Explanatory factors for first and second-generation non-western women’s inadequate prenatal care utilisation: a prospective cohort study

Abstract

BackgroundLittle research into non-western women’s prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women’s prenatal care utilisation and its explanatory factors according to generational status.MethodsData from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women’s prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios.ResultsThe unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation.ConclusionIrrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤19 or ≥36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0528-x) contains supplementary material, which is available to authorized users.

Women‐centered care: Implementation of CenteringPregnancy® in The Netherlands

“…As this is a group that has demonstrated to be more difficult to reach in other care models, resulting in insufficient prenatal care, 16,18 it is important to understand how this was influenced by the CP model of prenatal care. As this is a group that has demonstrated to be more difficult to reach in other care models, resulting in insufficient prenatal care, 16,18 it is important to understand how this was influenced by the CP model of prenatal care.…”

“…This was especially true for first-and second-generation migrant women who entered care late resulting in fewer prenatal visits. [16][17][18] This suggests that prenatal interventions aimed at reducing risk factors and/ or negative health outcomes are not sufficiently reaching women who may need them the most and are thus not fully effective as a strategy to improve health behavior. 15,19,20 As the number of adverse perinatal outcomes is higher in non-Western women and in Western women living in disadvantaged areas, and is also related to lifestyle and to health system failure, [21][22][23][24] it has been argued that specific care and attention should be given to these so-called marginalized groups by providing more social support and partnership within a redesign of prenatal care that is tailored to women with less healthier lifestyles.…”

“…15,19,20 As the number of adverse perinatal outcomes is higher in non-Western women and in Western women living in disadvantaged areas, and is also related to lifestyle and to health system failure, [21][22][23][24] it has been argued that specific care and attention should be given to these so-called marginalized groups by providing more social support and partnership within a redesign of prenatal care that is tailored to women with less healthier lifestyles. 14,16,18 In addition, a general call for Dutch maternity care reform has emerged from dissatisfied consumer groups demanding a more woman-centered approach. 25 CenteringPregnancy (CP) is an innovative model of prenatal care in which the traditional individual (provider-to-user) prenatal visits are replaced by 10 two-hour group sessions consisting of eight to twelve women with similar gestational ages.…”

“…[12][13][14] In addition, women with a lower education status are more likely to be obese or underweight and are less likely to believe that they can exercise control over their own health status. [16][17][18] This suggests that prenatal interventions aimed at reducing risk factors and/ or negative health outcomes are not sufficiently reaching women who may need them the most and are thus not fully effective as a strategy to improve health behavior. Feijen et al reported that 24.7% of all women in The Netherlands starting prenatal care in community-based midwifery practice had not attended a sufficient number of prenatal care visits.…”

“…Feijen et al reported that 24.7% of all women in The Netherlands starting prenatal care in community-based midwifery practice had not attended a sufficient number of prenatal care visits. 14,16,18 In addition, a general call for Dutch maternity care reform has emerged from dissatisfied consumer groups demanding a more woman-centered approach. [16][17][18] This suggests that prenatal interventions aimed at reducing risk factors and/ or negative health outcomes are not sufficiently reaching women who may need them the most and are thus not fully effective as a strategy to improve health behavior.…”