However, these do not fully explain the patterns of utilisation: inadequate utilisation of antenatal care is also due to a lack of perceived benefit of antenatal care by pregnant women, as well as a lack of understanding regarding how it can address potential threats to the health of both the mother and the child [ 6, 7].
(This category also includes women who made more than adequate use of prenatal care (i.e. received ≥ 110% of expected visits) Inadequate utilisation: onset at ≥ 12 weeks and/or received < 50% of expected visits Adequate utilisation: onset < 12 weeks and received ≥ 50% of expected visits.
However, non-western ethnicity does not of itself explain these women's inadequate utilisation of prenatal care; instead, via a number of underlying factors, it influences the need, propensity and ability to make use of care [ 12, 13].
19 A key limitation in campaigns to reduce admissions has been an inadequate utilisation of existing evidence.
For this study, the modified index (see Additional file 1) was dichotomised into: Inadequate utilisation: onset at ≥ 12 weeks and/or received < 50% of expected visits Adequate utilisation: onset < 12 weeks and received ≥ 50% of expected visits.
For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation.
Our findings also show similarities to those of a systematic review on determinants of inadequate prenatal care utilisation in industrialised western countries [ 29].
For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%.
In the blockwise structured model, adjusting first for demographic and pregnancy factors, then for socioeconomic factors and then for sociocultural factors resulted in a continued reduction of both first and second-generation non-western women's higher odds of inadequate prenatal care utilisation to that of native Dutch women.
The majority of studies included in the review focused upon the factors that compromise access, suggesting that more is known about why women do not access care than about the potential negative consequences of inadequate care or how to improve access and utilisation.
