Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies

Abstract

Objective Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of nonmedical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular. Methods Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011)(2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status. Results In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake. Conclusions for PracticeOur study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups. SignificanceWhat is already known on this subject? Non-medical antenatal care (ANC) contributes to an enhanced pregnancy experience and improved birth outcomes. A recent study showed a lower uptake of non-medical antenatal care among migrants than among women without migration background using unadjusted data. Socioeconomic status has been hypothesized to impact the utilization of non-medical ANC.What this study adds? This study highlights the existence of social inequalities in non-medical ANC use. Our results suggest that there is a strong relationship between the use of non-medical ANC and migration background and educational attainment, with 1st generation migrants and women with low and medium levels of education having a lower uptake of services.

Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland

“…Adjustability of the findings between our two comparison groups was limited due to inability to control the Socio-Economic Status (SES), education level, and the timing of migration. In earlier studies, both SES and education ( Bakken et al., 2015 ; Choté et al., 2011 ; Ludwig et al., 2020 ; Henriksson et al., 2020 ), as well as length of stay, level of acculturation ( Ludwig et al., 2020 ; Henderson et al., 2018 ; Kingston et al., 2011 ; Waldum et al., 2020 ), and language skills ( Navodani et al., 2019 ; Esscher et al., 2014 ) have been found as essential confounders when comparing maternal health of migrants and country-born parturients. Therefore, these factors remain a potential topic for further research.…”

Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study

“… 10 Fragmentation can cause overutilisation since people use different services simultaneously and important information for patient care and counselling can be lost if transitions are not standardised and communication between providers is not clearly structured. In addition, navigating through the system may be challenging for some women as pertaining inequalities in service utilisation suggest: large-scale surveys found a social gradient in utilisation of medical antenatal visits, 11 non-medical antenatal visits 12 and of health check-up examinations for children. 3 Women’s difficulties in accessing antenatal and postnatal care were also described by qualitative studies.…”

Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project

“…Swedish studies show that migrant women,39 including Somali-born women,19 commence ANC later, make fewer ANC visits and are less likely to contact obstetric care for decreased fetal movements 20. Finally, lower attendance in childbirth preparation and parenting classes during pregnancy among migrant women in Sweden and elsewhere has also been reported 40–42…”