Page 12 - Non-western women in maternity care in the Netherlands • Exploring ‘inadequate’ use of prenatal care and the experiences of care professionals

suboptimal use of prenatal care and the different needs and expectations may complicate the provision of optimal care to non-western clients who are at greater risk for poor pregnancy outcomes.
Only a few studies in developed countries have explored the experiences of midwives or other maternity care providers with women from ethnic minorities. In a survey conducted among midwives in Spain, 67% of the 102 respondents stated that language barriers were a key difficulty in providing health education to African women [13]. Fifty-four per cent of the respondents used additional materials such as books, videos and leaflets to educate these women. In the UK, maternity care professionals were interviewed about their perceptions of the effect that ethnic background, social status and class have on service delivery for UK-born ethnic minority women [14]. The maternity care professionals perceived UK-born ethnic minority women to be more assertive and to have better language proficiency and better comprehension of the healthcare system than ethnic minority women born elsewhere. In an ethnographic study carried out in a British hospital, midwives were found to have stereotypical ideas about South Asian women that were used to make decisions about the care these women want, need and deserve [15]. These stereotypes were centred on four themes: communication problems, lack of compliance with care and misuse of services, making a fuss about nothing, and a lack of maternal instinct. In a qualitative study conducted in Ireland, communication difficulties, cultural differences and suboptimal knowledge and use of services were some of the main issues raised by maternity service providers about ethnic minority women [16]. In another qualitative study conducted in Canada, health care providers reported several differences in expectations between them and immigrant clients: language, cultural competency, the type of care provided and the medicalisation of pregnancy [17]. A focus group study conducted in Norway revealed that midwives and public health nurses encountered health challenges and cultural challenges when caring for migrant women [18]. The first three studies each focused specifically on a certain aspect of experiences with ethnic minority women: communication, the effect of the migrant’s background, social status and class on service delivery or stereotypes. Only the remaining three studies considered various aspects of maternity care providers’ experiences with ethnic minority women. These studies were conducted in Ireland, Canada and Norway, countries with a different migration history and different migrant groups than the Netherlands. Furthermore, the maternity care
128 Non-western women in maternity care in the Netherlands