Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
Matern Child Health J. 2011 Aug;15(6):689-99. doi: 10.1007/s10995-010-0619-2.
Despite compulsory health insurance in Europe, ethnic differences in access to health care exist. The objective of this study is to investigate how ethnic differences between Dutch and non-Dutch women with respect to late entry into antenatal care provided by community midwifes can be explained by need, predisposing and enabling factors. Data were obtained from the Generation R Study. The Generation R Study is a multi-ethnic population-based prospective cohort study conducted in the city of Rotterdam. In total, 2,093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese Creole and Surinamese Hindustani background were included in this study. We examined whether ethnic differences in late antenatal care entry could be explained by need, predisposing and enabling factors. Subsequently, logistic regression analysis was used to assess the independent role of explanatory variables in the timing of antenatal care entry. The main outcome measure was late entry into antenatal care (gestational age at first visit after 14 weeks). With the exception of Surinamese-Hindustani women, the percentage of mothers entering antenatal care late was higher in all non-Dutch compared to Dutch mothers. We could explain differences between Turkish (OR = 0.95, CI: 0.57-1.58), Cape Verdean (OR = 1.65. CI: 0.96-2.82) and Dutch women. Other differences diminished but remained significant (Moroccan: OR = 1,74, CI: 1.07-2.85; Dutch Antillean OR 1.80, CI: 1.04-3.13). We found that non-Dutch mothers were more likely to enter antenatal care later than Dutch mothers. Because we are unable to explain fully the differences regarding Moroccan, Surinamese-Creole and Antillean women, future research should focus on differences between 1st and 2nd generation migrants, as well as on language barriers that may hinder access to adequate information about the Dutch obstetric system.
尽管欧洲实行强制性医疗保险，但在获得医疗保健方面仍存在种族差异。本研究旨在调查荷兰和非荷兰女性在社区助产士提供的产前护理方面进入后期的差异，这些差异可以用需求、倾向和促成因素来解释。数据来自 Generation R 研究。Generation R 研究是一项在鹿特丹市进行的多民族、基于人群的前瞻性队列研究。共有 2093 名荷兰、摩洛哥、土耳其、佛得角、荷属安的列斯群岛、苏里南克里奥尔语和苏里南印度斯坦语背景的孕妇参与了这项研究。我们研究了晚期产前护理进入是否可以用需求、倾向和促成因素来解释。随后，我们使用逻辑回归分析来评估解释变量在产前护理进入时间中的独立作用。主要的结果测量是晚期进入产前护理（首次就诊的孕龄在 14 周后）。除了苏里南印度斯坦语的女性外，所有非荷兰女性的晚期进入产前护理的比例都高于荷兰女性。我们可以解释土耳其（OR=0.95，CI：0.57-1.58）、佛得角（OR=1.65，CI：0.96-2.82）和荷兰女性之间的差异。其他差异缩小但仍然显著（摩洛哥：OR=1.74，CI：1.07-2.85；荷兰安的列斯群岛：OR=1.80，CI：1.04-3.13）。我们发现非荷兰母亲比荷兰母亲更有可能较晚进入产前护理。由于我们无法完全解释摩洛哥、苏里南克里奥尔语和安的列斯群岛妇女的差异，未来的研究应该集中在第一代和第二代移民之间的差异，以及语言障碍可能阻碍获得关于荷兰产科系统的充分信息的差异。
