Prenatal Care Disparities by Maternal Nationality in Cyprus: A Retrospective Cohort Study

Background

Migrant women often experience barriers to accessing maternity services, resulting in inequalities in prenatal care utilisation and recommended antenatal screening. Evidence from Mediterranean countries remains limited. This study evaluated nationality-related inequalities in prenatal care utilisation and antenatal screening within the public maternity care system in Cyprus.

Methods

A retrospective observational study was conducted using maternity records from 1,150 births at Paphos General Hospital, Cyprus, between 2015 and 2020. Maternal nationality was classified into seven geographic subgroups. Outcomes included prenatal care adequacy, trimester-specific ultrasound uptake, infectious disease screening, and Pap testing. Multivariable logistic regression models were adjusted for maternal age, education, parity, smoking during pregnancy, and chronic medical conditions.

Results

Adequate prenatal care was achieved by only 29.4% of women, ranging from 50.0% among women from Cyprus/Greece to 13.9% among women from the Middle East and North Africa (MENA). Compared with women from Cyprus/Greece, MENA women had higher odds of inadequate prenatal care (aOR=4.12, 95% CI: 2.51–6.74), absence of first-trimester ultrasound (aOR=5.35, 95% CI: 3.29–8.72), absence of second-trimester ultrasound (aOR=6.08, 95% CI: 3.69–10.02), and absence of Pap testing (aOR=10.70, 95% CI: 5.08–22.55) (all p<0.001). No significant nationality-related differences were observed for third-trimester ultrasound after adjustment.

Conclusions

Significant nationality-related inequalities in prenatal care utilisation and antenatal screening exist within the public maternity care system in Cyprus. The greatest disparities were observed in early engagement with antenatal services, particularly among women from MENA countries, highlighting the need for strategies that promote timely access and equitable maternity care.

Key messages

• Nationality-related inequalities in prenatal care utilisation and antenatal screening persist within the public maternity care system in Cyprus, particularly among women from MENA countries.

• Strategies that promote timely entry into antenatal care and equitable access to maternity services are needed in increasingly diverse populations.