annual difference from −6% to +2%). Compared with the Swedish rate, the fertility rate among Finns in Sweden was from 4% to 5% higher in 1978–1982, but remained thereafter clearly below the Swedish rate. After 1992 the fertility among Finns in Sweden has decreased substantially, and the rate for the years 1996–1998 was more than one third below the Swedish and

Discussion

The reproductive health of Finns in Sweden has been investigated earlier (National Board of Health and Welfare, 1998). The previous comparisons, however, have been made between Finns and other nationalities in Sweden, while this was the first study with comparisons including both Finnish and Swedish data, as required by the golden standard for migration studies (Kasl & Berkman, 1983).

Our study showed that parturients’ background characteristics among Finns in Sweden differed from those among,

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