Factors explaining inadequate prenatal care utilization by first and second generation non-western women in The Netherlands

Abstract

Background: In many industrialized western countries non-western women constitute a substantial part of the prenatal care client population. In The Netherlands, these women have also been shown to be more likely to make inadequate use of prenatal care. Explanatory factors for this include, among others, poor language proficiency, lower education and teenage pregnancies. However, these studies did not take into account the number of prenatal visits, and did not distinguish between first and second generation non-western women. By taking both prenatal care initiation and the number of prenatal visits into account, this quantitative study aims to provide a more in depth understanding of the factors explaining first and second generation non-western women’s inadequate prenatal care utilization in The Netherlands. Methods: Data on prenatal care utilization and possible explaining factors were derived from the national DELIVER study, a cohort of 7907 women recruited between September 2009 and February 2011 from 20 primary midwifery care practices in The Netherlands. To assess prenatal care utilization, the Kotelchuck index was modified to the Dutch primary midwifery care context. Possible explanatory variables were grouped according to an elaborated version of the Andersen model of healthcare utilization. After initial descriptive and univariate analysis, logistic block wise regression analyses were conducted and percentage change in odds ratio calculated. Results: Preliminary results show that whether or not having a partner, the partner’s ethnic origin and the language spoken at home, explain a substantial part of second generation non-western women’s inadequate prenatal care utilization. Explanatory factors for first generation women are: the two earlier mentioned factors plus planning and wantedness of pregnancy and socioeconomic status. Conclusions: These results demonstrate that there are similarities and differences between first and second generation non-western women who make inadequate use of prenatal care. These insights need to be taken into account when developing measures to improve prenatal care utilization by non-western women in The Netherlands and other industrialized western countries.