Barriers to prenatal care in Europe.
BACKGROUND
In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades.


METHODS
A case-control study was performed in ten European countries (Austria, Denmark, Germany, Greece, Hungary, Ireland, Italy, Portugal, Spain, and Sweden). Postpartum interviews were conducted between 1995 and 1996. A total of 1283 women with inadequate prenatal care (i.e., with 0, 1, or 2 prenatal care visits or a first prenatal care visit after 15 completed weeks of pregnancy) and 1280 controls with adequate prenatal care were included in the analysis combining data from the ten countries.


RESULTS
Based on combined data of the ten countries, lack of health insurance was found to be an important risk factor for inadequate prenatal care (crude odds ratio [OR] at 95% confidence interval [CI]: 30.1 [20.1-47.1]). Women with inadequate prenatal care were more likely to be aged < 20 years (16.4% vs 4.8%) and with higher parity (number of children previously borne) than controls. They were more likely to be foreign nationals, unmarried, and with an unplanned pregnancy. Women with inadequate care were also more likely to have less education and no regular income. They had more difficulties dealing with health services organization and child care. Cultural and financial barriers were present, but after adjusting for confounders by logistic regression, perceived financial difficulty was not a significant factor for inadequate prenatal care (adjusted OR [95% CI]: 0.7 [0.4-1.3]).


CONCLUSIONS
Personal, socioeconomic, organizational, and cultural barriers to prenatal care exist in Europe.
Delvaux
T
T
School of Public Health, Department of Epidemiology and Social Medicine, Free University of Brussels, Belgium. tdelvaux@itg.be
Buekens
P
P
Godin
I
I
Boutsen
M
M
D000328:Adult; D016022:Case-Control Studies; D004522:Educational Status; D005060:Europe; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008423:Maternal Age; D009035:Mothers / Q000193:education / Q000523:psychology* / Q000706:statistics & numerical data; D010298:Parity; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires