Ethnic differences in antenatal care use in a large multi-ethnic urban population in the Netherlands
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Objective: to determine differences in antenatal care use between the native population and different ethnic minority groups in the Netherlands. Design: the Generation R Study is a multi-ethnic population-based prospective cohort study. Setting: seven midwife practices participating in the Generation R Study conducted in the city of Rotterdam. Participants: in total 2093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese-Creole and Surinamese-Hindustani background were included in this study. Measurements: to assess adequate antenatal care use, we constructed an index, including two indicators; gestational age at first visit and total number of antenatal care visits.Logistic regression analysis was used to assess differences in adequate antenatal care use between different ethnic groups and a Dutch reference group, taking into account differences in maternal age, gravidity and parity. Findings: overall, the percentages of women making adequate use are higher in nulliparae than in multiparae, except in Dutch women where no differences are present.Except for the Surinamese-Hindustani, all women from ethnic minority groups make less adequate use as compared to the native Dutch women, especially because of late entry in antenatal care. When taking into account potential explanatory factors such as maternal age, gravidity and parity, differences remain significant, except for Cape-Verdian women. Dutch-Antillean, Moroccan and Surinamese-Creole women exhibit most inadequate use of antenatal care. Key conclusions: this study shows that there are ethnic differences in the frequency of adequate use of antenatal care, which cannot be attributed to differences in maternal age, gravidity and parity. Future research is necessary to investigate whether these differences can be explained by socio-economic and cultural factors. Implications for practise: clinicians should inform primiparous women, and especially those from ethnic minority groups, on the importance of timely antenatal care entry.