Delayed booking for antenatal care

Late booking amongst African women in a London borough, England: implications for health promotion

The National Institute for Health and Clinical Excellence guidance is that a pregnant woman should see a midwife within the first 13 weeks into her pregnancy, in what is known as the 'booking appointment' or the 'full assessment' where she discusses with the midwife her care plan, medical and family histories and social circumstances. Significant numbers of black African women present after 13 weeks into the pregnancy. This study explores why black African women access the booking appointment after 13 weeks of pregnancy in a London borough. The study took a qualitative approach and used semi-structured interviews with 23 women who self-identified as black African migrants born in a sub-Saharan African country, and had experience of using ante-natal services in the borough. Participants discussed how their cultural understandings of pregnancy influenced timing of the booking appointment. The data was analysed using the thematic approach. Cultural, economic and political contexts within which they experienced pregnancy influenced the timing. Whilst acknowledging the benefits of early booking, this was said to be at odds with their cultural beliefs where pregnancy disclosure within 13 weeks was considered inappropriate. Lack of information about the booking appointment and unresolved immigration issues led to perceptions that they were being brought under the Immigration Department's radar through the booking appointment. Whilst most health promotion information regarding the booking appointment is designed in a top-down fashion, health planners should also recognize ethnic diversities so as to market the booking appointment using downstream approaches that take account of the cultural, political and economic contexts in which migrants/ethnic minority populations live.

Factors associated with late booking for antenatal care in central Manchester

A cohort study was carried out to examine the factors associated with late booking amongst the resident population of Central Manchester Health Authority. The factors of importance were found to include teenage pregnancy, unemployment in the household, ethnic origin, moving during pregnancy, geographical area of residence and opinions about the value of antenatal care. Some reasons for delay in consulting doctors were identified, including uncertainty about the pregnancy and in some cases because it was unwelcome. Delays were also noted to occur in the health service referral system.