title: Determinants of prenatal health care utilisation by low-risk women: a prospective cohort study.
abstract: BACKGROUND
  Prenatal health care is pivotal in providing adequate prevention and care to pregnant women.
  
  
  OBJECTIVE
  We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands.
  
  
  METHODS
  We used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care.
  
  
  RESULTS
  We collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care.
  
  
  CONCLUSIONS
  Inadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services.
authors: Department of Midwifery Science, AVAG, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: esther.feijen@inholland.nl.
authors: Esther I
authors: EI
authors: Feijen-de Jong
authors: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Sociology and Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, The Netherlands. Electronic address: d.e.m.c.jansen@umcg.nl.
authors: Danielle E M C
authors: DE
authors: Jansen
authors: National Association for Specialty Training for General Practice and GP Trainers, Utrecht, The Netherlands. Electronic address: f.baarveld@huisartsopleiding.nl.
authors: Frank
authors: F
authors: Baarveld
authors: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. Electronic address: agathawb75@yahoo.com.
authors: Agatha W
authors: AW
authors: Boerleider
authors: Department of Midwifery Science, AVAG, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: evelienspelten@yahoo.com.
authors: Evelien
authors: E
authors: Spelten
authors: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands; Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: f.schellevis@nivel.nl.
authors: François
authors: F
authors: Schellevis
authors: Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: s.a.reijneveld@umcg.nl.
authors: Sijmen A
authors: SA
authors: Reijneveld
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D006801:Humans; D008880:Midwifery; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Health care utilisation; Midwifery; Obstetrics; Pregnancy; Public health