Explaining Ethnic Differences in Late Antenatal Care Entry by Predisposing, Enabling and Need Factors in the Netherlands. The Generation R Study

Abstract

Despite compulsory health insurance in Europe, ethnic differences in access to health care exist. The objective of this study is to investigate how ethnic differences between Dutch and non-Dutch women with respect to late entry into antenatal care provided by community midwifes can be explained by need, predisposing and enabling factors. Data were obtained from the Generation R Study. The Generation R Study is a multi-ethnic population-based prospective cohort study conducted in the city of Rotterdam. In total, 2,093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese Creole and Surinamese Hindustani background were included in this study. We examined whether ethnic differences in late antenatal care entry could be explained by need, predisposing and enabling factors. Subsequently, logistic regression analysis was used to assess the independent role of explanatory variables in the timing of antenatal care entry. The main outcome measure was late entry into antenatal care (gestational age at first visit after 14 weeks). With the exception of Surinamese-Hindustani women, the percentage of mothers entering antenatal care late was higher in all non-Dutch compared to Dutch mothers. We could explain differences between Turkish (OR = 0.95, CI: 0.57–1.58), Cape Verdean (OR = 1.65. CI: 0.96–2.82) and Dutch women. Other differences diminished but remained significant (Moroccan: OR = 1,74, CI: 1.07–2.85; Dutch Antillean OR 1.80, CI: 1.04–3.13). We found that non-Dutch mothers were more likely to enter antenatal care later than Dutch mothers. Because we are unable to explain fully the differences regarding Moroccan, Surinamese-Creole and Antillean women, future research should focus on differences between 1st and 2nd generation migrants, as well as on language barriers that may hinder access to adequate information about the Dutch obstetric system.

Disparities in Access to Prenatal Care Services for African Immigrant Women in Spain

“…Our results are in keeping with those of other recently published studies in Spain [23,24], [25][26][27][28][29], and elsewhere in the world [18][19][20][30][31][32][33][34].…”

Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review

“…Three articles described quantitative observational studies: 2 cohort studies [20,21] and 1 cross-sectional study [22] with methodological quality scores varying between 75% and 100%.…”

“…Nine studies were conducted in a European country [20,21,23,28,29,31-33,35], four in Canada [22,25,27,30] and three in Australia [24,26,34]. …”

“…Three studies reported factors for sub-Saharan African women : Somali or Ghanaian [29,32,33]; eight for Asian women : South Asian [22], Sri Lankan [23], Filipino [26], Vietnamese [27], Indian [30], Thai [34] or a mixture of Asian origins [24,28]; and two for Turkish women [21,31]. One study reported factors for Muslim women not further specified [25].…”

“…Unemployment was another characteristic that was identified. In a Dutch study, enabling factors (including being in employment) explained Turkish women’s delayed entry into prenatal care [21]. In two studies, low or intermediate educational level was associated with late entry into prenatal care [20,21].…”