title: The association of ethnic minority density with late entry into antenatal care in the Netherlands.
abstract: In the Netherlands, non-Western ethnic minority women make their first antenatal visit later than native Dutch women. Timely entry into antenatal care is important as it provides the opportunity for prenatal screening and the detection of risk factors for adverse pregnancy outcomes. In this study we explored whether women's timely entry is influenced by their neighborhood. Moreover, we assessed whether ethnic minority density (the proportion of ethnic minorities in a neighborhood) influences Western and non-Western ethnic minority women's chances of timely entry into care differently. We hypothesized that ethnic minority density has a protective effect against non-Western women's late entry into care. Data on time of entry into care and other individual-level characteristics were obtained from the Netherlands Perinatal Registry (2000-2008; 97% of all pregnancies). We derived neighborhood-level data from three other national databases. We included 1,137,741 pregnancies of women who started care under supervision of a community midwife in 3422 neighborhoods. Multi-level logistic regression was used to assess the associations of individual and neighborhood-level determinants with entry into antenatal care before and after 14 weeks of gestation. We found that neighborhood characteristics influence timely entry above and beyond individual characteristics. Ethnic minority density was associated with a higher risk of late entry into antenatal care. However, our analysis showed that for non-Western women, living in high ethnic minority density areas is less detrimental to their risk of late entry than for Western women. This means that a higher proportion of ethnic minority residents has a protective effect on non-Western women's chances of timely entry into care. Our results suggest that strategies to improve timely entry into care could seek to create change at the neighborhood level in order to target individuals likely of entering care too late.
authors: Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands.
authors: Anke G
authors: AG
authors: Posthumus
authors: Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands; VU University Amsterdam, Department of Organization Sciences, Amsterdam, the Netherlands.
authors: Vera L N
authors: VL
authors: Schölmerich
authors: Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands.
authors: Eric A P
authors: EA
authors: Steegers
authors: Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America.
authors: Ichiro
authors: I
authors: Kawachi
authors: Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands.
authors: Semiha
authors: S
authors: Denktaş
mesh_terms: D003151:Community Health Centers / Q000706:statistics & numerical data; D003710:Demography; D005260:Female; D049674:History, 21st Century; D006801:Humans; D008913:Minority Groups / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D011156:Population Density; D011247:Pregnancy; D011295:Prenatal Care / Q000266:history / Q000706:statistics & numerical data*; D013997:Time Factors