Antenatal care in the European Union : equal chances for all new citizens of the Community

Background: Antenatal care can contribute towards promoting the public health aims of the European Union (EU) and provides a catalyst that enables the process of growing together as a community of nations. Moreover, patient mobility and its implications for patient safety become increasingly important throughout the EU. Differences in the approaches to antenatal care need to be known in order to avoid duplications or gaps in care for women seeking care in a country other than their home country. Aims The overall aim of this study was to make cross-border antenatal care safer and to contribute to the evidence base to enable the best possible starting conditions for the Community's future citizens. To meet this aim, the best available sources on antenatal care within all member states were critically analysed, examining evidence-based and expert recommendations. The theoretical background for making decisions on antenatal care was developed. Moreover, a comprehensive review of the content of national guidelines on antenatal care was required to find out whether a common minimum guideline would be beneficial, and what this guideline might contain. A model was needed to be developed for integrating existing guidelines to a common minimum guideline to complement national health policies. Study design: The study used a mixed methods approach, which consisted of a survey conducted across the EU and an extensive critical review of the state of the art regarding guidelines and antenatal care. In addition, a critical in-depth appraisal of the national guidelines from England and Wales and Germany was conducted, using the instrument of the AGREE collaboration for the appraisal of guidelines for research & evaluation as well as a critical comparison of the individual recommendations of the two national guidelines. In the survey, the Ministries of Health and equivalent bodies, as well as the societies of obstetricians and midwives were asked to complete a structured questionnaire on the content of national guidelines for antenatal care. Descriptive analyses identified which and how many states recommend a test and to how many people this applied. The tests which were recommended by more than 50% of the states and applied to more than 50% of the inhabitants of the EU were compared to the measures supported by scientific evidence. Finally the correlation between the Gross National Product (GNP) of a state and the number of tests recommended was investigated. Conclusion: This study presents in detail what the national guidelines of the member states of the EU recommend for antenatal care and how they relate to current scientific evidence. As the findings from the survey were seen as important for enhancing safety in cross-border antenatal care, they were published during the course of the study (Bernloehr et al 2005; 2007). In addition, the findings from the study demonstrate for the first time that extracting the measures from national guidelines that are recommended by the majority of states and apply to the majority of inhabitants of the EU leads to the development of a guideline compatible with scientific evidence. On the basis of all parts of the study, a common minimum guideline for antenatal care in the EU was established and recommended as it was found that such a guideline is useful and possible under the legislation of the EU. (Abstract shortened by ProQuest.).