Abstract
BackgroundDespite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. This study aimed to give a systematic review of factors affecting non-western women’s use of prenatal care (both medical care and prenatal classes) in industrialized western countries.MethodsEleven databases (PubMed, Embase, PsycINFO, Cochrane, Sociological s, Web of Science, Women’s Studies International, MIDIRS, CINAHL, Scopus and the NIVEL catalogue) were searched for relevant peer-reviewed articles from between 1995 and July 2012. Qualitative as well as quantitative studies were included. Quality was assessed using the Mixed Methods Appraisal Tool. Factors identified were classified as impeding or facilitating, and categorized according to a conceptual framework, an elaborated version of Andersen’s healthcare utilization model.ResultsSixteen articles provided relevant factors that were all categorized. A number of factors (migration, culture, position in host country, social network, expertise of the care provider and personal treatment and communication) were found to include both facilitating and impeding factors for non-western women’s utilization of prenatal care. The category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors.Lack of knowledge of the western healthcare system and poor language proficiency were the most frequently reported impeding factors. Provision of information and care in women’s native languages was the most frequently reported facilitating factor.ConclusionThe factors found in this review provide specific indications for identifying non-western women who are at risk of not using prenatal care adequately and for developing interventions and appropriate policy aimed at improving their prenatal care utilization.
Highlights
Despite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do
A meta-analysis by Gagnon et al showed that Asian, North African and sub-Saharan African migrants were at greater risk of feto-infant mortality than ‘majority’ populations in western industrialized countries, with adjusted odds ratios of 1.29, 1.25 and 2.43 respectively
This study found that Asian and sub-Saharan African migrants are at greater risk of preterm birth, with adjusted odds ratios of 1.14 and 1.29 respectively [10]
Summary
Despite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. Despite universal healthcare insurance coverage in most industrialized western countries, studies in these countries have shown that non-western women make inadequate use of prenatal care. They are less likely to initiate prenatal care in good time [3,5,6,7], attend all prenatal care appointments [8] and attend prenatal classes [9]. Besides an increased risk for adverse perinatal outcomes, non-western women are at increased risk of adverse maternal outcomes, in terms of both mortality [11,12] and morbidity [13]
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