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health dutch study utilization women difference group antenatal care netherland immigrant model factor moroccan distress turkish service symptom gender variable antenatal pregnancy symptom perception background research language perception antillean journal level health care utilization surinamese acculturation condition status generation r study survey attitude education population morbidity effect entry generation dutch language proficiency health care disease mother proficiency number medicine .00 science analysis language proficiency result immigrant groups sample table illness rotterdam health services fi ndings path coef ficients dutch women lamers / measure health care use family country complaint drugs use self-rated respondent propensity utilization propensity relation underutilization health status signi ficant 0.001