title: Factors associated with four or more antenatal care services among pregnant women: a cross-sectional survey in eight South Central Coast provinces of Vietnam.
abstract: BACKGROUND
  In Vietnam, four or more antenatal care (ANC4+) visits/services among pregnant women have not been officially reported in the health system. Moreover, the factors associated with the use of ANC4+ services have not been studied in previous studies. In this study, we conducted an exploratory analysis to identify the rate of utilization of ANC4+ services and factors associated with use of ANC4+ services among pregnant women in rural areas of Vietnam.
  
  
  METHODS
  The study was conducted in eight provinces in the South Central Coast region of Vietnam between August 2013 and May 2014. A total of 907 women, who delivered in the past 1 year, participated in the study. Multivariate logistic regression model was used to examine the association between all potential factors and utilization of ANC4+ services.
  
  
  RESULTS
  The rate of utilization of ANC4+ services by women in eight South Central Coast provinces was 53.9%. Factors negatively associated with using ANC4+ services were belonging to ethnic minority groups having lower education, doing informal works, having lower income, having lower knowledge on ANC4+ services, and receiving no financial support from the husband. In particular, financial support from the husband was considered important in improving the use of ANC4+ services by women in rural areas.
  
  
  CONCLUSIONS
  The study asserted an inadequacy for ANC4+ utilization and can contribute to missed opportunities to achieve better maternal outcomes for women in rural areas of Vietnam. The necessity of introducing ANC4+ services in the national guidelines on maternal health care should be disseminated to health policy-makers. Strategies to increase ANC4+ utilization should focus on knowledge improvement and on poor, low-income, and ethnic minority women.
authors.affiliation: Department of Reproductive Health, Hanoi School of Public Health, Ba Dinh, Ha Noi, Vietnam.
authors.forename: Bui Tt
authors.initials: BT
authors.lastname: Ha
authors.affiliation: Department of Personnel and Organization, Ministry of Health, Ba Dinh, Ha Noi, Vietnam.
authors.forename: Pham V
authors.initials: PV
authors.lastname: Tac
authors.affiliation: Department of Reproductive Health, Hanoi School of Public Health, Ba Dinh, Ha Noi, Vietnam ; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Duong M
authors.initials: DM
authors.lastname: Duc
authors.affiliation: Department of Reproductive Health, Hanoi School of Public Health, Ba Dinh, Ha Noi, Vietnam.
authors.forename: Doan Tt
authors.initials: DT
authors.lastname: Duong
authors.affiliation: Department of Reproductive Health, Hanoi School of Public Health, Ba Dinh, Ha Noi, Vietnam.
authors.forename: Le M
authors.initials: le M
authors.lastname: Thi
keywords: South Central Coast provinces; Vietnam; antenatal care services; ethnic minority; male involvement; pregnant women