Geographical, Ethnic and Socio-Economic Differences in Utilization of Obstetric Care in the Netherlands

Abstract

BackgroundAll women in the Netherlands should have equal access to obstetric care. However, utilization of care is shaped by demand and supply factors. Demand is increased in high risk groups (non-Western women, low socio-economic status (SES)), and supply is influenced by availability of hospital facilities (hospital density). To explore the dynamics of obstetric care utilization we investigated the joint association of hospital density and individual characteristics with prototype obstetric interventions.MethodsA logistic multi-level model was fitted on retrospective data from the Netherlands Perinatal Registry (years 2000–2008, 1.532.441 singleton pregnancies). In this analysis, the first level comprised individual maternal characteristics, the second of neighbourhood SES and hospital density. The four outcome variables were: referral during pregnancy, elective caesarean section (term and post-term breech pregnancies), induction of labour (term and post-term pregnancies), and birth setting in assumed low-risk pregnancies.ResultsHigher hospital density is not associated with more obstetric interventions. Adjusted for maternal characteristics and hospital density, living in low SES neighbourhoods, and non-Western ethnicity were generally associated with a lower probability of interventions. For example, non-Western women had considerably lower odds for induction of labour in all geographical areas, with strongest effects in the more rural areas (non-Western women: OR 0.78, 95% CI 0.77–0.80, p<0.001).ConclusionOur results suggest inequalities in obstetric care utilization in the Netherlands, and more specifically a relative underservice to the deprived, independent of level of supply.

Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study

“…Finally, further research could also establish whether the association between income and obstetric care holds when looking at other perinatal outcomes such as episiotomy, use of uterine stimulants, analgesics in labor and anesthesia in migrant populations. Indeed, two studies conducted in Berlin [19,27] and one in the Netherlands [28] found differences in anesthesia provision and induction of labor between women with and without migration backgrounds. While two of them included measures of socioeconomic position (education [19,28] and neighborhood socioeconomic status [28]) none took into account the individual or household income of participants.…”

Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system

“…The findings that individuals with lower SES tend to receive prenatal care less frequently and are at higher risk for obstetric complications are consistent with the findings of previous studies [ 1 , 2 ]. Individuals with low SES tend to be disadvantaged in terms of medical service utilization [ 1 , 2 , 15 ]. Pregnant women with low SES have been shown to have adverse obstetric outcomes associated with inadequate prenatal visits [ 1 , 4 , 6 , 15 ].…”

“…Individuals with low SES tend to be disadvantaged in terms of medical service utilization [ 1 , 2 , 15 ]. Pregnant women with low SES have been shown to have adverse obstetric outcomes associated with inadequate prenatal visits [ 1 , 4 , 6 , 15 ]. The results of the current study that obstetric complications were poor in women in the MA group is consistent with the results of previous studies demonstrating that low SES is a risk factor for poor obstetric outcomes [ 1 – 6 ].…”

Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

“…In view of general relationships between socioeconomic factors and health, we included socioeconomic factors as possible related factors, and chose the percentage of women with a bachelor's degree and the percentage of low‐income households in each prefecture based on data availability. The percentage of women aged between 20 and 44 with a bachelor's degree was calculated using the 2010 Population Census.…”