Utilization of antenatal care among immigrant women in Norway: a nationwide register-based cohort study

International research suggests that immigrants face poorer access to antenatal care, but comprehensive nationwide studies identifying variations across immigrant groups are lacking. Using national registries like the Medical Birth Registry, we compared antenatal care utilization among immigrant women by country/region of origin to Norwegian women.

We included 348,547 singleton births between 2012-2018 by women aged ≥ 16 years registered with ≥ 1 antenatal consultation in primary care, including 79,671 (22.9%) births by immigrant women. We calculated odds ratios (OR) and 95% confidence intervals (CI) using both crude and adjusted logistic regression models, assessing the likelihood of immigrant women having fewer consultations than recommended by national guidelines compared to Norwegian women per trimester. Estimates were adjusted for relevant sociodemographic variables.

Large country-specific differences in estimates were noted across all trimesters. In the crude models, Eritrean (OR 3.01 [95%CI: 2.76-3.28]), Somali (OR 2.63 [95%CI: 2.48-2.79]) and Ethiopian (OR 1.90 [95%CI: 1.67-2.16]) women, and women from other Sub-Saharan countries (OR 1.92 [95%CI: 1.77-2.08]), had the highest odds of initiating antenatal care later than the first trimester. In later trimesters, care utilization by immigrants and Norwegian women were more similar, except for lower utilization among Somali women. Sociodemographic variables explained much of the observed differences.

Late initiation and substandard utilization of antenatal care among certain immigrant groups exists in Norway. Timely access to antenatal care is important for maternal and child health. Efforts should be initiated to facilitate earlier initiation of antenatal care, particularly among Eritrean, Somali, Ethiopian and other Sub-Saharan women.