Social determinants and equity in access to prenatal care in an italian region

Introduction: Equity in health care is defined as equal access to available care for equal need, equal utilization for equal need, equal quality of care for all. Many governments have made commitments to tackle inequities in access but making this policy operational will be difficult without a clear picture of what is currently known about equity of access to health care services. Aims: To identify the possible role of various social determinants to equity in access to prenatal care in Umbria, an Italian Region, during the period 2010. Methods: Data was obtained from routine maternity discharge data. Prenatal care indicators are indicators of inadequate or late access to first visit (increased to 12 weeks gestational) and low number of visits (lower than 4). Logistic regression models were used to analyze the magnitude of various social indicators, such as citizenship, occupation, education, and parity with respect to prenatal care indicators.Results: The study included 8525 mothers. Significant differences in prenatal care indicators were documented. In multivariate analysis model, foreign national has been confirmed to be strongly associated with having made the first visit later than the 12th week, particularly for African women (99% CI=2.2-4.1) ; with a low number of prenatal visits, particularly for Asian women (99% CI=2.5-6.7). Having made the first visit beyond the 12th week was associated with even more variables: young age (<20 years) (99% CI=1.7-6.8), pluriparity(99% CI=1.2-1.7) and rural residency (99% CI=1.1-1.5). Having made a low number of visits was associated with even more variables: low educational qualifications (99% CI=2.9-4.3), condition of housewife (99% CI=3.0-4.7) and of unemployment (99% CI=2.5-4.6). Conclusions:The study shows that some maternal factors put women at a disadvantage in relation to access to adequate prenatal care. Access inadequate prenatal care is a public health problem, resulting in risk of complications during birth and neonatal mortality. Policies measures aimed at social-demographic inequalities will reduce adverse perinatal events. More research is needed to explore possible mechanisms underlying social determinants and access inadequate prenatal care and necessary to help improve maternal and fetal health.