Objective: to examine the association and interaction between language proficiency, social risk factors and lack of adherence to antenatal care in African immigrant women (AIW). Methodology: retrospective cohort study. Two hundred and thirty-one AIW with delivery dates from 2007 to 2010 were identified, and data were collected on knowledge of Spanish, referral to a social worker because of social risk factors, and adequacy of antenatal care using the Kessner Index (KI) and the authors' own index (OI). The Spanish-born population sample was obtained by simple random sampling in a 1:3 ratio. Odds ratios (OR) were estimated by non-conditional logistic regression. The term 'language*referral to social worker' was included in the logistic models to study interaction. Findings: eighty-four per cent of AIW had insufficient knowledge of Spanish, and 47% had been referred to a social worker. Of the AIW who had not been referred to a social worker, the association between poor knowledge of Spanish and inadequate antenatal care was weak and not significant (OR for KI 1.31). On the contrary, of the AIW who had been referred to a social worker, the association was stronger and significant (OR for KI 8.98; p interaction=0.026). Social risk factors were the main independent factors associated with inadequate antenatal care in Spanish women (adjusted OR 3.17; 95% confidence interval 1.42-7.06). Conclusions: this study found that the main factor associated with inadequate antenatal care in AIW is insufficient language proficiency, but only in the presence of social risk factors, which have also been associated with worse antenatal care in Spanish women. © 2014 Elsevier Ltd.

Neonatal health inequalities Pregnancy Immigration Antenatal care

Communication Barriers human communication disorder middle aged Logistic Models ethnology Surveys and Questionnaires Humans migrant psychology Emigrants and Immigrants Spain female Africa pregnancy questionnaire Retrospective Studies adult statistical model retrospective study