The new late comers for antenatal care.

THE Maternity in Great Britain survey (Joint Committee of R.C.O.G., 1948) was one of the first large-scale investigations into both the efficacy of sound antenatal care and the quality of such care received by various social categories in the general population. It was found that, of the 13,500 mothers interviewed, only 125 (0-9%Y.) received no antenatal supervision at all. This group consisted mainly of multiparous wives of manual workers, married women with illegitimate children and unmarried mothers. The authors of this report, after pointing out that expectant mothers who are well-to-do come markedly earlier for antenatal supervision, suggest that it is: ". . . a reflection of the adequacy of the present antenatal services that only 33% of agricultural and 37% of manual workers' wives are supervised during the first term. The unfavourable position of these two groups who together form 70% of all expectant mothers is particularly evident if only women who are expecting their fourth or higher order birth are considered. Among these the proportion attending during the first three months is 53% for the professional group, 23% for the manual workers and 15% for the agricultural workers" (p. 33). Another national study, conducted eight years later (Butler and Bonham, 1963), lent support to the findings of this earlier investigation. A recent reanalysis of some of this perinatal mortality survey material shows that, while 60% of social class I mothers attended for their first antenatal visit before the 17th week of pregnancy, only 50% of social class Ill and 39% of social class V mothers came before this week. When all those coming after the 28th week for their first visit were grouped together we found that late attendance was also related to social class. Whereas only 4-14% of social class I mothers attended after the 28th week, this increased to 6-36% through social class III to 11 30% for social class V. With regard to the receipt of antenatal care, therefore, both of these studies show that, as a group, women of low socio-economic status contribute the highest proportion of underutilizers. Given these findings and the fact that over 10 years have elapsed since the last national survey, it was thought timely to re-examine the utilization of maternity care facilities, especially as relevant sociological data were available in Aberdeen. These data, indeed, are unique, consisting of full medical and social histories of all maternity patients experiencing hospital, nursing home and domiciliary confinements in Aberdeen since 1948. These records have been summarized and stored on 80-column punched cards. Completeness of records is largely ensured through the operation of a centralized hospital-based maternity service in the city. Although choice of antenatal care exists, all National Health Service patients are required to attend the central (hospital) clinic at least once (usually following the confirmation ofpregnancy by a general practitioner) when the required information is collected for the records. Furthermore, the existence of very adequate obstetric facilities in the city has reduced domiciliary confinements to a minimum-and these few are usually from choice, not necessity (Baird and Thompson, 1969). In selecting the data for analysis, complete records for three two-year periods were taken, the periods being well spaced to provide a reasonable measure of possible time trends. The analysis was further restricted to legitimate births for two principal reasons. In the first place, for a variety of reasons, records for illegitimate births tend to be less complete. In particular, where there is no husband, allocation to the Registrar General's social class categories presents considerable difficulty, making any comparison in this group, using social class, of doubtful validity. Further, while a relatively high proportion of this population are drawn from outside the Aberdeen district, a comparable proportion of illegitimate pregnancies occurring in Aderdeen are completed elsewhere. It was considered that, because Aberdeen possessed a relatively more efficient maternity service than most areas in Great Britain, the local situation with respect to the provision of maternity care may shed some light on the future development of maternity care in other areas of the country.