The impact of social factors on attendance at antenatal care services and the subsequent effect on mothers’ health, measured during the years of economic transition in Latvia

Abstract

The goal of the study is to evaluate the risk factors having an impact on attendance at antenatal care services in Latvia during the years of economic transition as well as the impact of those factors on mothers and newborns’ health. Based on Latvian statistical data and published surveys, we analysed the possible impact of social and economic factors on attendance at antenatal care services. To illustrate the posed problems, we carried out a small pilot follow-up study, comparing social profiles, incidences of reproductive tract infections and HIV infection and pregnancy outcome on 200 consecutive unselected pregnant women who received antenatal care and 25 pregnant women who did not. Despite the fact that antenatal care is free of charge and the social security system facilitates the attendance of antenatal care visits, 4.6% of pregnant women in 1997 and 3.3% of pregnant women in 2002 did not attend antenatal care. Their perinatal outcome is significantly worse, as they are more likely to deliver preterm and growth-retarded babies and have a greater risk of perinatal mortality. Women delivering without previous antenatal care were characterised by poor socio-economic status and have limited access to health care and family planning services due to their low educational level, low income and high incidence of different addictions. More frequently, they were in the risk group having sexually transmitted and HIV infections. As a result, newborns had lower birth weight, were more likely to have intrauterine infection and intrauterine growth retardation. Low social class, high substance abuse, and a high rate of genital infections are associated with lack of antenatal care and compromised neonatal outcome. Improving the availability of primary health care and easy access to social and family planning services are priorities for the socially depressed during the reform period of the health care system in Latvia. Standard protocols for the management of women without previous antenatal care have to be developed.