title: Antenatal care use in urban areas in two European countries: Predisposing, enabling and pregnancy-related determinants in Belgium and the Netherlands.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Organisation, Policy and social Inequalities in Health care (OPIH), Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium.|Department of Nursing and Midwifery, Nursing and Midwifery Research Unit, University Hospital Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
authors.forename: Jana
authors.initials: J
authors.lastname: Vanden Broeck
authors.affiliation: Department of Midwifery Science, AVAG, Groningen and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Feijen-de Jong
authors.affiliation: Department of Midwifery Science, AVAG, Groningen and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: Klomp
authors.affiliation: Organisation, Policy and social Inequalities in Health care (OPIH), Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium.|Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Putman
authors.affiliation: Organisation, Policy and social Inequalities in Health care (OPIH), Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium. katrien.beeckman@uzbrussel.be.|Department of Nursing and Midwifery, Nursing and Midwifery Research Unit, University Hospital Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. katrien.beeckman@uzbrussel.be.
authors.forename: Katrien
authors.initials: K
authors.lastname: Beeckman
mesh_terms: D000328:Adult; D001530:Belgium; D005006:Ethnicity; D005260:Female; D006801:Humans; D016015:Logistic Models; D009426:Netherlands; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D014505:Urban Population