Abstract
Approximately 21% of Germany's inhabitants or their parents have been born abroad. There is evidence that immigrant women are starting antenatal care later than nonimmigrants. In Berlin, equality in health care access had improved until 2011-2012, leaving only women with Low German language proficiency and an insecure residence status particularly at risk. With the recent influx of refugees, we analyzed whether access to antenatal and postpartum care differs depending on immigration, residence status, income, and education. At our Berlin tertiary care center, a modified version of the Migrant Friendly Maternity Care Questionnaire was administered to women who delivered in the first half of 2017. Multivariate modeling compared nonimmigrant women, immigrants, and women who are direct descendants of immigrants. The study included 184 nonimmigrant women, 214 immigrant women, and 62 direct descendants of immigrants. Germany is relatively good in prenatal care for immigrant women, as most are getting adequate prenatal care. However, 21% of immigrants compared with 11% of nonimmigrant women started pregnancy care after the first trimester (P=.03). Low income was a more powerful predictor than immigration status for starting prenatal care after the first trimester. Immigrant women (23%) were less informed on postpartum care availability than nonimmigrants (3%) and used less postpartum midwifery care. When designing health care interventions for immigrant women, not only migration-specific factors should be considered but also low income as a barrier to access to maternity care.
Highlights
21% of Germany's inhabitants or their parents have been born abroad
At our Berlin tertiary care center, a modified version of the Migrant Friendly Maternity Care Questionnaire was administered to women who delivered in the first half of 2017
One respondent answered that her status was undocumented, she was from Syria and started antenatal care (ANC) in 12 + 3 gestational weeks and had 10 ANC visits
Summary
21% of Germany's inhabitants or their parents have been born abroad. There is evidence that immigrant women are starting antenatal care later than nonimmigrants. Results: The study included 184 nonimmigrant women, 214 immigrant women, and 62 direct descendants of immigrants. Between 2015 and 2016, there has been an 8.5% increase in people with an immigration background in the German population.[1] A 2016 publication reported that ~21% of Germany's inhabitants were either born outside Germany (first-generation immigrants) or are the direct descendants of immigrants (second generation).[2] The German birth rate has increased, related partially to the influx of newly arrived young women in the past years.[3]. Studies from the United Kingdom, New Zealand, and Austria have shown that ethnic minority women[4,5,6] and immigrants[7,8] tend to start antenatal care (ANC) at a later gestational age than the overall population. A case-control study of ten European countries from 1995 to 1996 found that being another nationality, lacking health insurance, young age, higher parity, unmarried, less education, no regular income, and unplanned pregnancy were factors leading to inadequate ANC.[9]
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