Interventions facilitating access to perinatal care for migrant women without medical insurance: A scoping review protocol.

INTRODUCTION: Inadequate pregnancy monitoring for pregnant migrant women without medical insurance (PMWMI) exposes them to severe complications during childbirth and consequences for the health of their child (e.g. preterm delivery, low birth weight, etc.). This scoping review aims to identify existing interventions globally to improve access to perinatal care for PMWMI. It will also highlight the strengths, weaknesses as well as the costs of these interventions.
MATERIALS AND METHODS: The methodological framework developed by Arksey & O'Malley (2005) will be used. An electronic search of studies from 2000 to 2021, published in French or English, will be conducted in 12 databases. Publication in Websites of non-governmental organizations working on migrant women without medical insurance issues will be also searched. All articles related to perinatal follow-up and care of PMWMIs, regardless of design, will be included. Editorial comments will be excluded. Outcomes of interest will focus on the impacts, strengths, weaknesses, and cost of interventions. Selection of articles and data extraction will be done by two independent researchers following the Tricco et al. (2018) reporting guide. Finally, a deliberative workshop with experts will allow to identify the most promising and appropriate interventions that can facilitate access to perinatal services by PMWMIs in the Quebec province of Canada.

Introduction

Although the phenomenon, known as the ‘healthy immigrant effect’, has been repeatedly reported [1, 2], in many countries [3], migrant women face inadequate pregnancy follow-up [4] resulting in more miscarriages, fetal growth problems, premature birth and high perinatal mortality [5]. Those without any medical insurance are more vulnerable than other migrants [6, 7]. They often consult a healthcare provider very late during pregnancy [8] and frequently have severe complications during childbirth [7]. They also experience a higher number of emergency caesarean sections, which can be traumatic for the mother and the unborn child [6]. These women also have a high prevalence of postpartum depression [9], parasitic [10] and other infectious diseases (Hepatitis B; Hepatitis C; HIV) / AIDS). The fact they experienced challenges in accessing perinatal care [11], constitutes a double burden. This issue among pregnant migrant women without medical insurance (PMWMI) is a complex subject. Several interventions exist to address this including; (i) earlier care (ii) regular care; (iii) culturally appropriate; (iv) geographically accessible; (v) multidisciplinary; (vi) integrated with other community services / resources and at lower cost [12, 13].

We have not identified a scoping or systematic review of these interventions which would allow a better understanding of access to perinatal care for PMWMIs. It is therefore opportune to carry out some in order to list the interventions promoting the access of PMWMI women to perinatal care. As mentioned by Arksey and O’Malley (2005) and Levac (2010), a scoping review [14, 15] of these interventions will allow us to synthesize them, to know their strengths, their weaknesses and their costs. Thus, it will be possible to implement appropriate interventions depending on the context in order to facilitate access to perinatal care for PMWMIs. Knowing the costs would help inform decision-makers about the financial benefits of investing in setting up these interventions. This scoping review will fill the literature gap. It aims to identify interventions that have been employed to improve access to perinatal care for PMWMI. It will also highlight the strengths, weaknesses as well as the costs of these interventions.

Materials and methods

Methodological framework

The methodological framework developed by Arksey & O’Malley (2005) [14] and taken up by other authors [15, 16] will be used. This framework highlights six steps necessary for a good Scoping Review: (i) definition of the research question; (ii) identification of relevant studies; (iii) selection of studies; (iv) data extraction; (v) analysis and aggregation of results; and, (vi) consultation exercise.

Research questions

The purpose of this scoping review project is to identify interventions (practices and policies) that support PMWMIs’ access to perinatal care. It will answer the two following questions:

What are the interventions that facilitate access to perinatal care for PMWMI women?

What are their impacts on perinatal health, what are their strengths, weaknesses and what is the cost of implementation?

Inclusion criteria

Inclusion and exclusion criteria will be based on Population, Interventions, Comparators and Design and Outcomes or Anticipated Outcomes (PICO), summarized in Table 1.

Table 1

PICO (Population, Interventions, Comparator and design, Outcomes).

Population (P)	Women who are pregnant or in labor or in the postpartum period; 12 years and over; Migrant; without medical insurance
Interventions (I)	Carrying out pregnancy tests; Prenatal care (during pregnancy follow-up); Immediate obstetric and neonatal care (during labor, delivery and within two hours after delivery); Postpartum care (within 42 days of delivery); Newborn care (up to 28 days after birth); Pregnancy follow-up; prenatal education; vaccination; Screening for diseases during pregnancy; Childbirth assistance.
Comparator and design (C)	All articles, regardless of design, will be included except editorial articles and comments
Outcomes or intended results (O)	Strengths and weaknesses (facilitators and obstacles) of the targeted interventions; cost of these interventions and impacts / effect of these interventions

Population (P)

Migrants are not a homogeneous population. According to the glossary of the International Organization for Migration, the term "migrant" refers to "a person who has voluntarily moved or is forced to move, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons, in order to improve his or her material and social conditions, his or her future prospects or those of his or her family" [17]. In addition to coming from different countries and cultures, a distinction is made between migrants: (i) in a regular situation whose entry and stay in the host country are in accordance with the applicable law; (ii) and, in an irregular situation contravening the regulations of the host country by entering it irregularly or remaining there beyond the validity of the residence permit [17, 18]. As part of this review, internal displaced as well as refugees and asylum seekers without health insurance will also be considered. This review will include articles that focus on migrant women 12 years and older without health insurance who are either pregnant, in labor, or postpartum. Articles that focus on the perinatal period of migrant women without health insurance will be considered.

Interventions (I)

They include the care provided to uninsured migrants during the perinatal period as well as the policies and practices implemented to promote their access to this care. The perinatal period adopted for this study is broader than the World Health Organization definition [19] and extends from the beginning of pregnancy to the first months of life of the newborn [20]. Care during pregnancy including prenatal education, labor, delivery and postpartum, as presented in the Médecin du Monde (MdM) reference framework [21] will therefore be considered. Details of prenatal care (during pregnancy follow-up), immediate obstetric and neonatal care (during labor, delivery, and within two hours of delivery), postpartum care (within 42 days of delivery), and newborn care (up to 28 days after birth) are presented in Table 2.

Table 2

Types of intervention / care and related essential intervention package.

Type of intervention	Package of essential interventions
Prenatal care (provided during pregnancy by a qualified health professional to ensure the birth of a healthy child with minimal risk to the mother)	History and clinical examination
	Management of unwanted pregnancies
	Management and/or referral of pregnant women with complications
	Information and counseling (health education)
	Preparation for childbirth
	The childbirth preparation plan
	Prevention and management of anemia
	Tetanus vaccination
	Prevention and treatment of malnutrition
	Screening and treatment of syphilis
	Information, screening and treatment of precancerous cervical cancer lesions
	Identification of victims of gender-based violence
	Screening and management of pregnancy complications
	Registration of medical data
	Malaria prevention and management a
	Antiparasitic treatment a
	Prevention of mother-to-child transmission of HIV a
Immediate obstetric and neonatal care (preventive and curative care provided during labor, delivery, and the immediate postpartum period (2 hours after delivery) to reduce maternal and neonatal mortality and morbidity through early detection and timely management of obstetric and neonatal complications)	Early referral for complications and/or situations requiring specialized care
	Care during labor and delivery in the presence of a qualified health professional
	Neonatal care
	Immediate postpartum (maternal and newborn monitoring, information and counseling on hygiene, home health care, nutrition, exclusive breastfeeding, family planning, postpartum care, child care, and danger signs and emergency preparedness)
	Detection and management of victims of gender-based violence
	Prevention and early detection of fistula
	Registration of births and/or deaths at the civil registry and of medical information in health registers and diaries
	Monitoring and response to maternal deaths and near misses "échappées belles, here Fin French at the institutional and community levels
	Prevention of malaria a
	Prevention of mother-to-child transmission of HIV a
Postpartum care (given to the mother after delivery and up to 42 days after delivery (6 weeks), the postpartum period is divided into three parts: (i). the immediate postpartum during the first 24 hours of the newborn’s life; (ii) the early postpartum from the 2nd to the 7th day after birth; (iii) the late postpartum covering a period from the 8th to the 42nd day after birth).	Monitoring of the mother’s health and well-being
	Screening and management of postpartum complications
	Information and counseling
	Promotion, protection and support of exclusive breastfeeding
	Prevention and management of anemia
	Tetanus vaccination
	Screening and treatment of STIs
	Attention to victims of gender-based violence
	Family planning counseling and provision of appropriate contraceptive methods
	Early detection of fistula
	Registration of births, deaths, and medical information in registers and health books
	Monitoring and responding to maternal deaths and "échappées belles”
	Prevention of mother-to-child transmission of HIV
Neonatal care (Provided to children after birth within the first 28 days to ensure a smooth transition to extra-uterine life)	Resuscitation of the newborn at birth
	Immediate care of the newborn
	Promotion, early initiation
	Monitoring and surveillance of the newborn’s condition and well-being
	Hepatitis B, BCG and polio vaccinations
	Screening and initial treatment of at-risk newborns
	Prevention and management of congenital syphilis
	Information and counseling
	Registration of births and deaths at the civil registry, and medical information in health registers and health cards
	Prevention of malaria a
	Prevention of mother-to-child transmission of HIV a

a: To be considered in endemic areas

Comparator and design (C)

All empirical scientific studies, regardless of design, in French or English of any high, medium or low income country- (see S1 Appendix which presents the complete list of countries as listed by the World Bank in 2021) [22] will be accepted. Media articles, editorial comments, as well as studies focusing only on the profile of PMWMIs will be excluded. No comparison is foreseen.

Outcomes or intended results (O)

The impacts, strengths, weaknesses and implementation costs of interventions aimed at providing access to perinatal care for PMWMIs will be reported.

Data sources and study identification

This scoping review has been registered in Research Registry (6864; https://www.researchregistry.com/browse-the-registry#home/). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) [23] (see S1 Checklist) will be followed in carrying out this review. The specifications of the elements relating to the construction of the Flow diagram will be explicitly mentioned. Articles will be selected via: (i) electronic bibliographic databases CINHAL, Web of Science, Medline-Ovid, Pubmed, Embase, Cochrane Library, Scopus, ScienceDirect, Hinari, Lilacs, Cairn and Banque de Données Santé Publique (BDSP); (ii) reference lists; (iii) key journals in the field of immigration (Revue Migrations Forcées; Migrations Société); and (iv) Websites of non-governmental organizations (Médecin du monde, Médecin sans Frontières (MSF), United Nations High Commissioner for Refugees (UNHCR). A working meeting between the co-researchers of this project, including an experienced librarian (CS), has already allowed the definition of the search strategy presented in Table 3. This strategy was developed using descriptors or thesauri with the logical operators "AND" and "OR" to identify relevant studies published between 2000 and 2021 in French or English. The year 2000 was a landmark turning point for the entire world with the formulation of the eight Millennium Development Goals (MDGs), where emphasis was put in poverty and hunger reduction (MDG 1) the promotion of gender equality and empower of women (MDG 3) and among other child mortality reduction (MDG 4) [24]. The selected articles will be exported to Rayyan [25] via EndNote.

Table 3

Search strategy in CINAHL, to be modified as needed for other databases.

Number	Queries
1	TI (Immigrant* OR migrant* OR temporary worker* OR ‘migrant worker*’ OR ‘foreign worker’ OR ‘foreign workers’ OR ‘domestic worker*’ OR ‘live-in caregiver*’ OR caregiver OR caregivers OR refugee OR refugees* OR asylum) OR AB (Immigrant* OR migrant* OR temporary worker* OR ‘migrant worker*’ OR ‘foreign worker’ OR ‘foreign workers’ OR ‘domestic worker*’ OR ‘live-in caregiver*’ OR caregiver OR caregivers OR refugee OR refugees* OR asylum)
2	(MM "Immigrants+") OR (MM "Refugees+")
3	1 OR 2
4	TI (Woman OR women OR female OR females OR adolescent OR adolescents) OR AB (Woman OR women OR female OR females OR adolescent OR adolescents)
5	3 AND 4
6	TI (parturition OR pregnancy OR pregnancies OR pregnant OR gestat* OR Prenatal OR ‘Pre natal’ OR ‘Pre-natal OR ante-natal OR ‘ante natal’ OR antenatal OR ‘peri natal’ OR perinatal OR peri-natal OR ‘post natal’ OR post-natal OR postnatal OR ‘newborn care’ OR ‘neonatal care’) OR AB (parturition OR pregnancy OR pregnancies OR pregnant OR gestat* OR Prenatal OR ‘Pre natal’ OR ‘Pre-natal OR ante-natal OR ‘ante natal’ OR antenatal OR ‘peri natal’ OR perinatal OR peri-natal OR ‘post natal’ OR post-natal OR postnatal OR ‘newborn care’ OR ‘neonatal care’)
7	TI (illness OR illnesses OR disease OR diseases OR ailed OR suffering OR pain) OR AB (illness OR illnesses OR disease OR diseases OR ailed OR suffering OR pain)
8	6 OR 7
9	TI (‘Childbirth assistance’ OR ‘delivery assistance’ OR ‘assisted delivery’ OR ‘Assisted Parturition’ OR ‘Assisted childbirth) OR AB (‘Childbirth assistance’ OR ‘delivery assistance’ OR ‘assisted delivery’ OR ‘Assisted Parturition’ OR ‘Assisted childbirth)
10	(MH "Prenatal Care")
11	TI (monitoring OR ‘follow up’ OR exam* OR visit OR ‘education OR treatment OR ‘follow up’ OR follow-up OR Screening OR screen OR test OR tests OR testing OR diagnosis OR care OR consultation OR service OR visit OR diagnosis) OR AB (monitoring OR ‘follow up’ OR exam* OR visit OR ‘education OR treatment OR ‘follow up’ OR follow-up OR Screening OR screen OR test OR tests OR testing OR diagnosis OR care OR consultation OR service OR visit OR diagnosis)
12	TI (Ceasarean OR caesarian OR section OR cesarian OR "cesarean section" OR "caesarean section" OR CS OR C-S OR "C Section" OR C-Section OR "abdominal delivery" OR "abdominal deliveries" OR "cesarean birth" OR "cesarian birth" OR "cesarean deliveries" OR "cesarian deliveries" OR "cesarean delivery" OR "cesarian delivery") OR AB (Ceasarean OR caesarian OR section OR cesarian OR "cesarean section" OR "caesarean section" OR CS OR C-S OR "C Section" OR C-Section OR "abdominal delivery" OR "abdominal deliveries" OR "cesarean birth" OR "cesarian birth" OR "cesarean deliveries" OR "cesarian deliveries" OR "cesarean delivery" OR "cesarian delivery")
13	(MH "Childbirth") OR (MH "Childbirth Education")
14	(MM "Delivery, Obstetric+")
15	9 OR 10 OR 11 OR 12 OR 13 OR 14
16	TI (Uninsured OR insurance OR ‘without health insurance’ OR ‘Uninsured patient*’) OR AB (Uninsured OR insurance OR ‘without health insurance’ OR ‘Uninsured patient*’)
17	(MM "Insurance, Health+")
18	16 OR 17
19	5 AND 8 AND 15 AND 18

Study selection

A librarian of the Université du Québec en Outaouais (CS) will be responsible for applying the search strategy and extracting articles from the databases in order to prepare the EndNote bibliographic database. This database will then be cleaned and duplicates removed before exporting the articles to Rayyan platform. The selection of articles will be based on the inclusion and exclusion criteria defined by the PICO and will be done in two stages. At the first stage of selection, an article will be eligible if, through its title and abstract, it is possible to clearly identify the PICO in relation to those selected for the study. To do this, two researchers will independently examine the title and the abstract of the articles identified according to an algorithm built with predetermined eligibility criteria (Fig 1) and will justify in writing the eligibility of the articles. An article will be retained if both declare it eligible. Any disagreement will be resolved either by discussion, or by another co-researcher who will review the title and abstract and give a verdict. The article will be retained if two of these three people declare it eligible. This is an iterative process in which the researchers involved in the project will meet at the beginning, middle and end of the abstract review phase to discuss challenges and uncertainties related to the selection of studies in order to refine the research strategy if necessary. At the final stage, eligible articles will be read in their entirety. For any question regarding the content of an article, the authors will be contacted for further clarification. To harmonize the selection process, the selection of 10% of the articles will be discussed by all researchers beforehand.

Fig 1

First round screening algorithm of a peer‐reviewed paper.

Data extraction

We developed a data extraction grid (S2 Appendix) that is an adaptation of the grid used by Stirling Cameron et al. [26] in their scoping review on access to and use of sexual and reproductive health services by refugee and asylum-seeking women in high-income countries. This grid, built in an excel spreadsheet, will allow the extraction of the following information: name of authors; year of publication; country; title and abstract; study design; study population; sample size; interventions (antenatal care, immediate obstetric and neonatal care, postpartum care, newborn care, policies and practices in favor of this care); impact; strengths; weaknesses; and cost of implementation of these interventions. Because the data extraction process is iterative, the data extraction grid will be updated by the researchers as the data extraction progresses. Two researchers will independently extract data from the first five studies, and then meet to harmonize the data extraction (consistent with the research question and purpose of the study).

Data analysis

The data analysis will be done in four steps: 1) organizing the studies into logical categories related to the targeted objectives; 2) reporting the results by intended objectives; 3) examining their meaning; 4) comparing the interventions implemented and their outcomes in regard to the setting (high-, medium- or low-income country), and 5) discussing the implications for future research, clinical practice, and health policy. In addition, a narrative summary will describe how the results are related to the research questions. The results that will be obtained, i.e., the interventions in favor of access to perinatal care by PMWMIs, the impact, strengths, weaknesses, and cost of implementation of these interventions, will be submitted for expert review as described in the following section.

Expert consultation

This process is based on a participatory approach [27] in order to deepen the results [15] and to constructively contextualize [28] the identified interventions with expert researchers and practitioners whose work focuses on access to sexual and reproductive health services for vulnerable persons and immigrant women. In addition to the researchers, 15 experts who will take part in this workshop will have the following profiles: (i) academics (three) working in the field of the access to perinatal care for vulnerable populations; (ii) experts (three) of a non-governmental organization (NGO) that provide perinatal care to vulnerable populations; (iii) experts (three) of community-based organizations that provide perinatal care to PMWMI; (iv) experts (three) who work or have worked in a municipality’s immigration team; (v) experts (three) of the public health system and who are familiar with the issues of access to perinatal services for PMWMI. Experts will be identified and invited by email to participate in a workshop. Upon their agreement, written informed consent will be obtained prior to the start of the workshop. Due to the context of the COVID-19 pandemic, the deliberative workshop will be virtual via a Zoom platform. It will address the following questions: (i) What interventions would promote access to perinatal services for PMWMI in the Quebec context? (ii) Which are the most promising and affordable (efficient) for this population in Quebec? (iii) What recommendations (for policy makers, community organizations, NGOs) could be made based on the interventions identified? The deliberative workshop will take approximately three hours. It will be conducted in four stages: (1) The first (30 minutes) will be the presentation of the results of the scoping review by the research team; (2) The second (45 minutes) will be group work, four groups of 5–6 people. Each group will discuss in depth the questions posed and summarize them; (3) The third (60 minutes) will consist of a plenary presentation of the conclusions of the group work; (4) Finally, the research team will synthesize the recommendations and present them in plenary for final validation (30 minutes).

This project has been accepted by the Research Ethics Committee of the Université du Québec en Outaouais. Written informed consent will be required from the experts who will be joining the consultation session.

Discussion

Our project aims to identify interventions that support access to perinatal care for pregnant migrant women without medical insurance by answering broad research questions and providing an overview of the literature. Thus, a scoping review described above is more appropriate for this study than the more common systematic review. Also, by using this approach we can determine whether it is appropriate to undertake a full systematic review. Another strength of this approach is the fact that it allows, through the consultation of experts, to deepen and adapt the results obtained [29].

Although the results of this scoping review should be interpreted with caution as only French or English studies will be considered and their quality is not assessed. In addition, a scoping review focuses on the mapping and scope of studies, rather than the depth of information; it describes what is known rather than providing new knowledge. These limitations are inherent in this method and do not affect the results that will be obtained. At the end of the expert consultation, the most promising and appropriate interventions will be identified to facilitate access to perinatal services by PMWMIs in the Quebec province of Canada. In addition to a scientific article, an advocacy and policy brief will also be drafted and submitted to policy makers in charge of immigration and migrant health to facilitate the consideration and integration of the results obtained.

Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist.

(DOCX)

Click here for additional data file.

Complete list of countries considered.

(DOCX)

Click here for additional data file.

Extraction grid.

(DOCX)

Click here for additional data file.

22 Oct 2021

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Kelli K Ryckman

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for stating the following financial disclosure:

“Yes, this project has been funding by the SHERPA University Institute via 2020-2021 annual competition to support researchers of the SHERPA University Institute and by the Social Sciences and Humanities Research Council (SSHRC) via SSHRC institutional grants - winter 2021 competition”

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.

4. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“Acknowledgements:

We would like to thank the SHERPA University Institute and The Social Sciences and Humanities Research Council (SSHRC) for funding the project.

Funding:

This project has been funding by the SHERPA University Institute via 2020-2021 annual competition to support researchers of the SHERPA University Institute and by the Social Sciences and Humanities Research Council (SSHRC) via SSHRC institutional grants - winter 2021 competition.”

We note that you have provided additional information within the Acknowledgements Section. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“Yes, this project has been funding by the SHERPA University Institute via 2020-2021 annual competition to support researchers of the SHERPA University Institute and by the Social Sciences and Humanities Research Council (SSHRC) via SSHRC institutional grants - winter 2021 competition”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

5. We note that you have referenced (Open Grey, Wholis, unpublished reports]) which has currently not yet been accepted for publication. Please remove this from your References and amend this to state in the body of your manuscript: (“Open Grey, Wholis, [unpublished reports]”) as detailed online in our guide for authors

http://journals.plos.org/plosone/s/submission-guidelines#loc-reference-style

6. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.

7. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

8. We note that this manuscript is a systematic review or meta-analysis; our author guidelines therefore require that you use PRISMA guidance to help improve reporting quality of this type of study. Please upload copies of the completed PRISMA checklist as Supporting Information with a file name “PRISMA checklist”.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Partly

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a well written scoping review proposal to identify interventions to improve access to perinatal care for migrant women without medical insurance.

A clear structure for the review is given, with a comprehensive search strategy, inclusion and exclusion criteria given.

I have one main critique:

Within the data analysis section it states in step 4 that they will be: “discussing the implications for future research, clinical practice, and health policy.” The methodological framework for scoping reviews developed by Arksey & O’Malley (2005) specifically states that due to the quality of studies not being assessed within a scoping review that as a result the generalisability and robustness of the studies cannot be determined. Careful consideration therefore needs to be given to the extent to which their scoping review results will lead to implications for policy and practice, or further justification given if they do feel this is appropriate.

All other comments are of a very minor nature:

The sentence in the introduction: “These women also have a high prevalence of postpartum depression6, parasitic7 and other infectious diseases (Hepatitis B; Hepatitis C; HIV) / AIDS) due to the challenges experienced in accessing perinatal care8.” Currently reads as though women are at risk of infectious diseases due to the challenges of accessing perinatal care, but my understanding is that these infections are already present but make accessing care early all the more necessary.

No explanation/justification is given as to why the search begins from the date 2000.

If there are any questions regarding the content of an article, will the article authors be contacted in any way for clarification?

Please ensure correct ordering of Tables / Appendices – ie in the text Table 3 is referred to prior to Table 2 and Appendix 2 prior to Appendix 1 – please reorder correctly.

Please note the abbreviation is incorrect in several places – ie PMWMI has been replaced by the incorrect PMWNI (seen in abstract and introduction – but please check throughout).

Table 3: In English “échappées belles" are normally termed “near misses”. I had to Google for a translation to the above term, so it could help some readers if both terms were used within the table.

Appendix 1: Is it possible to rotate the table by 90 degrees for publication, so that the columns become rows to make it easier for the reader to see what data will be extracted.

Appendix 2: Please add the World Bank reference from the text to the Appendix as well

Figure 1: In the legend it states “4: Time horizon ...” – however this is not added into the actual diagram at present.

Reviewer #2: The authors of this scoping review are seeking to addresses an important issue, and their overall approach is well-suited to the topic of inquiry. It will make an important contribution to the literature on maternity care for migrant women, and it is strengthened by the element of expert consultation which is included. However, the protocol is unclear in places and would benefit from further refining. I would suggest the following points are considered:

Major issues

1. p.3 – In the opening paragraph, the authors make reference to challenges faced by migrant women accessing maternity care in high-income countries. However, listed in Appendix 2 it is stated that both high-income countries as well as low- and middle-income countries will be included in this review, which is a little confusing for the reader and needs to be clarified. In addition, it will be helpful for the authors somewhere in the paper to discuss how they will deal with the differences in findings from the varying contexts of HICS’s vs LMIC’s.

2. p.3 – The introduction paints a picture of catch-all poor perinatal outcomes for migrant women. As the authors correctly acknowledge, migrant women constitute a heterogeneous group and the research is equivocal about obstetric outcomes for some migrant women, citing the healthy migrant effect. A more nuanced introduction would strengthen the introductory section.

3. p.4 – In the ‘population’ paragraph, the authors quote the definition of ‘migrant’ which describes voluntary migration, but then later on state that studies which include asylum seekers will be considered. Although migrant categories are hard to define and overlapping, for the purpose of this scoping review, it would be helpful to clearly outline what the authors are referring to by ‘migrant women’ – is this all categories of migrants, whether forced or voluntary, as the search terms suggest? If so, the definition of ‘migrant women’ which the authors cite needs adapting. Does it include those who migrate within their country (as the International Organization for Migration definition includes)?

4. p.4 – In the ‘intervention’ paragraph, the authors discuss the intervention in the PICO framework as being the actual maternity or newborn care which women receive. However, on p.3 the research question states that the authors are interested in “interventions that facilitate access to perinatal care”. There needs to be further clarity as to whether it’s perinatal care itself or interventions to facilitate access to perinatal care that is the topic of inquiry, which then needs to be reflected in the protocol title and the intervention.

5. p.4 – Newborn care is listed in the ‘intervention’ paragraph but related search terms are not included in the search strategy.

6. p.4 – In the ‘comparator and design’ section, the authors state the study inclusion criteria. From my understanding of this scoping review and according to the PICO framework, there is no ‘comparator’ in this review, so this needs to be reworked.

7. p.4/5 – In the ‘data sources’ paragraph, it is stated that grey literature will be included, but earlier on p.4 in the ‘comparator and design’ section, the authors state that all empirical scientific studies will be included – it would help the reader to understand the inclusion criteria if the authors state whether they are only going to include peer-reviewed published studies or studies that are not peer-reviewed.

Minor issues

p.3 – In the second paragraph of the introduction, the authors state that using a scoping review will allow them to synthesise the interventions, and yet there is not further mention of data synthesis in the paper. Arksey and O’Malley (2005) do not require data synthesis in their approach to scoping reviews – this just needs to be clarified in the manuscript.

This an important piece of work to conduct, and with the above revisions / clarifications, I believe it will lead to a scoping review which will contribute to the corpus of knowledge relating to maternity care for migrant women. However, based on the revisions / clarifications needed, I suggest that this protocol needs major revisions.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Esther Sharma

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

15 Dec 2021

We already uploaded response to reviewers file.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

12 Jan 2022

14 Feb 2022

Kelli K Ryckman

Academic Editor

PLOS ONE

Dear Kelli K Ryckman

We would like to thank the reviewers for their thorough critics and comments concerning our manuscript " Interventions facilitating access to perinatal care for migrant women without medical insurance: a scoping review protocol " (PONE-D-21-27767). The manuscript has been revised according to the journal requirements and to comments of our reviewers and we have addressed all their questions.

Our answers are written in italics under each comment made by the reviewers and the changes related to these comments are presented in the text of the article, with track changes.

I. Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Response: Reference list has been revised and no change made.

II. Reviewer #1:

Thank you for the opportunity to re-review this article. There are still a couple of areas that require clarification before publication to ensure consistency throughout the manuscript.

1. There still seems to be some confusion over the inclusion of grey literature. The abstract states “Grey literature will also be searched” and the search strategy states that “(iv) sites of non-governmental organizations (Médecin du monde, Médecin sans Frontières (MSF), United Nations High Commissioner for Refugees (UNHCR)” will be searched, which would be expected to find grey literature. However, the response to the reviewers states that grey literature has been removed from the data sources. Please ensure the whole manuscript is consistent regarding this, making it explicit whether unpublished studies will be included.

Response: Thanks for the comment. We will be considering only publications from the three main non-governmental organizations involved in addressing issues concerning migrant women without medical insurance, namely Médecin du monde, Médecin sans Frontières (MSF), United Nations High Commissioner for Refugees (UNHCR). There for we will not search into any other sources except the aforementioned.

Through out the manuscript, our consideration in terms of data sources include the 12 databases and three websites.

2. The study selection currently appears to read that if the PICO for your review is not clearly identifiable in the title / abstract that you will exclude the study. Within a review it is usual to retain ‘potentially eligible’ studies at this stage too, where aspects of your inclusion/ exclusion criteria for the review are not fully reported in the title / abstract of the retrieved citation but may be reported if the full article is read. The flow chart suggests that studies will be included if the abstract does not provide adequate detail – but the prose needs to reflect this too. eg as stated by Askey and O’Malley (2005) “If the relevance of a study is unclear from the abstract, then the full article will be obtained.”

Response: Sorry for the misunderstanding. In order to light more the reader, we added in the legend of figure 1 an explanation as follow: “The plain text twill be considered for reading”. This means that any inclusion at that stage remains potentially eligible and then will be reassessed in reading the plain text.

3. Expert consultation section – states that informed consent will be obtained, but in the ethics declaration it states that consent is not required. Could the ethics statement be updated to better reflect that while consent is not required for the review, consent will be gained for the expert consultation workshops? This will provide better consistency through the manuscript.

Response: We thank you for this important comment. We formulate the following excerpt: Written informed consent will be required from the experts who will be joining the consultation session. Please, see on P 7.

4. In the version provided Figure 1 does not states “ye” not “yes” and “exclu” not “exclude”. I presume this would be rectified if we had a copy of the actual Figure?

Response: Thanks. The wording has been adjusted in the algorithm in Figure 1.

5. The definition of migrant no longer reads well – it would be better as "a person who has

voluntarily moved or is forced to move, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons …”

Response: Thanks a lot for the suggestion. We truly found it very readable. So, we take it into account. Please see on P 4.

6. I agree with the other reviewer that there is lack of clarity over the word ‘synthesize’. The authors need to give a plan for how data will be ‘synthesized’ within the expert consultation. Alternatively, would the word ‘summarize’ better describe the planned process that the word ‘synthesize’? This would also potentially more closely reflect the approach proposed by Askey and O’Malley (2005).

Response: Thank you. As suggested, we change the word ‘synthezise’ to ‘summarize’. Please see on P 7

Submitted filename: Response to Reviewers-14janv2022.docx

Click here for additional data file.

28 Feb 2022

Interventions facilitating access to perinatal care for migrant women without medical insurance: a scoping review protocol

PONE-D-21-27767R2

Dear Dr. Sia,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Kelli K Ryckman

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

4 Mar 2022

PONE-D-21-27767R2

Interventions facilitating access to perinatal care for migrant women without medical insurance: a scoping review protocol

Dear Dr. Sia:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Kelli K Ryckman

Academic Editor

PLOS ONE