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Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review

Agatha W Boerleider1*, Therese A Wiegers1, Judith Manniën2, Anneke L Francke13 and Walter LJM Devillé145

Author Affiliations

1 Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, , Utrecht, The Netherlands

2 Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

3 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081BT, Amsterdam, Netherlands

4 Faculty of Social and Behavioural Sciences, University of Amsterdam, Oudezijds Achterburgwal 185, 1012DK, Amsterdam, The Netherlands

5 National Knowledge and Advisory Center on Migrants, Refugees and Health (Pharos), Herenstraat 35, 3507LH, Utrecht, The Netherlands

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BMC Pregnancy and Childbirth 2013, 13:81  doi:10.1186/1471-2393-13-81

Published: 27 March 2013



Despite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. This study aimed to give a systematic review of factors affecting non-western women’s use of prenatal care (both medical care and prenatal classes) in industrialized western countries.


Eleven databases (PubMed, Embase, PsycINFO, Cochrane, Sociological Abstracts, Web of Science, Women’s Studies International, MIDIRS, CINAHL, Scopus and the NIVEL catalogue) were searched for relevant peer-reviewed articles from between 1995 and July 2012. Qualitative as well as quantitative studies were included. Quality was assessed using the Mixed Methods Appraisal Tool. Factors identified were classified as impeding or facilitating, and categorized according to a conceptual framework, an elaborated version of Andersen’s healthcare utilization model.


Sixteen articles provided relevant factors that were all categorized. A number of factors (migration, culture, position in host country, social network, expertise of the care provider and personal treatment and communication) were found to include both facilitating and impeding factors for non-western women’s utilization of prenatal care. The category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors.

Lack of knowledge of the western healthcare system and poor language proficiency were the most frequently reported impeding factors. Provision of information and care in women’s native languages was the most frequently reported facilitating factor.


The factors found in this review provide specific indications for identifying non-western women who are at risk of not using prenatal care adequately and for developing interventions and appropriate policy aimed at improving their prenatal care utilization.