Salway et al. BMC Public Health 2011, 11:514 http://www.biomedcentral.com/1471-2458/11/514 In 2008, an international study group comprising researchers from Germany, Canada and the UK received funding from VolkswagenStiftung to undertake a six month scoping study focused on the maternity experi- ences and outcomes of immigrant and minority ethnic women in the three contrasting countries. The funding source clearly dictated a focus on Germany, while the UK and Canada were felt to offer the potential for use- ful comparative analyses given their common commit- ment to accessibility of public health services and their sustained attention to issues of migration and ethnocul- tural diversity within both policy and research arenas. A range of activities were undertaken within each of the three countries consisting of: a comprehensive narrative review of literature and policy documents; electronic and telephone consultation with selected experts includ- ing practitioners, policy-makers and researchers; and a participatory consultation workshop with service users, practitioners and researchers. These in-country activities resulted in a series of briefing papers which then formed the basis of a two-day symposium at which the project members from the three countries shared findings. The three-country symposium allowed for comparison of: the wider context of migration and ethno-cultural diver- sity, including concepts and terminologies and potential areas of confusion and contention; issues and challenges to maternity service delivery for migrant and minority populations; and exploration of the similarities and dif- ferences between the country settings in terms of the research evidence base and priorities for future knowl- edge generation. Specific emphasis was placed on exam- ining how migration and consequent ethno-cultural diversity had been problematized and responded to within the respective healthcare systems. Primarily intended to inform the development of a lar- ger programme of international comparative work (whose aim would be to gain broad theoretical and practical insights into how healthcare systems might promote better maternal health outcomes for migrant and minority women), the objectives of the preliminary work reported on here were to 1) establish a clear and comprehensive conceptual framework informed by, and having pertinence to, the three countries of focus, 2) establish a detailed methodological approach for further investigation, and 3) establish an explicit operational structure that would enable active involvement of pol- icy-makers, practitioners and service users. The present paper reflects on the experiences of the project team in addressing these objectives to identify various challenges and opportunities offered by such international com- parative research. In the sections below we highlight some general issues that would likely be relevant to cross-national compara- tive public health research irrespective of the exact Page 3 of 13 substantive focus. However, since a number of papers have discussed cross-national comparative health and social research in general terms [16,17], our main focus is the ways in which research focused on ethnicity, migration and health is helped or hindered by an inter- national comparative approach. We aim to alert the reader to issues that require careful reflection and to suggest some principles that may guide future work. Discussion The discussion that follows is organised into three sec- tions following the objectives listed above, namely: iden- tifying a conceptual framework; designing a methodological approach; and establishing an opera- tional structure. Within each section we summarise the key observations from the preliminary studies underta- ken, highlighting (i) insights gained from the compara- tive approach and (ii) challenges raised by exploring the issues cross-nationally. 1. Identifying a common, cross-national conceptual framework In the initial stages of our project, we chose to define ‘migrant/minority’ women broadly as those women who trace a significant part of their family heritage outside their current country of residence. We recognised the need to explore the ways in which ethnic and migrant statuses are understood across the three countries, rather than impose any rigid conceptualisation or opera- tionalisation from the outset. Our preliminary studies confirmed significant diversity in the language and con- cepts employed within the three countries in research, policy dialogue and everyday societal discourse that engages with issues of migration and ethnicity. Further- more, the cross-national comparative work highlighted the way in which our choice of terms and the meaning attached to key concepts is socially and historically situ- ated, as well as the complex and contentious nature of such concepts. We highlight here four areas where par- ticular divergence was apparent, and where this diver- gence prompted important reflection on current conceptualisations adopted by researchers in the three country teams; their strengths and limitations. Terms, categories and labels We found instances of: the same term being used to mean different things both within and across the coun- try settings; certain terms carrying pejorative connota- tions in one or more of the countries while being acceptable in the others; and certain terms being com- monly used in one setting with no conceptual equivalent existing in the other two countries. For instance, there was confusion over the terms ‘migrant’ and ‘immigrant’. Researchers in Canada