Beeckman et al. BMC Public Health 2010, 10:527 http://www.biomedcentral.com/1471-2458/10/527 R E S E A R C H A R T I C L E Open Access Determinants of the number of antenatal visits in a metropolitan region Katrien Beeckman1*, Fred Louckx1†, Koen Putman2† Abstract Background: Antenatal care has a positive effect on pregnancy, both clinically and psychologically, but consensus about the optimal number of antenatal visits is lacking. This study aims to provide insight into the dynamics of the number of antenatal visits a woman receives. Independent effects of predisposing, enabling and pregnancy-related determinants are examined. Methods: Women were recruited in nine clinical centres in the Brussels Metropolitan region. Antenatal care use was measured prospectively. A Poisson regression model was applied to measure the independent effect of individual determinants on the number of antenatal visits. Results: Data on antenatal care trajectories in 333 women were collected. The multivariate analyses showed that women with a Maghreb or Turkish origin had 14% fewer visits compared with European (EU15) women. More highly educated women had 22% more visits compared with those with a low education. Women with a high income had 14% more antenatal visits compared with those with a low income. Fewer antenatal visits were observed in multiparae (15%), women initiating care after 14 weeks of gestation (31%), women without medical risks during the pregnancy (12%) and in women with a continuity of care index of 50% or more (12%). More visits were observed in delivering after week 37 (22% increase). Conclusions: Predisposing and enabling factors have to be considered when antenatal care programmes are evaluated in a metropolitan area. Variations in the number of antenatal visits show that socially vulnerable women are more at risk of having fewer visits. Background Antenatal care is generally considered to have a positive effect on the health of both mother and baby [1-4]. As well as medical follow-up, advice and information is given and treatment can be provided when needed [1]. Antenatal care not only affects the pregnancy clinically, it also has a psychological effect, preparing women for childbirth and motherhood [5,6]. Guidelines in antenatal care are diverse and not entirely evidence-based. For example, the advised number of antenatal visits differs considerably between Western countries [7-14] and ranges from a minimum of six in the Netherlands [8] to fifteen in Finland [14]. In Belgium, ten visits for * Correspondence: katrien.beeckman@vub.ac.be † Contributed equally 1Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Laarbeeklaan 103, 1090 Brussels, Belgium Full list of author information is available at the end of the article primiparae and about seven for multiparae are advised [13]. Although there is no consensus about the optimal number of antenatal visits, it is proved that inadequate antenatal care is related to a worse pregnancy outcome [14-16]. It is important for health policy makers to understand what factors have an influence on a reduced number of antenatal visits. Analysis of utilization of healthcare services is frequently based on the beha- vioural model developed by Andersen and Newman [17]. This model has been widely used in analyses of other health services disciplines (eg breast cancer screening [18,19] or studies in care for the elderly [20,21]) but only a few studies have applied it when examining the number of antenatal visits [22,23]. This conceptual framework helps a better understand- ing of the relationship between societal determinants, determinants of the health care system and individual determinants on the use of health care [17]. Figure 1 represents the framework as defined by Andersen and © 2010 Beeckman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.