Etnische verschillen in het gebruik van kraamzorg

Majda Lamkaddem, Anouk van der Straten, Marie-Louise Essink-Bot, Manon van Eijsden en Tanja Vrijkotte

Ethnic differences in uptake of professional maternity care assistance

This supplementary information is presented as submitted by the corresponding author. It has not been copy-edited by NTvG.


Professional maternity care assistance (MCA) is an important part of perinatal healthcare in the Netherlands. MCA offers care to mother and infant at the home. One important aspect of MCA care is the provision of information to the mother regarding health and risk behaviours towards the infant.. MCA is widely used in the Netherlands. However, mothers of non-Western origin seem to use less MCA than Dutch mothers. The differences between ethnic groups as to the utilisation rate of MCA have not been thoroughly quantified, and the reasons for those difference are unknown. The present study therefore focusses on ethnic differences in the utilisation of MCA, and on the factors that could explain those differences. Moreover, the effect of MCA on health risk behaviour towards the infant are being examined.


Survey data of 3967 mothers from the ABCD-study (Amsterdam Born Children and their Development, inclusion during pregnancy in 2003-2004) were used. We examined the role of ethnicity, age, socioeconomic status, language mastery, parity, living situation and place of birth for MCA utilization, and the effect of MCA utilisation on health risk behaviour towards the infant (smoking inside, infant sleep behaviour, breastfeeding, vitamin K practice, response to infant crying). Interaction analyses were used to examine potential differences between Dutch mothers and mothers with a non-Western background as to the association between MCA utilisation and health risk behaviour reduction.


Mothers of non-Western origin used less often MCA than Dutch mothers (Ghanaian: 70%, Turkish:75%, Moroccan: 79%, Surinamese: 81%, Dutch Caribbean:85% vs. Dutch: 95%). A higher education, a better mastery of the Dutch language, having a paid job and home delivery were all independently associated with the use of MCA, and also partly explained ethnic differences in use of MCA. Mothers who received MCA gave more often breastfeeding, more often vitamin K when not breastfeeding, and lived more often in smoke free houses. The protective effect of MCA was stronger for non-Western mothers than for Dutch mothers concerning the sleeping habits of the infant and vitamin K practice. This was not the case for the other three risk behaviours (smoking inside, breastfeeding, response to infant crying).


Mothers of non-Western origin use more often professional MCA. Cultural factors might play a role in this difference, besides socioeconomic factors and language mastery. Given that the use of MCA is associated with a lower health risk behaviour towards the infant, and that this association is larger for mother with a non-Western background, efforts should be made to enhance the accessibility of professional MCA for those groups.