Background Maternal age and cohabitation (women living with a partner in marriage or in a common-law relationship) are known to be associated with adverse birth outcomes. However, how these two factors jointly contribute to birth outcomes is not well understood, particularly among minor mothers. Methods All live births that occurred in Argentina 2001–2021 (N=13 807 028) were used to estimate the prevalence of births to minor mothers (<18 years). In analyses restricted to mothers aged ≤24 years (N=5 159 231), multinomial and binary logistic models were used to obtain crude and adjusted ORs (aOR) for the joint association between cohabitation status and maternal age groups (minors: ≤15 and 16–17 years, and young adults: 18–19 years and 20–24 years) with preterm birth (PTB), small-for-gestational age (SGA) groups and repeat birth. Results Minor mothers accounted for 6% of all births (n=791 731), lived in poor regions and were more likely to have incomplete primary education and no employment. Among mothers aged <24 years, adverse outcomes jointly varied according to cohabitation status and maternal age (p value for interaction <0.001 in all models). Adverse outcomes were more frequent among minors. Compared with non-cohabiting mothers aged 20–24 years, cohabiting mothers aged 20–24 years had lower odds of very PTB (0.82% vs 1.19%), moderately PTB (7.15% vs 6.33%), extreme SGA (1.98% vs 2.56%) and moderately SGA (3.63% vs 4.48%, respectively). However, compared with non-cohabiting mothers aged 20–24 years, cohabiting minor mothers, particularly those aged ≤15 years had higher odds of very PTB (24–31 gestation weeks) (AOR: 1.86 (95% CI 1.76, 1.97)), moderately PTB (32–36 weeks) (AOR: 1.53 (95% CI 1.49, 1.57)), extreme SGA (<3rd percentile) (AOR: 1.10 (95% CI 1.06, 1.14)) and moderately SGA (3rd to <10th percentile) (AOR: 1.05 (95% CI 1.01, 1.08)). Conclusions The cohabitation advantage among young adults was not observed among minor mothers, particularly those aged ≤15 years.

The intricate relationship between immigration and health, a complex and multidimensional phenomenon, presents challenges for both receiving and sending countries of immigrants. Given the complex mechanisms involved, understanding and assessing the factors associated with disparities in immigrants’ health is a theoretical, methodological, and empirical challenge. Acknowledging and systematically understanding this phenomenon is crucial for the social cohesion of increasingly diverse countries. This introductory chapter reflects on the multifaceted nature of immigrant health, a theme that subsequent chapters in the book delve into from a more empirical perspective. This chapter first identifies current challenges in studies on immigrant health, offering reflections on these challenges’ effects on contemporary societies. Secondly, it provides an overview of immigration to Spain in recent decades, shedding light on the associated challenges in health policy management. Following this, the conceptual frameworks that guide most of the studies included in this book are presented. Special attention is given to the perspective of the healthy immigrant, discussing their ability to describe and explain phenomena related to immigrant health, along with the recognition of its limitations. The chapter concludes by presenting the main objectives of the book.

Birthweight has been extensively used to construct perinatal indicators for identifying and monitoring newborns at risk. These indicators include measures such as low birthweight (<2500 grams irrespective of gestational age) and being small for gestational age (e.g., birthweight below the tenth percentile for a given gestational age). Determinants of adverse health at birth encompass biological and behavioral factors, often exhibiting a social pattern, with the highest prevalence observed in families of low socioeconomic status. Given the strong link between health and social outcomes throughout the life course, perinatal health is considered a vital dimension for examining how inequalities are (re)produced in society. Although immigrants are categorized as a socially vulnerable group experiencing multiple disadvantages, such as racism and discrimination, international evidence indicates that the offspring of foreign-born (immigrant) mothers often experience similar or even better perinatal health outcomes than their counterparts in the receiving country, which supports the healthy immigrant paradox. In this chapter, we conduct a narrative synthesis of the literature based on a systematic search using two electronic databases (PubMed and Web of Sciences) to identify quantitative studies published in peer-reviewed journals before March 2023. These studies were written in English or Spanish and include the birthweight outcomes of the offspring of immigrant women residing in Spain, with comparison groups consisting of the offspring of Spanish-born women. Using the vote-counting method, we assessed 28 studies that met our inclusion criteria. The findings of our review generally confirm the perinatal health advantage of small children among the offspring of most immigrant-origin mothers in Spain, except for those of African and Asian descent, compared with children of Spanish-born women. However, mothers from most immigrant origins exhibited higher risks than Spanish-born ones of delivering children with macrosomia (high birthweight), which challenges the interpretation of immigrants’ health advantage.

Introduction: Sweden, with its history of restrictive alcohol policies and a large and diverse migrant population, constitutes an interesting context for studies on alcohol consumption patterns in migrant groups. This study examines how hazardous drinking among migrants in Sweden varies by origin, duration of residence and age at migration.

Methods: Pooled cross-sectional survey data from the Västra Götaland region of Sweden, collected in 2011 and 2015, were linked to register data containing demo-graphic, socioeconomic and migration-related factors (i.e., country of birth, duration of residence, age at migration), for 7754 migrants and 68,493 Swedish-born individuals aged 18–84 years. Logistic regression analyses were applied to estimate odds ratios (OR) and 95% confidence intervals (CI) for hazardous drinking, identified by the validated Alcohol Use Disorders Identification Test.

Results: Relative to Swedish-born individuals, migrants from other Nordic countries had higher odds of hazardous drinking (OR 1.45, 95% CI 1.18–1.77), while migrants from other European (OR 0.55, 95% CI 0.44–0.69) and non-European (OR 0.25, 95% CI 0.20–0.31) countries showed lower likelihoods. Among non-Nordic migrants in particular, hazardous drinking was more common among those with a longer duration of residence and those who migrated at pre-school ages.

Discussion and Conclusions: Hazardous drinking among non-Nordic migrants increasingly resembled that of the Swedish-born population over time, aligning with findings in less restrictive alcohol policy contexts. Understanding how drinking patterns vary among migrant groups over time and across policy contexts is essential for developing effective public health strategies to reduce hazardous consumption and associated health and social harms.

Background  Parental leave generosity is protective for mothers’ mental health in the postpartum period and beyond. Strong work requirements exist for parents in Sweden to receive more generous benefits which might penalise individuals who, due to poor health, have a weak labour market attachment. The aim of the study was to examine whether mothers with poor health prior to pregnancy are less likely to be eligible for more generous benefits in Sweden.

Methods  We used total population registers to study first-time mothers, aged 25–45 years, who were resident in Sweden and gave birth between 1 January 2009 and 30 September 2013 (n = 151,452). We used logistic regression to examine the association between health one and two consecutive years prior to pregnancy (to assess chronicity) and eligibility for earnings-related parental leave benefits.

Results  Mothers who were admitted to hospital or received specialist outpatient care for any health condition in the year prior to pregnancy were less likely to be eligible for earnings-related benefits (OR 0·79, 95%CI 0·76–0·83) compared to healthy mothers, particularly those with chronic health issues (OR 0·64, 95%CI 0·62–0·68). Findings were driven by mothers with mental disorders (OR 0·22, 95%CI 0·20–0·23 for the year before pregnancy), and associations were stronger for those with chronic health issues and for Swedish-born mothers.

Conclusion  Mothers with prior health conditions, particularly mental disorders, are less likely to benefit from the protective health effect of parental leave as they may not meet the eligibility requirements for more generous remunerations. This study highlights how the strong work requirement for accessing generous parental leave benefits could unintentionally exacerbate socioeconomic inequalities between mothers with and without poor mental health. Easing work requirements for eligibility to more generous parental leave remuneration could help reduce these inequalities and thus promote better mental health for all, particularly among more disadvantaged groups. As such, our findings empirically support the need for adopting the Health in All Policies framework when designing parental leave policies in order to minimise health inequalities.

In this concluding chapter, we outline key lessons for both public interventions and future research that emerge from the comprehensive exploration of immigrant health throughout this book. The discussion of lessons for public interventions underscores the importance of recognizing that immigrants are not a burden on the healthcare system. Furthermore, the need to safeguard rights without taking them for granted and the imperative of moving beyond universal access to health as a standalone solution are highlighted. When outlining lessons for future research, the chapter emphasizes the importance of adopting a context-sensitive approach. A call for a multidisciplinary perspective to be the future of immigrant health research is made, acknowledging the ongoing challenges associated with developing new theoretical frameworks. The underexploited life course perspective is identified as a crucial avenue for future exploration, accompanied by a resounding plea for more and better data to foster a better understanding of immigrant health.

Children of immigrants born in the host country–the second generation (G2)–face higher risks of unemployment and overqualification compared to the majority native population in Western Europe. While the health effects of unemployment and overqualification are well documented, it remains unclear whether these factors impact the mental health of the G2 in the same way as in the majority population. This study uses Swedish register data to examine the association between different labor market disadvantages, i.e., unemployment and overqualification, and mental health outcomes among the G2 and the majority population. The outcome was measured as time to the first prescription of psychotropic medications (anxiolytics, sedatives, hypnotics, and antidepressants). Descriptive findings showed that psychotropic prescription rates are higher among G2 groups compared to the majority population. Cox proportional hazards models, adjusted for demographic and socioeconomic factors, indicated that unemployment similarly impacts mental health across origin groups, suggesting that being unemployed does not contribute to the mental health inequality between the G2 and the majority population. G2 individuals, especially G2 European individuals, showed higher risks of psychotropic prescriptions across all employment types. These findings imply that improving the labor market position is not sufficient to address mental health inequalities between the G2 and the majority population.

Importance: Generous parental leave benefits have been associated with better mental health outcomes for parents after childbirth. However, few studies account for preconception mental health and working conditions, the latter being a requirement for generous parental leave benefits. Objective: To evaluate the association between levels of parental leave benefits and maternal postpartum mental health when preconception mental health, income, and employment status were considered. Design, Setting, and Participants: This population-based nationwide cohort study included first-time mothers aged 18 to 52 years who gave birth to a live singleton offspring between January 1, 2007, and December 31, 2011. Data were analyzed from March 8 to February 18, 2025. Exposure: Paid parental leave benefits, including higher level (qualified for earnings-related benefits equal to approximately 80% of their salary) vs basic level (a flat-rate benefit for those not meeting the work requirements for earnings-related benefits). Main Outcomes and Measures: Nationwide registers were used to perform multivariable logistic regression to calculate the odds of mental health outcomes from different levels of severity (prescription of antidepressants or anxiolytics, specialist outpatient care, and hospitalization) between mothers receiving higher-level and basic benefits. Decomposition analyses using the Karlson-Holm-Breen method were conducted to examine the contribution of preconception mental health, income, and employment status. Results: The sample included 210 800 first-time mothers (mean [SD] age, 28.6 [5.0] years), of whom 35 255 (16.72%) received basic benefits and 175 545 (83.28%) qualified for higher-level benefits. Mothers receiving basic benefits had higher odds of being prescribed antidepressants or anxiolytics (odds ratio [OR], 1.44; 95% CI, 1.37-1.51), receiving specialist outpatient care (OR, 2.27; 95% CI, 2.13-2.44), and being hospitalized (OR, 2.47; 95% CI, 2.06-2.97) compared with mothers receiving higher-level benefits. Higher odds remained after adjusting for preconception mental health, accounting for a 46.1% decrease for prescribed antidepressants or anxiolytics, 15.1% for outpatient care, and 10.7% for hospitalization. After adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR, 1.13; 95% CI, 1.02-1.24) and hospitalization (OR, 1.34; 95% CI, 1.03-1.76). Conclusions and Relevance: In this cohort study of first-time mothers in Sweden, higher-level benefits were associated with better mental health, particularly moderate-to-severe mental disorders. However, since eligibility for higher-level parental leave benefits is contingent on labor market attachment, both improving women's labor market attachment and relaxing the work requirements for higher-level parental leave could promote women's postpartum mental health.

Objective: This study aimed to examine differences in premature and early menopause across various regions in low and middle-income countries (LMICs). Methods: Data for 55 LMICs from the Demographic and Health Surveys (2013–2023) were classified into nine regions. Proportions of premature (aged <40 years) and early (aged <45 years) menopause were calculated. Logistic regressions adjusted for covariates were also run. Results: The proportion of women in premature menopause ranged from 1.58% in the European and Eastern Mediterranean regions to 6.87% in Southern Africa. For early menopause, proportions ranged from 4.92% in the Eastern Mediterranean region to 15.21% in the Americas. The Eastern Mediterranean region had systematic lower odds across menopause categories, even after the adjustments for relevant covariates. Conclusion: Significant variation exists in the proportion of the different age at menopause categories within LMIC regions. Higher proportions of premature and early menopause were found in all LMIC regions compared to those reported in current literature from high-income countries. A global health perspective on menopause is urgently needed, especially in relation to the increased disease risks with early and premature menopause, such as cardiovascular disease.

This essay offers an analysis of research on return migration and health by adopting the social determinants of health (SDH) framework proposed by the WHO. Specifically, we argue that the SDH are implicated in the decision to migrate, stay or return, which in itself also contributes to social health inequities. Most theoretical frameworks developed to study migration have predominantly considered primary migration movements. The lack of a fluid consideration of the migration phenomenon has a direct impact on our understanding of the relationship between migration and health. In this essay, we, first, address the challenges of defining and studying return and its implications for health research. Second, we propose to use the WHO's SDH framework to understand how social factors shape migrants' health, influence the decision to return and can contribute to health inequalities. The conceptual approach developed in this paper can help design future studies on the health of return migrants, fostering interdisciplinary collaborations to investigate how social factors are embodied, giving rise to health inequities in society that are intricately linked to the migration experience.