Effects of the prenatal healthcare access on the perinatal outcome:experience in an italian region

Background Many governments have made commitments to tackle inequalities in healthcare access based on studies which assessed the association between several socio-demographic factors and late initiation or fewer antenatal visits. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in antenatal care in an administrative region of Italy (i.e., Umbria) and the effects in perinatal outcome.. Methods Data were obtained from the administrative source of regional Standard Certificate of Live Birth between 2005 and 2010 and were merged with the Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyse the magnitude of the association of country of birth and citizenship, along with occupation, education, and parity and interaction variables with respect to late access to the first visit and low number of visits. To estimate disparities effects of the healthcare access of migrant women on the pregnancy outcome, we also implement a bivariate probit, which is also implemented to estimate the effects on the birth weight inequalities. Results The study included approximately 37,000 women. Heterogeneous effects of socio-demographic variables which refer to migrant women were documented on the prenatal care indicators analysed. From a multivariate model, we found that women born abroad Italy presented a higher probability to make the first visit later than the 12th week and low number of prenatal visits; the estimated odds ratio (OR) for the analysed indicators is about 60% great than natives, whereas estimating inequalities in prenatal care by the low number the measure ranges from 1:65 to 2:13. Access inequality was also observed when interactions were build for young age, pluriparity, and low education. In addition, we found that employment in migrant women improved access equality, possibly through the transmission of information of the negative consequences related with delayed or few prenatal visits. Conclusion Reduction of the access inequality in recent years, with reductions in birth weight disparities, supports the recent regional policy of integration process in prenatal healthcare access inequalities.