Non-Western women start prenatal care later

First- and second-generation non-Western women make less use of maternity care than native Dutch women. A number of factors play a role in this, such as their partner’s ethnicity and their socioeconomic situation. This has emerged from research conducted at the Netherlands Institute for Health Services Research (NIVEL) by Agatha Boerleider for her doctoral thesis. She received her PhD from the University of Amsterdam on April 2.

Non-Western women in the Netherlands use prenatal care differently than native Dutch women. Data on women from 20 midwifery practices have shown that while nearly 8% of the native Dutch women didn’t make optimal use of maternity care, this percentage was 22% among first-generation and 16% among second-generation non-Western women.
 
Contributing factors
“For both first and second-generation non-Western women, this suboptimal use of prenatal care can be explained by sociocultural factors such as not having a partner or having a first-generation non-native Dutch partner,” Boerleider explains. “For the first generation, socioeconomic factors – like a low net household income – also play a role.”
 
Starting prenatal care late
Among the women who didn’t make optimal use of maternity care, most were found to have started prenatal care late in their pregnancy. One of the advantages of starting such care early on is that women can then be provided with timely information about the dangers of smoking and alcohol use and the importance of good nutrition.
Interviews with these women revealed that they had started prenatal care late because they did know they were pregnant, did not think they had access to maternity care (for example, because they were living in the Netherlands illegally), or were not ready to do this yet (for example, because they had not yet told their family they were pregnant, or were thinking about having an abortion).
 
Aiming for optimal care
During the research she carried out for her PhD project, Agatha Boerleider also interviewed midwives and maternity care assistants about their experiences with non-Western clients. These interviews showed that a language barrier, limited knowledge about the Dutch maternity care system, and the important role played by the family can make providing care to non-Western women more difficult. Agatha Boerleider: “In spite of this, midwives and maternity care assistants are striving for optimal care by being alert, proactive, creative, and flexible, and by taking these women by the hand and explaining how the Dutch system works. By coming up with their own solutions and approaches they do just a little bit more than is usual when caring for most native Dutch pregnant women.”

Funding
AVAG Midwifery Academy Amsterdam Groningen (Academie Verloskunde Amsterdam Groningen) (in Dutch)
EMGO/VUMC
Dutch Ministry of Education, Culture, and Science