Abstract
Background: Examining determinants of antenatal care (ANC) is important to stimulate equitable distribution of ANC across Europe. This study (1) compares ANC utilisation in Belgium and the Netherlands and (2) identifies predisposing, enabling and pregnancy-related determinants.
Methods: Secondary data analysis is performed using data from Belgium, and the Netherlands. The content and timing of care during pregnancy (CTP) tool measured ANC use. Non-parametric tests and ordinal logistic regression are performed to gain insight in the determinants of health care use.
Results: Dutch women receive appropriate ANC more often than Belgian women. Multivariate analysis showed that lower education, unemployment, lower continuity of care and non-attendance of antenatal classes are associated with a lower likelihood of having more appropriate ANC.
Conclusions: Predisposing and pregnancy related variables are most important to influence the content and timing of ANC, irrespective of the country women live in. Lower health literacy in socially vulnerable women might explain the predisposing determinants of health care use in both countries. Stimulating accessibility to antenatal courses or organising public education are recommendations for practice. Regarding pregnancy-related determinants, improving continuity of care can optimise ANC use in both countries. Background An understanding of the individual determinants (patientrelated factors) of antenatal care (ANC) utilisation may assist the pursuit of adequate levels of care recommended for every pregnancy. ANC is important because it enables early and continuing risk assessment, health promotion and medical and psychosocial follow-up [1]. Despite its value, some women do not make proper use of ANC [2]. According to Andersen and Newman ‘s health behavioural model, individual determinants of health care utilisation can be divided into predisposing, enabling [3] and need components [4]. With respect to ANC, predisposing determinants refer to individual characteristics which exist prior to the pregnancy and affect the propensity to use care. Previous studies have concluded that low maternal age [4–7], being single [7], low educational level [6–9], lack of a paid job [9], foreign ethnic background [6, 9] or origin [2, 5, 8], poor language proficiency [1, 7], (little) support from a social network [1] and lack of knowledge of the health care system [1] are associated with inadequate ANC utilisation. Enabling determinants refer to conditions which make ANC available to pregnant women. Absence of health insurance [6, 7], planned pattern of ANC [6], hospital type at booking [6], personalized communication and knowledge of cultural practices of the care provider [1] have been found to be associated with inadequate ANC. The pregnancy-need component of the determinants include pregnancy related elements explaining the degree of care needed/used. Inadequate use of * Correspondence: katrien.beeckman@uzbrusse