Association between maternal occupational status and utilization of antenatal care Study based on the perinatal survey of Baden-Wuerttemberg 1998-2003.

ABSTRACT

OBJECTIVES: Adequate utilization of antenatal care reduces the morbidity of mother and child. How frequent a pregnant woman attends antenatal care is dependent on many factors. The aim of this study was to assess the current influence of educational level and occupational status on maternal utilization of antenatal care under the conditions of an industrialized country and provision of universal coverage. METHODS: The perinatal database 1998-2003 of the German state of Baden-Wuerttemberg (556.948 pregnancies) was studied comparing antenatal care utilization for the different occupational categories obtained in the survey. For statistical analysis descriptive statistics and t test on equity of proportions for independent samples were used. RESULTS: As occupational groups at risk of insufficient antenatal care unskilled workers, trainees, students, and housewives were identified. High rates of utilization were found for the categories "top management/executive position" and "skilled workers". Rate of one or less consultations per pregnancy has declined significantly compared to 1998, but has increased again since 2000. Low utilization (2-5 consultations per pregnancy) has not decreased, showing rather constant differences between the occupational categories throughout the observed 6-year period. Unskilled workers, trainees, students, and housewives avail less of prenatal care above standard (more than ten consultations per pregnancy). CONCLUSIONS: Differences in an individual woman's use of antenatal care is, besides many other factors, associated with occupational status. Antenatal care promotion should target trainees, students, and unskilled workers prone to insufficient utilization and its consequences, an increase in obstetrical risk. For these groups, the occupational physician may play a key role in reaching the pregnant women on time, as obstetric care reaches them insufficiently and too late. Although housewives are the most numerous group, inhomogeneity regarding their educational level and previous occupational status has to be assumed, calling for further clinical studies to design appropriate interventional concepts.