Maternal and Child Health Journal

, Volume 15, Issue 7, pp 1067–1075 | Cite as

Predisposing, Enabling and Pregnancy-Related Determinants of Late Initiation of Prenatal Care

  • Katrien Beeckman
  • Fred Louckx
  • Koen Putman


Prenatal care is important for the health and wellbeing of women and their babies. There is international consensus that prenatal care should begin in the first trimester. This study aims to analyze the effects of predisposing, enabling and pregnancy-related determinants of late prenatal care initiation. In this prospective observational study, 333 women were recruited consecutively at the beginning of their prenatal care trajectory. Data was collected on the timing of the first prenatal visit and on socio-demographic and pregnancy-related characteristics, using a semi-structured interview. A multivariate binominal logistic regression was applied to analyze independent effects on late initiation of prenatal care. Bivariately late initiation of care was associated with being inactive on the labor market, non-European origin, not having lived in Belgium since birth, low income, receiving welfare benefits, not having a regular obstetrician and experiencing difficulties getting a first appointment. When adjusting for all determinants, our multivariate analyses showed that late initiation was associated with non-European origin, low income and not having a regular obstetrician. This study shows that late initiation of prenatal care is associated with predisposing and enabling determinants. In order to ensure timely initiation of care, policy-makers should focus on encouraging women to have a regular prenatal care provider before pregnancy and taking steps in lowering out-of-pocket fees for low-income women. Future research is needed to examine whether these determinants are associated with initiation of care only or whether they play a role in the pregnancy follow-up as well.


Prenatal care (Mesh) Health behavior model Socioeconomic factors (Mesh) Pregnancy (Mesh) Initiation of care 



This study was supported by a grant from the Brussels Metropolitan Region, for which we want to express our gratitude. We also want to thank the members of our advisory commission for their help and advice in our research project. The members of this commission are S. Alexander, C. Buekenhout, B. Buysse, G. Masuy-Stroobant, M. De Spiegelaere, V. De Vis, G. Vanbrempt and C. Van Vaerenbergh. Further, this study was made possible thanks to the clinical centres that provided the necessary support and the participation of the pregnant women themselves. We want to thank the Brussels-Capital Health and Social Observatory for making their data available for the comparison with our sample.


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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Faculty of Medicine and Pharmacy, Department of Medical Sociology and Health SciencesVrije Universiteit BrusselBrusselsBelgium
  2. 2.Interuniversity Center for Health Economics ResearchVrije Universiteit BrusselBrusselsBelgium

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