BACKGROUND:
Migrants in high-income countries (HICs), particularly those from racialised or socioeconomically disadvantaged backgrounds, face barriers to healthcare due to restrictive policies, discrimination, and language challenges. While the “healthy migrant effect” suggests better health outcomes among migrants, its relevance to maternal and early childhood health is unclear.

OBJECTIVES:
To assess maternal and early childhood health and social outcomes among migrants in HICs and examine the impact of healthcare access restrictions based on MIPEX-defined health system scores

METHODS:
A systematic review and meta-analysis of studies published between 2014 and 2024 comparing outcomes between foreign-born migrant women and children (up to five years old) and their local-born counterparts in HICs. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were used to calculate pooled odds ratios (ORs) for key outcomes. The review will be updated every 2–3 years to reflect emerging evidence.

RESULTS:
Fifty moderate-to-high-quality studies (n=67,471,879 across 16 HICs) were included. Migrant women had significantly higher odds of emergency caesarean births (OR=1.24), perinatal depression/anxiety (OR=1.67), food insecurity (OR=2.49), intimate partner violence (OR=2.20), and low Apgar scores (OR=1.37). Odds of low birth weight were slightly lower (OR=0.95). These disparities persisted in countries with restrictive healthcare policies. No significant differences were found for maternal mortality, severe maternal morbidity, preterm birth, fetal loss, NICU admission, or childhood vaccination. Data were limited for inclusive policy contexts and child health outcomes.

CONCLUSIONS:
Findings challenge the notion of a “healthy migrant effect” in the perinatal period. Migrant families face marked health inequities, particularly where healthcare access is restricted.

KEY MESSAGE:
Governments and policymakers must consider the adverse effects of restrictive healthcare and immigration policies on maternal and infant health. This living review will continue to track and synthesise emerging evidence, supporting policy responses that advance equity and universal health coverage. Further evidence is needed on how healthcare coverage affects migrant children’s long-term health and wellbeing. Marginalized - migrants