Late booking, ethnicity and migrant mothers

Objective Late booking in pregnancy is associated with poor outcomes. Early booking (completed health and social care assessment before 13.0 weeks) is a national ‘vital signs’ target, currently at 80% but set to increase to 90% in 2011. We wanted to investigate how late booking rates varied by ethnic group and country of birth in a multi-ethnic population. Method The cohort included 40 362 births with routinely collected data from 19 maternity units between July 2009 and May 2010, with information on gestational age at booking, ethnicity, country of birth. Results Of women born in the UK, the overall late booking rate was 19.6%, with similar overall rates for British Europeans (19.4%) and non-Europeans (20.4%). 8602 (21%) of the population were not born in the UK, and included as the largest migrant groups women from Pakistan (n=2283, 5.7%), Africa (1284, 3.2%) and Eastern Europe (1201, 3.0%). The late booking rate in the non-UK born population was 30.0%, significantly higher than for women born in the UK (OR 1.8, CI 1.7 to 1.9). This higher rate of late booking was evident across all migrant groups, and was highest for women from Africa (37.7%), Eastern Europe (34.1%) and Bangladesh (31.0%). Conclusion Migrant mothers are more likely to book late in pregnancy. Delayed engagement increases the high health and social risk that these women often present with, and impedes the ability to provide equitable care. The health service needs to increase its efforts in reaching migrant mothers, to ensure that they can receive equitable care.