Page 11 - Non-western women in maternity care in the Netherlands • Exploring ‘inadequate’ use of prenatal care and the experiences of care professionals

Introduction
Migration to the more developed regions of the world has shown a rising trend over the past years. The proportion of migrants worldwide living in more developed regions of the world increased from 53% in 1990 to 60% in 2010. Female migrants exceeded male migrants in number and comprised 51.5% of the migrant population in these regions [1]. Several studies conducted in developed countries have shown that the needs and expectations of migrants in terms of maternity care are not always met by the healthcare system [2-4]. Healthcare systems tend to focus their care mainly on the majority population and are not responsive enough to the ethnic diversity within the client population [2-5].
In the Netherlands, 11.4% of the population in 2011 was of non-western migrant origin, in the sense that at least one parent was born in Africa, Asia, Latin America or Turkey. Data from 2010 show that non-western women contributed 17.7% of all live births [6]. In the three majo r cities of the Netherlands – Amsterdam, Rotterdam and The Hague – they in fact contributed 47, 48 and 42% of the births respectively [7]. It can be concluded from this data that Dutch midwives, especially those working in the major cities, are providing care to a client population of which a substantial part is non-western in origin. These non-western clients are very diverse in origin, with Turks, Moroccans, Surinamese and Antilleans/Arubans comprising the largest groups in the Netherlands. This diversity in country of origin implies a diversity in cultural backgrounds and hence a variety of needs and expectations regarding maternity care. The Royal Dutch Organization of Midwives (KNOV) attaches great importance to placing women at the centre of care. This implies that midwives have to take the cultural background and the specific needs and expectations of their clients into account.
Non-western clients have also been shown to make suboptimal use of prenatal care compared to the majority population of the Netherlands [8,9]. This less than optimal use is mainly characterised by late start of prenatal care, and may delay detection and treatment of pregnancy complications, concurrent illnesses and health problems. Two Dutch studies have reported that the late start of prenatal care explains at least part of the high perinatal mortality observed among certain non-western groups [10,11]. Furthermore, non-western clients have been shown to be at higher risk of maternal mortality and congenital disorders [12]. Thus, both the
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