Abstract
ObjectiveNon-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 non-medical 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.MethodsBaseline 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.ResultsIn 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.
Highlights
Antenatal care (ANC) refers to the care that a pregnant woman receives throughout her pregnancy in order to maintain maternal and perinatal health (Vetter and Goeckenjan 2013)
Our results suggest that there is a strong relationship between the use of non-medical antenatal care (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
Medical ANC refers to the series of recommended medical appointments, screenings, and tests, that a woman is advised to book from the first trimester to the end of her pregnancy
Summary
Antenatal care (ANC) refers to the care that a pregnant woman receives throughout her pregnancy in order to maintain maternal and perinatal health (Vetter and Goeckenjan 2013). It can be divided into medical ANC and nonmedical ANC. In Germany, the scope of medical ANC is defined at the federal level by the maternity guideline (Gemeinsamer Bundesausschuss (G-BA) 2019) It entails medical appointments, (e.g. early in pregnancy to confirm the pregnancy; post-partum), three ultrasound screenings in weeks 9–12., 19–22 and 29–32, some tests and examinations (e.g. screening on gestational diabetes in week 25–28) and regular monthly (and in the third trimester more frequent) appointments to control the woman’s blood pressure, urine, and the foetus’s development and position. The regular control appointments can be led by a gynaecologist or a midwife, but the other services are to be provided by a gynaecologist
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