Beeckman et al. BMC Public Health 2010, 10:527 http://www.biomedcentral.com/1471-2458/10/527 Data on the complete antenatal care trajectory of three hundred thirty-three women were collected. Table 1 represents the predisposing, enabling and pregnancy- related characteristics in our sample. Concerning age, 79.5% of the women were aged between twenty one and thirty five. Of the women, 40.3% had the Belgian or other European (EU15) origin and 33.6% had a Maghreb or Turkish origin. 14.7% did not finish secondary school. 54.7% of the women were inactive on the labor market. For the enabling characteristics, we observed that 27.3% of the women had a low equivalent income. Regarding health insurance, 93.4% of the women had health insur- ance coverage and 9.3% received welfare benefits. The majority (52%) had no regular obstetrician. For the pregnancy related characteristics, 38.4% of the women were primiparae. The pregnancy was not planned in 22.8% of cases. 27.6% of the women had a history of obstetric risk, with 17.1% having a previous miscarriage and 0.9% having a previous stillbirth. Other obstetric risks in previous deliveries were the experience of a previous preterm birth (15.3%), a previous delivery of a low birth weight baby (6.3%) or an admission to an intensive neonatal care unit (7.8%) (results not shown in the table). High risk status during the antenatal care period (15.3%) was most often related to hospital admis- sion (7.2%). Other reasons were preterm contractions (3.6%), followed by hypertension (3%), gestational dia- betes mellitus (3%) and pre-eclampsia (2.1%) (results not shown). 24% of the women saw the same health care provider in more than half of their antenatal visits (COC >= 50%). Concerning pregnancy outcome, we observed 7.2% that delivered before 37 weeks of gestation. Overall, the median number of antenatal visits was 12 (Percentile 25-Percentile 75: 10-15) with a range between three and forty one (results not shown). Bivariate analyses showed significant differences in number of visits for origin (p < 0.001), education (p < 0.001) and occupational status (p < 0.001) (table 1). Concerning the enabling determinants we observed a relationship with equivalent income (p < 0.001). Furthermore, women without a regular generalist had fewer antenatal visits than did those who had one (p = 0.042). When examining the pregnancy-related determinants, we found a significantly lower number of antenatal visits in multiparae (p < 0.001). Women with an unplanned pregnancy also had significantly fewer visits (p = 0.002). Further, women who initiated care after week fourteen made significantly fewer antenatal visits (p < 0.001). No medical risk status during antenatal care (p = 0.023) and a continuity of carer index of 50% or above (p = 0.002) was also associated with a significantly lower number of antenatal visits. Additionally, more antenatal visits were Page 4 of 9 observed in women with a full term baby (>= 37 weeks) (p = 0.016). Determinants of the number of antenatal visits The Poisson regression model (table 2) shows the signif- icant predisposing, enabling and pregnancy-related fac- tors of the number of antenatal visits. The following characteristics were independently associated with the number of antenatal visits received: origin, educational level, equivalent income, parity, gestational age at initia- tion of care, high risk status during antenatal care, gestational age at delivery and continuity of care index. Women of Maghreb or Turkish origin had 14% fewer antenatal visits compared with those from Europe (EU15) (adjusted visit ratio 0.86, 95% CI 0.79-0.92). More highly educated women had 22% more antenatal visits compared with those with lower levels of educa- tion (adjusted visit ratio 1.22, 95% CI 1.10-1.35). Furthermore one enabling factor remained when con- trolling for confounders. Women with a high equivalent income had 14% more antenatal visits, and those with a moderate income had 9% more visits compared with those with a low income (adjusted visit ratio 1.14, 95% CI 1.02-1.27 and 1.09, 95% CI 1.01-1.19, respectively). When controlling for predisposing and enabling factors, the following-pregnancy related factors were observed: multiparae had 15% fewer visits than primiparae (adjusted visit ratio 0.85, 95% CI 0.80-0.91). Women who initiated care after week fourteen had 31% fewer antenatal visits (adjusted visit ratio 0.69, 95% CI 0.58- 0.82). Absence of high risk status during pregnancy was associated with 12% less antenatal visits (adjusted visit ratio 0.88, 95% CI 0.81-0.96). A delivery after 37 weeks of gestation lead to 22% more antenatal visits compared to a preterm delivery (adjusted visit ratio 1.22, 95% CI 1.07-1.39). After controlling for all independent vari- ables, women with a COC index of more than 50% had 12% less antenatal visits compared with women with less continuity of care in their antenatal care trajectory (adjusted visit ratio 0.88, 95% CI 0.82-0.94). Discussion In this study, predisposing, enabling and pregnancy- related variables were considered in measuring the num- ber of antenatal visits in a metropolitan area. Besides origin, educational level and equivalent income, parity, gestational age at initiation of care and at delivery, high risk during antenatal care and continuity of care index were related with the number of antenatal visits. The influence of predisposing determinants on the number of antenatal visits show a trend towards fewer antenatal visits in socio-economically disadvantaged women. Petrou et al. [35] also observed the importance of origin in relation to the number of antenatal visits.