
Enhanced Maternity care for Migrant women in Norway (Emma-Nor)
Emma-Nor is a research project with a focus on maternal and perinatal health in a migration context.
Migrant women, who constitute 28 % of new mothers in Norway, experience poorer pregnancy outcomes, such as stillbirth and preterm birth, compared with non-migrant women. However, this highly heterogeneous population has both higher and lower risks for adverse outcomes, differing in migrant history, length of residence, socioeconomics, language proficiency, health literacy, and physical and mental health.
In this project we identify subgroups of migrant women with particularly high-risk for complications and adverse pregnancy outcomes through epidemiological studies. We deepen understanding via qualitative research, and then design, evaluate, and implement sustainable interventions to improve antenatal-, intrapartum- and postpartum care for migrant women through randomized controlled trials (RCTs) and process evaluations.
We investigate associations between migrant-related factors, such as maternal country of birth, reason for migration and length of residence and different outcomes, by means of epidemiological studies using data from the Medical Birth Register and Statistics Norway.
Projects
In Emma-Nor we have identified subgroups of migrant women with particularly high-risk for complications and adverse pregnancy outcomes through epidemiological studies. We have deepened understanding via qualitative research, and designed, evaluated, and implemented interventions to improve antenatal care (group antenatal care for Somali women in Sweden, Hooyo), intrapartum care (Community-based doula support) through randomized controlled trials (RCTs) and process evaluations.
Currently, we are developing and evaluating a risk-assessment tool for antenatal care in Norway (PreGO). We are also planning for a trial on Mother-to-mother proactive telephone support to prevent postpartum depression in migrant women, a collaborative project with Australian researchers.
Epidemiology
Publications
Stalheim, A. M., Nilsen, R. M., Vangen, S., Vik, E. S., Alnæs‐Katjavivi, P., Iversen, M. M.,& Strandberg, R. B. (2026). Adverse pregnancy outcomes in women with type 1 diabetes: A nationwide, population‐based study, 1999–2021. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.70215
Nilsen, R. M., Strandberg, R. B., Yaya, Y., Fismen, A. S., Macsali, F., Morken, N. H., & Sørbye, L. M. (2024). Pre-pregnancy obesity among immigrant and non-immigrant women in Norway: Prevalence, trends, and subgroup variations. Acta Obstetricia et Gynecologica Scandinavica, 103(10), 2081–2091.https://doi.org/10.1111/aogs.14843
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2023). Associations between non-registered ultrasound examination in pregnancy and adverse perinatal outcomes in immigrant and non-immigrant women: A Norwegian population-based study 1999–2016. Scandinavian Journal of Public Health. https://doi.org/10.1177/14034948241274596
Stalheim, A. M., Iversen, M. M., Jenum, A. K., Sletner, L., Stafne, S. N., Qvigstad, E., & Strandberg, R. B. (2023). Seasonal variation in gestational diabetes mellitus among women in Norway: A national population-based study. BMJ Open, 13(3), e063725. https://doi.org/10.1136/bmjopen-2022-063725
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2023). Risk of subsequent preeclampsia by maternal country of birth: A Norwegian population-based study. International Journal of Environmental Research and Public Health, 20(5), 4109. https://doi.org/10.3390/ijerph20054109
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2021). Placental abruption in immigrant women in Norway: A population-based study. Acta Obstetricia et Gynecologica Scandinavica, 100(4), 658–665. https://doi.org/10.1111/aogs.14053
Vik, E. S., Aasheim, V., Nilsen, R. M., Small, R., Moster, D., & Schytt, E. (2020). Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study. PLOS Medicine, 17(11), e1003395. https://doi.org/10.1371/journal.pmed.1003395
Vik, E., Nilsen, R., Aasheim, V., Small, R., Moster, D., & Schytt, E. (2020). Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: A population-based study. BMC Health Services Research. https://doi.org/10.21203/rs.2.19047/v2
Strandberg, R. B., Nilsen, R. M., Morken, N. H., & Vik, E. S. (2020). Gestational diabetes mellitus by maternal country of birth and length of residence in immigrant women in Norway. Diabetic Medicine. https://doi.org/10.1111/dme.14255
Aasheim, V., Nilsen, R. M., Morken, N. H., & Schytt, E. (2020). Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration-related factors. Sexual & Reproductive Healthcare, 26, 100553. https://doi.org/10.1016/j.srhc.2020.100553
Vik, E., Aasheim, V., Schytt, E., Small, R., Moster, D., & Nilsen, R. (2019) Stillbirth in relation to maternal country of birth and other migration-related factors: A population-based study in Norway. BMC Pregnancy and Childbirth, 19(1), 5. https://doi.org/10.1186/s12884-018-2140-3
Nilsen, R. M., Strandberg, R. B., Yaya, Y., Fismen, A. S., & Morken, N. H. (2019). Preconception folic acid supplement use in immigrant women (1999–2016). Nutrients, 11(10), 2300. https://doi.org/10.3390/nu11102300
Nilsen, R. M., Strandberg, R. B., Morken, N. H., & Vik, E. S. (2018). Preeclampsia by maternal reasons for immigration: A population-based study. BMC Pregnancy and Childbirth, 18(1), 423. https://doi.org/10.1186/s12884-018-2034-4
Costa, R., Rodrigues, C., Dias, H., Covi, B., Mariani, I., Valente, E. P., ... & IMAgiNE EURO study group. (2022). Quality of maternal and newborn care around the time of childbirth for migrant versus non-migrant women during the COVID‐19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region. International Journal of Gynecology & Obstetrics, 159, 39-53.
Juarez SP, Small R, Hjern A, Schytt E. Length of residence and caesarean section in migrant women in Sweden: a population-based study. Eur J Public Health. 2018
Juarez SP, Small R, Hjern A, Schytt E. Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study. Paediatr Perinat Epidemiol. 2017;31(6):509-21.
Berbres M, Hesselman S, Ternstrom E, Schytt E. Women's use of Swedish health care during the postpartum period in relation to maternal country of birth-A population-based study. Acta Obstet Gynecol Scand. 2024;103(10):2101-11.
Publikasjonar
Stalheim, A. M., Nilsen, R. M., Vangen, S., Vik, E. S., Alnæs‐Katjavivi, P., Iversen, M. M.,& Strandberg, R. B. (2026). Adverse pregnancy outcomes in women with type 1 diabetes: A nationwide, population‐based study, 1999–2021. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.70215
Nilsen, R. M., Strandberg, R. B., Yaya, Y., Fismen, A. S., Macsali, F., Morken, N. H., & Sørbye, L. M. (2024). Pre-pregnancy obesity among immigrant and non-immigrant women in Norway: Prevalence, trends, and subgroup variations. Acta Obstetricia et Gynecologica Scandinavica, 103(10), 2081–2091.https://doi.org/10.1111/aogs.14843
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2023). Associations between non-registered ultrasound examination in pregnancy and adverse perinatal outcomes in immigrant and non-immigrant women: A Norwegian population-based study 1999–2016. Scandinavian Journal of Public Health. https://doi.org/10.1177/14034948241274596
Stalheim, A. M., Iversen, M. M., Jenum, A. K., Sletner, L., Stafne, S. N., Qvigstad, E., & Strandberg, R. B. (2023). Seasonal variation in gestational diabetes mellitus among women in Norway: A national population-based study. BMJ Open, 13(3), e063725. https://doi.org/10.1136/bmjopen-2022-063725
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2023). Risk of subsequent preeclampsia by maternal country of birth: A Norwegian population-based study. International Journal of Environmental Research and Public Health, 20(5), 4109. https://doi.org/10.3390/ijerph20054109
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2021). Placental abruption in immigrant women in Norway: A population-based study. Acta Obstetricia et Gynecologica Scandinavica, 100(4), 658–665. https://doi.org/10.1111/aogs.14053
Vik, E. S., Aasheim, V., Nilsen, R. M., Small, R., Moster, D., & Schytt, E. (2020). Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study. PLOS Medicine, 17(11), e1003395. https://doi.org/10.1371/journal.pmed.1003395
Vik, E., Nilsen, R., Aasheim, V., Small, R., Moster, D., & Schytt, E. (2020). Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: A population-based study. BMC Health Services Research. https://doi.org/10.21203/rs.2.19047/v2
Strandberg, R. B., Nilsen, R. M., Morken, N. H., & Vik, E. S. (2020). Gestational diabetes mellitus by maternal country of birth and length of residence in immigrant women in Norway. Diabetic Medicine. https://doi.org/10.1111/dme.14255
Aasheim, V., Nilsen, R. M., Morken, N. H., & Schytt, E. (2020). Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration-related factors. Sexual & Reproductive Healthcare, 26, 100553. https://doi.org/10.1016/j.srhc.2020.100553
Vik, E., Aasheim, V., Schytt, E., Small, R., Moster, D., & Nilsen, R. (2019) Stillbirth in relation to maternal country of birth and other migration-related factors: A population-based study in Norway. BMC Pregnancy and Childbirth, 19(1), 5. https://doi.org/10.1186/s12884-018-2140-3
Nilsen, R. M., Strandberg, R. B., Yaya, Y., Fismen, A. S., & Morken, N. H. (2019). Preconception folic acid supplement use in immigrant women (1999–2016). Nutrients, 11(10), 2300. https://doi.org/10.3390/nu11102300
Nilsen, R. M., Strandberg, R. B., Morken, N. H., & Vik, E. S. (2018). Preeclampsia by maternal reasons for immigration: A population-based study. BMC Pregnancy and Childbirth, 18(1), 423. https://doi.org/10.1186/s12884-018-2034-4
Costa, R., Rodrigues, C., Dias, H., Covi, B., Mariani, I., Valente, E. P., ... & IMAgiNE EURO study group. (2022). Quality of maternal and newborn care around the time of childbirth for migrant versus non-migrant women during the COVID‐19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region. International Journal of Gynecology & Obstetrics, 159, 39-53.
Juarez SP, Small R, Hjern A, Schytt E. Length of residence and caesarean section in migrant women in Sweden: a population-based study. Eur J Public Health. 2018
Juarez SP, Small R, Hjern A, Schytt E. Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study. Paediatr Perinat Epidemiol. 2017;31(6):509-21.
Berbres M, Hesselman S, Ternstrom E, Schytt E. Women's use of Swedish health care during the postpartum period in relation to maternal country of birth-A population-based study. Acta Obstet Gynecol Scand. 2024;103(10):2101-11.
Publikasjonar
Stalheim, A. M., Nilsen, R. M., Vangen, S., Vik, E. S., Alnæs‐Katjavivi, P., Iversen, M. M.,& Strandberg, R. B. (2026). Adverse pregnancy outcomes in women with type 1 diabetes: A nationwide, population‐based study, 1999–2021. Acta Obstetricia et Gynecologica Scandinavica. https://doi.org/10.1111/aogs.70215
Nilsen, R. M., Strandberg, R. B., Yaya, Y., Fismen, A. S., Macsali, F., Morken, N. H., & Sørbye, L. M. (2024). Pre-pregnancy obesity among immigrant and non-immigrant women in Norway: Prevalence, trends, and subgroup variations. Acta Obstetricia et Gynecologica Scandinavica, 103(10), 2081–2091.https://doi.org/10.1111/aogs.14843
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2023). Associations between non-registered ultrasound examination in pregnancy and adverse perinatal outcomes in immigrant and non-immigrant women: A Norwegian population-based study 1999–2016. Scandinavian Journal of Public Health. https://doi.org/10.1177/14034948241274596
Stalheim, A. M., Iversen, M. M., Jenum, A. K., Sletner, L., Stafne, S. N., Qvigstad, E., & Strandberg, R. B. (2023). Seasonal variation in gestational diabetes mellitus among women in Norway: A national population-based study. BMJ Open, 13(3), e063725. https://doi.org/10.1136/bmjopen-2022-063725
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2023). Risk of subsequent preeclampsia by maternal country of birth: A Norwegian population-based study. International Journal of Environmental Research and Public Health, 20(5), 4109. https://doi.org/10.3390/ijerph20054109
Mæland, K. S., Morken, N. H., Schytt, E., Aasheim, V., & Nilsen, R. M. (2021). Placental abruption in immigrant women in Norway: A population-based study. Acta Obstetricia et Gynecologica Scandinavica, 100(4), 658–665. https://doi.org/10.1111/aogs.14053
Vik, E. S., Aasheim, V., Nilsen, R. M., Small, R., Moster, D., & Schytt, E. (2020). Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study. PLOS Medicine, 17(11), e1003395. https://doi.org/10.1371/journal.pmed.1003395
Vik, E., Nilsen, R., Aasheim, V., Small, R., Moster, D., & Schytt, E. (2020). Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: A population-based study. BMC Health Services Research. https://doi.org/10.21203/rs.2.19047/v2
Strandberg, R. B., Nilsen, R. M., Morken, N. H., & Vik, E. S. (2020). Gestational diabetes mellitus by maternal country of birth and length of residence in immigrant women in Norway. Diabetic Medicine. https://doi.org/10.1111/dme.14255
Aasheim, V., Nilsen, R. M., Morken, N. H., & Schytt, E. (2020). Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration-related factors. Sexual & Reproductive Healthcare, 26, 100553. https://doi.org/10.1016/j.srhc.2020.100553
Vik, E., Aasheim, V., Schytt, E., Small, R., Moster, D., & Nilsen, R. (2019) Stillbirth in relation to maternal country of birth and other migration-related factors: A population-based study in Norway. BMC Pregnancy and Childbirth, 19(1), 5. https://doi.org/10.1186/s12884-018-2140-3
Nilsen, R. M., Strandberg, R. B., Yaya, Y., Fismen, A. S., & Morken, N. H. (2019). Preconception folic acid supplement use in immigrant women (1999–2016). Nutrients, 11(10), 2300. https://doi.org/10.3390/nu11102300
Nilsen, R. M., Strandberg, R. B., Morken, N. H., & Vik, E. S. (2018). Preeclampsia by maternal reasons for immigration: A population-based study. BMC Pregnancy and Childbirth, 18(1), 423. https://doi.org/10.1186/s12884-018-2034-4
Costa, R., Rodrigues, C., Dias, H., Covi, B., Mariani, I., Valente, E. P., ... & IMAgiNE EURO study group. (2022). Quality of maternal and newborn care around the time of childbirth for migrant versus non-migrant women during the COVID‐19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region. International Journal of Gynecology & Obstetrics, 159, 39-53.
Juarez SP, Small R, Hjern A, Schytt E. Length of residence and caesarean section in migrant women in Sweden: a population-based study. Eur J Public Health. 2018
Juarez SP, Small R, Hjern A, Schytt E. Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study. Paediatr Perinat Epidemiol. 2017;31(6):509-21.
Berbres M, Hesselman S, Ternstrom E, Schytt E. Women's use of Swedish health care during the postpartum period in relation to maternal country of birth-A population-based study. Acta Obstet Gynecol Scand. 2024;103(10):2101-11.
Qualitative studies
Publications
Schytt E, Brandal C, Skaar MB, Vik ES, Aasheim V. Midwives' experiences with telephone triage for migrant women prior to admission to Norwegian labour wards, when language barriers exist. Sex Reprod Healthc. 2025;45:101139.
Aw-Nuur, H. A., Diriye, N. A., Aasheim, V., Engen, T., Mehrara, L., & Vik, E. S. (2024). Somali immigrant women’s knowledge of and experiences with folic acid supplement use before and during pregnancy: A qualitative study from Norway. Sexual & Reproductive Healthcare, 39, 100946.
Asbjornsen, H. S., Ottemöller, F. G., & Vik, E. S. (2025). ‘I was ‘only’seen as a birthing woman:’the pregnancy, birth and postpartum experiences of women with refugee backgrounds in Norway. BMC Pregnancy and Childbirth, 25(1), 507.
Vik, E. S., Hashi, R. M., Hamud, M. E., Aasheim, V., Kringeland, T., & Aasekjær, K. (2022). Migrant Somali women’s experiences with their first contact with the labor ward prior to admission: A qualitative study. European journal of midwifery, 6, 45.
Utne, R., Antrobus-Johannessen, C. L., Aasheim, V., Aasekjær, K., & Vik, E. S. (2020). Somali women's experiences of antenatal care: A qualitative interview study. Midwifery, 83, 102656.
Schytt E, Brandal C, Skaar MB, Vik ES, Aasheim V. Midwives' experiences with telephone triage for migrant women prior to admission to Norwegian labour wards, when language barriers exist. Sex Reprod Healthc. 2025;45:101139.
Literature studies
Bains, S., Mæland, K. S., & Vik, E. S. (2021). Helse i svangerskapet blant innvandrerkvinner i Norge–en utforskende litteraturoversikt. Tidsskrift for Den norske legeforening.
Wenger, L. S., Saifee, J. F., Macikunas, A., Shetty, J., Fredricks, K., Wiemker, V., Russel, E.A., Vik, E.S. & Brandenberger, J. (2025). Examining Structural and Social Supports Offered to Resettled Refugees in 10 Host Countries–A Scoping Review Acknowledging Health in All Policies. Current Tropical Medicine Reports, 12(1), 10.
Intervention studies
Ongoing projects
PreGO
PreGO is an innovative digital decision-support tool that supports midwives and physicians in assessing pregnancy-related risk factors in a migrant context.
The current phase focuses on evaluating the feasibility, usability, and clinical relevance of the tool. A PhD candidate is currently being recruited and will contribute to the development and evaluation of PreGO through three studies:
- a usability study assessing clinicians’ perceptions of PreGO in clinical practice.
- a Delphi study to establish clinician consensus on migration-related factors, outcome variables, and weighting principles for inclusion in the tool
- a nationwide population-based registry study examining migration-related determinants of adverse perinatal outcomes.
Additional qualitative studies within the broader PreGO project are exploring clinicians’ and women’s experiences of pregnancy risk assessment and the use of PreGO, informing the continued refinement and future implementation of the tool.
To support the qualitative components of the project, Master's students in Midwifery will be involved in data collection and analysis.
Finalized projects
Our research on community-based doula support for migrant women forms an important foundation for the EmmaNor project.
The intervention has been tested in a randomized controlled trial (RCT) and evaluated from multiple perspectives using qualitative and mixed-methods studies.
Publications
Schytt E, Wahlberg A, Eltayb A, Tsekhmestruk N, Small R, Lindgren H. Community-based bilingual doula support during labour and birth to improve migrant women's intrapartum care experiences and emotional well-being-Findings from a randomised controlled trial in Stockholm, Sweden [NCT03461640]. PLoS One. 2022;17(11):e0277533.
Schytt E, Wahlberg A, Eltayb A, Small R, Tsekhmestruk N, Lindgren H. Community-based doula support for migrant women during labour and birth: study protocol for a randomised controlled trial in Stockholm, Sweden (NCT03461640). BMJ Open. 2020;10(2):e031290.
Schytt E, Wahlberg A, Small R, Eltayb A, Lindgren H. The community-based bilingual doula - A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences. Sex Reprod Healthc. 2021;28:100614.
Purandare R, Adahl K, Stillerman M, Schytt E, Tsekhmestruk N, Lindgren H. Migrant women's experiences of community-based doula support during labor and childbirth in Sweden. A mixed methods study. Sex Reprod Healthc. 2024;41:101000.
Lindgren H, Eltayb A, Wahlberg A, Tsekhmestruk N, Small R, Schytt E. Multi-tasking community-based bilingual doulas are bridging gaps-Despite standing on fragile ground. A qualitative study of doulas' experiences in Sweden. Midwifery. 2022;105:103231.
Byrskog U, Small R, Schytt E. Community-based bilingual doulas for migrant women in labour and birth - findings from a Swedish register-based cohort study. BMC Pregnancy Childbirth. 2020;20(1):721.
Hooyo - Group antenatal care for Somali-born women in Sweden
Publications
Ahrne M, Byrskog U, Essen B, Andersson E, Small R, Schytt E. Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project. BMJ Open. 2023;13(1):e066000.
Ahrne M, Byrskog U, Essen B, Andersson E, Small R, Schytt E. Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation. BMC Pregnancy Childbirth. 2022;22(1):721.
Ahrne M, Schytt E, Andersson E, Small R, Adan A, Essen B, Byrskog U. Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives. Midwifery. 2019;74:107-15.
Byrskog U, Ahrne M, Small R, Andersson E, Essen B, Adan A, et al. Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project. BMJ Open. 2019;9(7):e030314.
Thesis
Planned studies
Project organisation
The project is led by researchers at Western Norway University of Applied Sciences (HVL). The research team includes collaborators from the University of Bergen (UiB), Uppsala University in Sweden, Dalarna University in Falun, Sweden, and La Trobe University in Melbourne, Australia.
Project Leaders
Members
- Roy Miodini Nilsen, HVL
- Linn Marie Sørbye, HVL
- Anne Siri Fismen, HVL
- Thomas Potrebny, HVL
- Yngve Lamo, HVL
- Svein-Ivar Lillehaug, HVL
- Ferenc Macsali, The Norwegian Institute of Public Health
- Nils-Halvdan Morken, University of Bergen
- Merete Benestad, HVL
Other research partners
- Rachana Aryal, Norske kvinners sanitetsforening
- Hilde Sjøbø Asbjørnsen, University of Bergen
- Fungisai Puleng Gwanzura Ottemöller, University of Bergen
- Elin Ternström, Dalarna University, Sweden
- Malin Berbres, Uppsala University, Sweden
- Touran Shafiei, La Trobe University, Australia
- Della Forster, La Trobe University, Australia
- Robyn Matthews, La Trobe University, Australia