title: Explanatory factors for first and second-generation non-western women's inadequate prenatal care utilisation: a prospective cohort study.
abstract: BACKGROUND
  Little research into non-western women's prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women's prenatal care utilisation and its explanatory factors according to generational status.
  
  
  METHODS
  Data from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women's prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios.
  
  
  RESULTS
  The unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation.
  
  
  CONCLUSIONS
  Irrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤ 19 or ≥ 36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands. agathawb75@yahoo.com.
authors.forename: Agatha W
authors.initials: AW
authors.lastname: Boerleider
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. judithmannien@gmail.com.
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.affiliation: Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, the Netherlands. c.m.v.vanstenus@utwente.nl.
authors.forename: Cherelle M V
authors.initials: CM
authors.lastname: van Stenus
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands. t.wiegers@nivel.nl.
authors.forename: Therese A
authors.initials: TA
authors.lastname: Wiegers
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Esther.Feijen@inholland.nl.
authors.forename: Esther I
authors.initials: EI
authors.lastname: Feijen-de Jong
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. evelienspelten@yahoo.com.|Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. evelienspelten@yahoo.com.
authors.forename: Evelien R
authors.initials: ER
authors.lastname: Spelten
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands. w.l.j.m.deville@uva.nl.|Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands. w.l.j.m.deville@uva.nl.|National Knowledge and Advisory Centre on Migrants, Refugees and Health (Pharos), Utrecht, the Netherlands. w.l.j.m.deville@uva.nl.
authors.forename: Walter L J M
authors.initials: WL
authors.lastname: Devillé
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003144:Communication Barriers; D003469:Culture; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007182:Income; D007348:Insurance, Health; D007802:Language; D016015:Logistic Models; D008880:Midwifery; D009018:Morocco / Q000208:ethnology; D009426:Netherlands; D009427:Netherlands Antilles / Q000208:ethnology; D016017:Odds Ratio; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013532:Suriname / Q000208:ethnology; D011795:Surveys and Questionnaires; D014421:Turkey / Q000208:ethnology; D055815:Young Adult