title: Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review.
abstract: BACKGROUND
  Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking.
  
  
  OBJECTIVE
  To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries.
  
  
  METHODS
  Search of publications in EMBASE, CINAHL and PubMed (1992-2010). Studies that attempted to study determinants of prenatal healthcare utilization in high-income countries were included. Two reviewers independently assessed the eligibility and methodological quality of the studies. Only high-quality studies were included. Data on inadequate use (i.e. late initiation, low-use, inadequate use or non-use) were categorized as individual, contextual and health behaviour-related determinants. Due to the heterogeneity of the studies, a quantitative meta-analysis was not possible.
  
  
  RESULTS
  Ultimately eight high-quality studies were included. Low maternal age, low educational level, non-marital status, ethnic minority, planned pattern of prenatal care, hospital type, unplanned place of delivery, uninsured status, high parity, no previous premature birth and late recognition of pregnancy were identified as individual determinants of inadequate use. Contextual determinants included living in distressed neighbourhoods. Living in neighbourhoods with higher rates of unemployment, single parent families, medium-average family incomes, low-educated residents, and women reporting Canadian Aboriginal status were associated with inadequate use or entering care after 6 months. Regarding health behaviour, inadequate use was more likely among women who smoked during pregnancy.
  
  
  CONCLUSIONS
  Evidence for determinants of prenatal care utilization is limited. More studies are needed to ensure adequate prenatal care for pregnant women at risk.
authors: Midwifery Academy Amsterdam-Groningen, Groningen, The Netherlands. esther.feijen@inholland.nl
authors: Esther I
authors: EI
authors: Feijen-de Jong
authors: Danielle Emc
authors: DE
authors: Jansen
authors: Frank
authors: F
authors: Baarveld
authors: Cees P
authors: CP
authors: van der Schans
authors: François G
authors: FG
authors: Schellevis
authors: Sijmen A
authors: SA
authors: Reijneveld
mesh_terms: D019049:Developed Countries; D005260:Female; D015438:Health Behavior; D006801:Humans; D007182:Income; D008423:Maternal Age; D010298:Parity; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013997:Time Factors