This 2006 study investigated ethnicity-related factors contributing to sub-standard maternity care and the effects on severe maternal morbidity among immigrant women in the Netherlands. In-depth interviews were carried out with 40 immigrant and 10 native Dutch women. The immigrant women reported that health care providers often paid insufficient attention to their pregnancy-related complaints, especially in cases of pre-eclampsia. They also reported delays in receiving information about diagnosis and treatment. Obstetricians who reviewed 20 of these cases judged sub-standard care to have played a role in the development of complications in 16 of them. The women themselves had problems identifying medically significant complications, presenting their complaints to health care providers effectively, and taking an active role as patients. Even highly educated migrant women showed low health literacy skills in their interaction with doctors. Patients' perspectives are valuable as one of the tools to evaluate the quality of maternity care. Communication by maternal health professionals can be improved through more sensitivity to social factors that affect immigrant women's health problems. Women with limited health literacy should be empowered through education about danger signs in pregnancy and information about preferences and policies in obstetrics in the Netherlands. They should also be invited to participate in medical decision-making. © 2011 Reproductive Health Matters.

Quality of care Netherlands Health literacy Ethnicity Provider-patient relations Maternal morbidity

doctor patient relation Netherlands maternal care Physician-Patient Relations educational status immigrant health care policy Communication health care personnel Pregnancy Complications human Ethnic Groups Stress, Psychological social aspect priority journal controlled study Cultural Competency Patient Education as Topic interview Humans Emigrants and Immigrants female pregnancy clinical article medical information Health Knowledge, Attitudes, Practice Article women's health adult health care quality preeclampsia Quality of Health Care patient attitude maternal morbidity disease severity ethnicity medical decision making Maternal Health Services