The project “ORAMMA: Operational Refugee And Migrant Maternal Approach” has a vision to develop an operational and strategic approach in order to promote safe motherhood, to improve access and delivery of maternal healthcare for refugee and migrant women and to improve maternal health equality within European Union. Moreover the project will increase awareness, commitment and action towards improving maternal health of refugees in EU.
There is an increasing need for a prompt, coordinated, and effective response for all migrant and refugee pregnant and lactating women with newborn babies. Migrant and refugee women face specific health risks and challenges during perinatal period that need to be dealt by well-trained multidisciplinary teams of health professional experts since they are characterized by a complex physical, psychological and mental state of health.
The majority of the refugee pregnant women, their families and their communities are not empowered to be healthy, do not always have adequate capacities to provide appropriate care during pregnancy or when the new baby has arrived, neither are they able to make healthy decisions and act upon those decisions, including the decision to seek care when needed. There is a lack of empower manifest in a number of levels while additionally gender constraints may prevent some refugee women from expressing the need for and obtaining care during perinatal period.
The ORAMMA project will develop, pilot implement and evaluate by comparative analysis an integrated and cost-effective approach on safe motherhood provision for migrant and refugee women, taking into consideration (a) best practices, (b) the special risks and characteristics of the target group and (c) the transferability of the model in different healthcare systems across EU: from camps sites in Greece, to National Health Services in the UK and to community-based model in Netherlands.

The project “ORAMMA: Operational Refugee And Migrant Maternal Approach” has a vision to develop an operational and strategic approach in order to promote safe motherhood, to improve access and delivery of maternal healthcare for refugee and migrant women and to improve maternal health equality within European Union. The majority of the refugee pregnant women, their families and their communities are not empowered to be healthy, do not always have adequate capacities to provide appropriate care during pregnancy or when the new baby has arrived, neither are they able to make healthy decisions and act upon those decisions, including the decision to seek care when needed. There is a lack of empower manifest in a number of levels while additionally gender constraints may prevent some refugee women from expressing the need for and obtaining care during perinatal period.
The general objective of the ORAMMA project is to promote safe pregnancy and childbirth through efficient provision of, access to, and use of quality skilled care for all migrant and refugee women and their newborn babies. Moreover, the project aims to strengthen the refuge maternal healthcare in primary care settings, and to promote community-based healthcare models for migrant and refugee populations.
The underpinning philosophy of the project lies in core values and principles that will be incorporated into the project activities and deliverables:
- Promotion of the rights of women and newborns.
- Promotion of gender equality as the basis of maternal and newborn health approaches.
- Ensuring equity in access to quality care, regardless of socio-economic status, with special attention to the poor and populations that are currently underserved, ensuring that all women survive and are healthy during pregnancy and childbirth and that newborn babies have a healthy start in life.
- Ensuring responsiveness to the needs of the migrant and refugee communities.
- Ensuring the effective continuum of care that includes all maternal and newborn care including timely and appropriate management of pregnancy related complications.
- A sustainable approach for maternal healthcare and safe motherhood.
- Promotion of primary care.
- Adoption of a multisectoral approach because of the complex set of interaction between many factors that influence refugee maternal and perinatal health outcomes.
- Development of partnerships in order to increase the availability of resources and maximize their effective use, reducing unnecessary duplication of activities for improving maternal and newborn health.
- Building upon on existing initiatives and activities to maximize use of resources and synergies.

The ORAMMA project has high relevance to the thematic priorities of the third programme of community action in the field of health (2014-2020), as well specific objectives of the 2016 work programme. In particular, it aims to address the following thematic priorities of the 2014-2020 programme:

- “Promote health, prevent diseases and foster supportive environments for healthy lifestyles taking into account the 'health in all policies' principle.” The project has a strong focus on health promotion since it focuses on promoting healthy and safe motherhood. The community based approached will take into consideration the importance of supportive environments to be successfully designed and implemented.
- “Support public health capacity-building and contribute to innovative, efficient and sustainable health systems.” The project will develop tools and expertise related to the maternal and perinatal healthcare of migrant and refugee women, as the Practice Guide and the Perinatal Personal Operational Plan. The produced results will not only be widely disseminated but also incorporated into a self-learning e-course that will remain open, free and accessible. The project results will contribute in filling in the gaps in specialized, holistic and compassionate healthcare for migrant and r

The ORAMMA project has developed an integrated mother and woman centered, culturally oriented and evidence based approach for the perinatal healthcare of migrant and refugee women. The method for this was: (a) a desk research for the collection of updated information on the national context related to the perinatal healthcare of migrant and refugee women (b) a qualitative survey on midwives thought the network of the European Midwives Association (EMA), (c) literature review of scientific papers and reports from major health organization (such as WHO) and medical journals on perinatal healthcare of migrant and refugee women (special risks, best practices, case studies, implementing tools, social issues etc.), (d) development of the main project deliverables, namely:
1) Practice Guide for perinatal care for migrant and refugee women,
2) Perinatal Personal Operational Plan (general health, psychosocial, perinatal assessment and plan) for migrant and refugee women,
3) Integrated approach for healthcare provision in perinatal period for migrant and refugee women, which will be pilot tested in the second year of the project implementation.
These deliverables will be pilot tested in the second year of the project implementation. Moreover, will be used in the capacity building and training activities foreseen for the next project’s phase.

The first year of implementation of the ORAMMA project the project consortium performed the following work:
a) EU and national context review on perinatal healthcare for migrant and refugee women. The starting point of the project was to conduct a field assessment/ mapping of healthcare provision in the different European settings in order to identify issues such as: the present situation and estimation of the current size of the population, the needs of the target groups and the needs of health professionals, the existing practices, social services and operational structures of healthcare provision, the special issues as legislation or other country specific issues to be taken into consideration.
b) SOP document which provided the specific research questions to be explored, methodology, scope and key words of the literature review as well as the objectives, structure, rating system and methodology for the conduct of the survey and analysis of the results.
c) Development of the Perinatal Practice Guide which contains evidence-base, best practices and recommendations in the related field. The practice guide has been addressed to health providers (such as public and private clinics), individual health professionals working with the target group and other community-based services that the target group visits.
d) Development of the Approach to integrated perinatal healthcare for migrant and refugee women which includes the rationale and all the characteristics of the approach, description and role of the multidisciplinary team, description of phases and specifications on each phase, decision trees and/or algorithms for the implementation of the model.
Moreover, the project consortium conducted all the preparatory activities for the implementation of the ORAMMA approach.
a) Development of the action plan for the community capacity building which includes the theoretical framework and the steps to community capacity building related to health provision in migrant and refugee communities.
b) Setting the pilot specifications regarding information for the organization, implementation, coordination and monitoring of the pilot implementation session in Greece, UK and the Netherlands.
c) Starting the recruitment of maternity peer supporters in order to support and assist migrant and refugee mothers during their visits with the health care professionals, the birth and the ante-natal period when the pilot implementation will begin.
In addition, dissemination activities are being carried out as a continuous process that runs through the project’s lifecycle. During the first half of the Dissemination WP focused on developing the dissemination plan and the main dissemination channels and instruments through which the dissemination and communication project’s outcomes were realized (project logo, project leaflet, website, newsletter, presentation of the ORAMMA project in external events).
Finally, an evaluation plan has been developed as well the interim evaluation report has been produced.

Approach to Integrated Perinatal Healthcare for Migrant And Refugee Women
The ORAMMA approach to integrated healthcare for migrant and refugee women is a detailed plan setting out the ORAMMA vision for establishing an approach to perinatal health services and applying practices that ensure safe motherhood for migrant and refugee women in European Union countries. The plan is structured around seven key drivers for providing and delivering quality maternity care. The approach focuses on continuity of care, primary care, multidisciplinary teams, knowledge and skills, migrant and refugee women’s experiences, “propagating keys” and facilitators and barriers. The ORAMMA approach will help care providers and stakeholders to understand and promote safety and quality of perinatal healthcare services for migrant and refugee women.
Practice Guide for Perinatal Care of Migrant, Asylum seeking and Refugee Women
The “Practice Guide for Perinatal Care of migrant, asylum-seeking and refugee women” aims to provide guidance on the antenatal, intrapartum and postnatal care of new migrant, asylum seeker or refugee women, including women who are seeking asylum or have refugee status. This document summarizes evidence and good practice to address the health risks associated with asylum-seeker, refugee and other migrant status during pregnancy and the postpartum period, as well as suggesting approaches to support these women during the perinatal period to meet their needs. This document aims to support practice and to be used as an informative tool for all stakeholders involved in health assessment of migrant and refugee women and other related services in the perinatal period. This emphasizes the importance of effective communication, building trust and nurturing a friendly relationship with women, ensuring that women are listened to and that there is an efficient interdisciplinary team providing holistic woman-centered care throughout all stages of pregnancy, birth and the postpartum period.
Perinatal Personal Operational Plan for the women and health care professionals
Perinatal Personal Operational Plan is developed in order to enhance the assessment, planning, management and monitoring of women’s and fetus/ infant’s health. This has been designed according to the evidence regarding refugee/migrant maternity care and assists care providers to improve maternity clinical practice and service delivery, quality of care and safety. Two different documents have been produced, one for the mother (my maternity plan) and one for the health care professionals. The document for healthcare professionals includes all the necessary detailed maternal notes and for the woman includes her individualized healthcare plan.

During the first half of the ORAMMA project the achieved outcomes that have been carried out are mainly all the preparatory actions setting the grounds for the development and the implementation of the ORAMMA model.
The Approach to Integrated Perinatal Healthcare for migrant and refugee women is a plan of action including the theoretical framework with all the characteristics of the perinatal healthcare approach, the role of the multidisciplinary team, the specifications of perinatal care phases, and directions for the implementation of this approach.
The Practice guide and the Perinatal Personal Operational Plan (PPOP) are the fundamental tools of the project. Practice guide will provide supporting evidence, good practice and quality standard recommendations to enable the delivery of sensitive and equitable perinatal care for migrant and refugee women. The Perinatal Personal Operational Plan -PPOP- (general health, psychosocial, perinatal assessment and plan) will enhance the assessment, planning, management and monitoring of women’s and fetus/ infant’s health.

The project considers the Dissemination activities as a continuous process that runs through the project’s lifecycle. During the first half of the project, the Dissemination WP focused on developing the dissemination plan and the main dissemination channels and instruments through which the dissemination and communication of the project’s outcomes will be realised:
- Dissemination and communication plan
- Extensive dissemination list containing medical associations, interested organizations and experts on the field, in each participating country
- Project’s Logo
- Development of project leaflet and project website
- Development of E-newsletters
- Presentations in external events
The most significant strength of the dissemination strategy of ORAMMA project is the access to an extensive network of midwife organisations and health professionals. The access to those groups has been made possible through the EFPC’s and EMA’s network which has built strong and established relationships within the European health community and is active on numerous projects throughout Europe. Moreover, all partners have established strong relations with their respective national health communities and health professional organisations. Up to the interim phase of the project, the partners have successfully managed to present the ORAMMA project to a series of external events along with the events organised in the frame of the project and managed to familiarize the health professionals with the objectives and aims and raise their interest in order to prepare the grounds for a further and widely dissemination the ORAMMA’s objectives and for an effective implementation of the pilot phase.
Regarding the evaluation activities to monitor the quality of the Project’s approach, the partnership has developed an evaluation and quality assurance plan at the early stages of the project. This plan specifies the procedures and standards for implementation, monitoring and evaluation of the project. Also, an Interim evaluation report was conducted at mid (12 month of the project) to assure the implementation of the project according to the plan, the appropriate execution of tasks and the quality of the results and deliverables.