Skip to main content

Advertisement

SpringerLink
Log in

Disparities in Access to Prenatal Care Services for African Immigrant Women in Spain

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

This retrospective cohort study compares the utilization of prenatal care between African immigrant and native Spanish women. For 2007–2010, we identified 231 pregnant African immigrant women. The native-born population sample was obtained by simple random sampling in a 1:3 ratio. The Kessner Index (KI) and our Own Index (OI) were applied to rate prenatal care adequacy in three categories (adequate, intermediate, and inadequate). Odds ratios (ORs) were estimated using non-conditional logistic regression. Prenatal care was adequate according to the indexes (KI or OI) in 21.3 and 25.8 % of North Africans and in 22.5 and 30.4 % of sub-Saharan Africans. The ORs of inadequacy when adjusted for maternal age, social risk factors, and previous reproductive outcomes were 30.32 and 35.47 (KI or OI) in North and 64.43 and 67.93 in sub- Saharan Africans. These results suggest significant differences in obtaining adequate prenatal care between immigrant and native Spanish women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cots F, Castells X, Garcia O, Riu M, Felipe A, Vall O. Impact of immigration on the cost of emergency visits in Barcelona (Spain). BMC Health Serv Res. 2007;7:9.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Rio I, Castello A, Barona C, Jane M, Mas R, Rebagliato M, Bosch S, Martínez E, Bolúmar F. Caesarean section rates in immigrant and native women in Spain: the importance of geographical origin and type of hospital for delivery. Eur J Public Health. 2010;20(5):524–9.

    Article  PubMed  Google Scholar 

  3. Comas M, Catala L, Sala M, Paya A, Sala A, Del Amo E, Castells X, Cots F. Descriptive analysis of childbirth healthcare costs in an area with high levels of immigration in Spain. BMC Health Serv Res. 2011;11:77.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Garcia-Subirats I, Perez G, Rodriguez-Sanz M, Salvador J, Jane M. Recent immigration and adverse pregnancy outcomes in an urban setting in Spain. Matern Child Health J. 2011;15(5):561–9.

    Article  PubMed  Google Scholar 

  5. Gispert R, Clot-Razquin G, Torne MM, Bosser-Giralt R, Freitas-Ramirez A. Differences in reproductive patterns between autochthonous and immigrant women living in Catalonia, Spain. Gac Sanit. 2008;22(6):574–7.

    Article  Google Scholar 

  6. Luque MA, Bueno-Cavanillas A. Fertility in Spain, 1996-2006: foreign versus Spanish women. Gac Sanit. 2009;23(Suppl 1):67–71.

    Article  Google Scholar 

  7. Rio I, Castello A, Jane M, Prats R, Barona C, Mas R, Rebagliato M, Zurriaga O, Bolúmar F. Reproductive and perinatal health indicators in immigrant and Spanish-born women in Catalonia and Valencia (2005–2006). Gac Sanit. 2010;24(2):123–7.

    Article  PubMed  Google Scholar 

  8. Fernandez MA, Cavanillas AB, de Mateo S. Differences in the reproductive pattern and low birthweight by maternal country of origin in Spain, 1996–2006. Eur J Public Health. 2011;21(1):104–8.

    Article  PubMed  Google Scholar 

  9. Gagnon AJ, McDermott S, Rigol-Chachamovich J, Bandyopadhyay M, Stray-Pedersen B, Stewart D, ROAM Collaboration. International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis. Paediatr Perinat Epidemiol. 2011;25(6):575–92.

    Article  PubMed  Google Scholar 

  10. World Health Organization. Department of Reproductive Health and Research. Randomized Trial WHO antenatal care: a manual for the implementation of the new antenatal care model. 2003. http://whqlibdoc.who.int/hq/2001/WHO_RHR_01.30.pdf.

  11. Villar J, Carroli G, Khan-Neelofur D, Piaggio G, Gulmezoglu M. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2001;4:CD000934.

    PubMed  Google Scholar 

  12. Villar JH, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizan J, Farnot U, Al-Mazrou Y, Carroli G, Pinol A, Donner A, Langer A, Nigenda G, Mugford M, Fox-Rushby J, Hutton G, Bergsjø P, Bakketeig L, Berendes H, Garcia J, WHO Antenatal Care Trial Research Group. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357(9268):1551–64.

    Article  CAS  PubMed  Google Scholar 

  13. Kogan MD, Martin JA, Alexander GR, Kotelchuck M, Ventura SJ, Frigoletto FD. The changing pattern of prenatal care utilization in the United States, 1981–1995, using different prenatal care indices. JAMA. 1998;279(20):1623–8.

    Article  CAS  PubMed  Google Scholar 

  14. Khan-Neelofur D, Gulmezoglu M, Villar J. Who should provide routine antenatal care for low-risk women, and how often? A systematic review of randomised controlled trials. WHO Antenatal Care Trial Research Group. Paediatr Perinat Epidemiol. 1998;12(Suppl 2):7–26.

    Article  PubMed  Google Scholar 

  15. Alexander GR, Cornely DA. Prenatal care utilization: its measurement and relationship to pregnancy outcome. Am J Prev Med. 1987;3(5):243–53.

    CAS  PubMed  Google Scholar 

  16. Spanish Society of Gynaecology and Obstetrics. Normal pregnancy prenatal care. Recommendations of the Spanish Society of Gynaecology and Obstetrics [in Spanish]. Madrid: Spanish Society of Gynaecology and Obstetrics 2010; 3. http://www.proSEGO.com.

  17. National Institute for Health and Clinical Excellence. National Collaborating Centre for Women’s and Children’s Health. NICE Clinical Guideline 62. Antenatal care routine care for healthy pregnant woman. 2008 http://www.nice.org.uk/nicemedia/pdf/CG62fullguideline.pdf.

  18. da Conceição F Santiago M, Figueiredo MH. Immigrant Women’s Perspective on Prenatal and Postpartum Care: Systematic Review. J Immigr Minor Health. 2013; 20. doi:10.1007/s10903-013-9915-4.

  19. Colón-Burgos JF, Colón-Jordan HM, Reyes-Ortiz VE, Marin-Centeno HA, Rios-Mota R. Disparities and barriers encountered by Immigrant Dominican mothers accessing prenatal care services in Puerto Rico. J Immigr Minor Health. 2013; 26. doi:10.1007/s10903-013-9875-8.

  20. Liang YW, Chang HP, Lin YH, Lin LY, Chen WY. Factors affecting adequate prenatal care and the prenatal care visits of immigrant women to Taiwan. J Immigr Minor Health. 2014;16(1):44–52.

    Article  PubMed  Google Scholar 

  21. Kessner DM, Singer J, Kalk CE, Schlesinger ER. Methodology: New York City analysis. In: Kessner DM, Singer J, Kalk CE, Schlesinger ER, editors. Infant death: an analysis by maternal risk and health care. Washington: Institute of Medicine and National Academy of Sciences; 1973.

    Google Scholar 

  22. Delgado-Rodríguez M, Gómez Olmedo M, Bueno Cavanillas A, Gálvez Vargas R. Comparison of 2 indexes of prenatal care and risk of preterm delivery. Gac Sanit. 1997;11(3):136–42.

    Article  PubMed  Google Scholar 

  23. Domingo Puiggròs M, Figaro Volta C, Loverdos Eseverri I, Costa Colomer J, Badia Barnusell J. Pregnant immigrant and neonatal morbidity. An Pediatr (Barc). 2008;68(6):596–601.

    Article  Google Scholar 

  24. Castelló A, Río I, Martínez E, Rebagliato M, Barona C, Llácer A, Bolumar F. Differences in preterm and low birth weight deliveries between Spanish and immigrant women: influence of the prenatal care received. Ann Epidemiol. 2012;22(3):175–82.

    Article  PubMed  Google Scholar 

  25. David M, Pachaly J, Vetter K. Perinatal outcome in Berlin (Germany) among immigrants from Turkey. Arch Gynecol Obstet. 2006;274(5):271–8.

    Article  PubMed  Google Scholar 

  26. Ny P, Dykes AK, Molin J, Dejin-Karlsson E. Utilisation of antenatal care by country of birth in a multi-ethnic population: a four-year community-based study in Malmö, Sweden. Acta Obstet Gynecol Scand. 2007;86(7):805–13.

    Article  PubMed  Google Scholar 

  27. Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244–60.

    Article  PubMed  Google Scholar 

  28. Downe S, Finlayson K, Walsh D, Lavender T. ‘Weighing up and balancing out’: a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG. 2009;116(4):518–29.

    Article  CAS  PubMed  Google Scholar 

  29. Chote AA, Koopmans GT, Redekop WK, de Groot CJ, Hoefman RJ, Jaddoe VW, Hofman A, Steegers EA, Mackenbach JP, Trappenburg M, Foets M. Explaining ethnic differences in late antenatal care entry by predisposing, enabling and need factors in The Netherlands. The Generation R Study. Matern Child Health J. 2011;15(6):689–99.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Gould JB, Madan A, Qin C, Chavez G. Perinatal outcomes in two dissimilar immigrant populations in the United States: a dual epidemiologic paradox. Pediatrics. 2003;111(6 Pt 1):e676–82.

    Article  PubMed  Google Scholar 

  31. Fuentes-Afflick E, Hessol NA, Bauer T, O’Sullivan MJ, Gomez-Lobo V, Holman S, Wilson TE, Minkoff H. Use of prenatal care by Hispanic women after welfare reform. Obstet Gynecol. 2006;107(1):151–60.

    Article  PubMed  Google Scholar 

  32. Bengiamin MI, Capitman JA, Ruwe MB. Disparities in initiation and adherence to prenatal care: impact of insurance, race-ethnicity and nativity. Matern Child Health J. 2010;14(4):618–24.

    Article  PubMed  Google Scholar 

  33. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202(4):335–43.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Janevic T, Savitz DA, Janevic M. Maternal education and adverse birth outcomes among immigrant women to the United States from Eastern Europe: a test of the healthy migrant hypothesis. Soc Sci Med. 2011;73(3):429–35.

    Article  CAS  PubMed  Google Scholar 

  35. Ray JG, Singh G, Burrows RF. Evidence for suboptimal use of periconceptional folic acid supplements globally. BJOG. 2004;111(5):399–408.

    Article  CAS  PubMed  Google Scholar 

  36. van Eijsden M, van der Wal MF, Bonsel GJ. Folic acid knowledge and use in a multi-ethnic pregnancy cohort: the role of language proficiency. BJOG. 2006;113(12):1446–51.

    Article  PubMed  Google Scholar 

  37. Peake JN, Copp AJ, Shawe J. Knowledge and periconceptional use of folic acid for the prevention of neural tube defects in ethnic communities in the United Kingdom: systematic review and meta-analysis. Birth Defects Res A Clin Mol Teratol. 2013;97(7):444–51.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  38. Brough L, Rees GA, Crawford MA, Dorman EK. Social and ethnic differences in folic acid use preconception and during early pregnancy in the UK: effect on maternal folate status. J Hum Nutr Diet. 2009;22:100–7.

    Article  CAS  PubMed  Google Scholar 

  39. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet. 1991;338(8760):131–7.

    Article  Google Scholar 

  40. De-Regil LM, Fernández-Gaxiola AC, Dowswell T, Peña-Rosas JP. Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2010;10:CD007950.

    PubMed  Google Scholar 

  41. Czeizel AE, Dudás I, Vereczkey A, Bánhidy F. Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients. 2013;5(11):4760–75.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Czeizel AE. Specified critical period of different congenital abnormalities: a new approach for human teratology. Congenit Anom. 2008;48:103–9.

    Article  Google Scholar 

  43. de Walle HE, de Jong-van den Berg LT. Insufficient folic acid intake in the Netherlands: what about the future? Teratology. 2002;66(1):40–3.

    Article  PubMed  Google Scholar 

  44. Lane IR. Preventing neural tube defects with folic acid: nearly 20 years on, the majority of women remain unprotected. J Obstet Gynaecol. 2011;31(7):581–5.

    Article  CAS  PubMed  Google Scholar 

  45. Navarrete-Muñoz EM, Giménez Monzó D, de García La Hera M, Climent MD, Rebagliato M, Murcia M, Iñiguez C, Ballester F, Ramón R, Vioque J. Folic acid intake from diet and supplements in a population of pregnant women in Valencia, Spain. Med Clin (Barc). 2010;135(14):637–43.

    Article  Google Scholar 

  46. Braekke K, Staff AC. Periconceptional use of folic acid supplements in Oslo. Acta Obstet Gynecol Scand. 2003;82(7):620–7.

    Article  PubMed  Google Scholar 

  47. Rowe RE, Garcia J. Social class, ethnicity and attendance for antenatal care in the United Kingdom: a systematic review. J Public Health Med. 2003;25(2):113–9.

    Article  PubMed  Google Scholar 

  48. Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clin North Am. 2004;51(3):619–37.

    Article  PubMed  Google Scholar 

  49. Campaigne A, Conway D. Detection and prevention of macrosomia. Obstet Gynecol Clin North Am. 2007;34(2):309–22.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

To all staff of the Primary Care Management departments of the Cantabrian Health Service for the support and the facilities given to the study. To Rosa María Plata Quintanilla for their assistance in developing the database. To Irene Castro and Maria Ruiz for their contribution to acquisition of data. This work was partially supported by the accesit for the best investigation protocol presented to the 12th edition of the National nursing research awards. In addition, Maria Paz Zulueta was the recipient of a Grant from IFIMAV for the best investigation protocol elaborated during the 5th course of methodology of investigation.

Conflict of Interest

None to declare.

Author information

Authors and Affiliations

  1. Department of Nursing, University of Cantabria, Avda de Valdecilla s/n, 39008, Santander, Spain

    María Paz-Zulueta & Miguel Santibáñez

  2. Department of Public Health Sciences, Faculty of Medicine, University of Cantabria, Avda. Cardenal Herrera Oria, s/n, 39011, Santander, Spain

    Javier Llorca

  3. Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain

    Javier Llorca & Miguel Santibáñez

  4. CIBER of Epidemiology and Public Health (CIBERESP), Santander, Spain

    Javier Llorca

  5. Departamento de Enfermería, Escuela de Enfermería, Universidad de Cantabria, Avda de Valdecilla s/n, 39008, Santander, Spain

    Miguel Santibáñez

Authors
  1. María Paz-Zulueta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Llorca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel Santibáñez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miguel Santibáñez.

Additional information

Miguel Santibañez and Javier Llorca share senior authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paz-Zulueta, M., Llorca, J. & Santibáñez, M. Disparities in Access to Prenatal Care Services for African Immigrant Women in Spain. J Immigrant Minority Health 17, 1355–1363 (2015). https://doi.org/10.1007/s10903-014-0086-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-014-0086-8

Keywords

Search

Navigation