Exploring social inequalities in the use and experience of prenatal care in Brussels

Abstract

Abstract Background The underlying mechanisms of perinatal health inequalities remain under-researched. A possible explanation is inadequate access to healthcare services and suboptimal care for certain groups. To explore this, our study analyses the mothers’ prenatal care trajectories and experiences of care in relation to socioeconomic and migration characteristics. Methods A survey of 750 migrant and non-migrant mothers interviewed in 4 maternity wards in Brussels. Based on the adaptation of the Migrant-Friendly Maternity Care Questionnaire, the survey focuses on mothers with a Belgian, North African (NA) and Subsaharan African (SSA) nationality. The data are analysed through descriptive statistics and logistic regression. Results This ongoing survey has a high response rate (83%). Preliminary subsample analyses (n = 276) show that the socioeconomic profiles of mothers vary substantially depending on nationality, with mothers from NA generally having a lower level of education, and mothers from SSA being strongly at risk of poverty. SSA women are particularly at risk of starting prenatal care late (32% compared to 4% of Belgians and NAs) and of having less than 7 recommended consultations (25% compared to 6% Belgians and 9% NAs). Low household income and maternal education were also strong predictors of late and infrequent prenatal care. Women from all three nationality groups had the same rate (10%) of planned C-sections, but women from SSA were much more likely to have an emergency c-section (16% vs 7% of Belgians and NAs). Women with a higher household income were less likely to have a c-section at all. Women from both NA and SSA were less likely to always have understood the information given by healthcare professionals. 90% of women with secondary school education understood all the information, compared to 60% of women without it. Conclusions Women’s care trajectories and experiences of care vary strongly depending on their nationality and socioeconomic situation. Key messages North African and Subsaharan African immigrants in Brussels live in different socioeconomic situations. Their care trajectories and experiences of care also show important differences. Socioeconomic characteristics, in addition to women’s migration status, are important factors affecting women’s perinatal care.