Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey

Journal of Perinatology volume 36, pages 420–426 (2016)Cite this article

Subjects

Abstract

Objective:

This study aims to investigate predictors of inadequate prenatal care (PNC) use among pregnant women in Canada.

Study Design:

Data for this secondary analysis was drawn from the Maternity Experiences Survey, a cross sectional, nationally representative survey that assessed peri- and post-natal experiences of mothers aged 15 and above in the Canadian provinces and territories. PNC use was measured by the Adequacy of Prenatal Care Utilization Index. Multivariate logistic regression analysis was conducted to determine socio-economic, demographic, maternal, delivery related and health service characteristics associated with inadequate PNC use.

Results:

Prevalence of inadequate PNC was at 18.9%. Regression analysis revealed that mothers who were immigrants (odds ratio (OR)=1.40; 95% (confidence interval) CI: 1.13–1.74), primiparous (OR=1.22; 95% CI: 1.04–1.44), smoked (OR=1.33; 95% CI: 1.04–1.69) or consumed alcohol (OR=1.32; 95% CI: 1.03–1.68) during their pregnancy were more likely to receive inadequate PNC. Mothers with a family doctor as PNC provider versus those with an obstetrician (OR=1.26; 95% CI: 1.08–1.48) were more likely to have inadequate PNC.

Conclusions:

This is the first nationwide study in Canada to examine the factors associated with inadequate PNC use. Results of this study may help design interventions that target women with profiles of socio-demographic and behavioral risk to optimize their PNC use.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Moos MK . Prenatal care: limitations and opportunities. J Obstet Gynecol Neonatal Nurs 2006; 35 (2): 278–285.

    Article  Google Scholar 

  2. Society of Obstetricians and Gynaecologists of Canada SOGC Clinical Practice Guidelines: Healthy Beginnings: Guidelines for Care During Pregnancy and Childbirth vol. 71. SOGC: Ottawa, 1998.

  3. Wildman K, Blondel B, Nijhuis J, Defoort P, Bakoula C . European indicators of health care during pregnancy, delivery and the postpartum period. Eur J Obstet Gynecol Reprod Biol 2003; 111: S53–S65.

    Article  Google Scholar 

  4. Feijen-de Jong EI, Jansen DE, Baarveld F, van der Schans CP, Schellevis FG, Reijneveld SA . Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review. Eur J Public Health 2011; 22: 904–913.

    Article  Google Scholar 

  5. Kingston D, Heaman M, Fell D, Chalmers B . Comparison of adolescent, young adult, and adult women’s maternity experiences and practices. Pediatrics 2012; 129 (5): e1228–e1237.

    Article  Google Scholar 

  6. Chen XK, Wen SW, Yang Q, Walker MC . Adequacy of prenatal care and neonatal mortality in infants born to mothers with and without antenatal high‐risk conditions. Aust N Z J Obstet Gynaecol 2007; 47 (2): 122–127.

    Article  Google Scholar 

  7. Ickovics JR, Kershaw TS, Westdahl C, Magriples U, Massey Z, Reynolds H et al. Group prenatal care and perinatal outcomes: a randomized controlled trial. Obstet Gynecol 2007; 110 (2 Pt 1): 330.

    Article  Google Scholar 

  8. Piaggio G, Ba’aqeel H, Bergsjø P, Carroli G, Farnot U, Lumbiganon P et al. The practice of antenatal care: comparing four study sites in different parts of the world participating in theWHO Antenatal Care Randomised Controlled Trial. Paediatr Perinat Epidemiol 1998; 12 (s2): 116–141.

    Article  Google Scholar 

  9. Guliani H, Sepehri A, Serieux J . Determinants of prenatal care use: Evidence from 32 low-income countries across Asia, Sub-Saharan Africa and Latin America. Health Policy Plan 2014; 29: 589–602.

    Article  Google Scholar 

  10. Stativa E, Rus AV, Suciu N, Pennings JS, Butterfield ME, Wenyika R et al. Characteristics and prenatal care utilisation of Romanian pregnant women. Eur J Contracept Reprod Health Care 2014; 20: 1–7.

    Google Scholar 

  11. Delgado-Rodríguez M, Gómez-Olmedo M, Bueno-Cavanillas A, Gálvez-Vargas R . Unplanned pregnancy as a major determinant in inadequate use of prenatal care. Prev Med 1997; 26 (6): 834–838.

    Article  Google Scholar 

  12. Kotelchuck M . The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight. Am J Public Health 1994; 84 (9): 1486–1489.

    Article  CAS  Google Scholar 

  13. Heaman MI, Moffatt M, Elliott L, Sword W, Helewa ME, Morris H et al. Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case-control study. BMC Pregnancy Childbirth 2014; 14 (1): 227.

    Article  Google Scholar 

  14. Delvaux T, Buekens P, Godin I, Boutsen M . Barriers to prenatal care in Europe. Am J Prev Med 2001; 21 (1): 52–59.

    Article  CAS  Google Scholar 

  15. Chalmers B, Dzakpasu S, Heaman M, Kaczorowski J . The Canadian maternity experiences survey: an overview of findings.: JOGC 2008; 30 (3): 217–228.

    PubMed  Google Scholar 

  16. Heaman M . Prenatal care. In: What Mothers Say: The Canadian Maternity Experiences Survey. Public Health Agency of Canada: Ottawa, 2009; 42–46.

    Google Scholar 

  17. Tough SC, Siever JE, Johnston DW . Retaining women in a prenatal care randomized controlled trial in Canada: implications for program planning. BMC Public Health 2007; 7 (1): 148.

    Article  Google Scholar 

  18. Pallikadavath S, Foss M, Stones RW . Antenatal care: provision and inequality in rural north India. Soc Sci Med 2004; 59 (6): 1147–1158.

    Article  Google Scholar 

  19. Abel MH . Maternal characteristics and inadequate prenatal care. Psychol Rep 1996; 79 (3): 903–912.

    Article  CAS  Google Scholar 

  20. Statistics Canada. Microdata User Guide: Maternity Experiences Survey, 2006. Available at http://www23.statcan.gc.ca/imdb-bmdi/document/5019_D1_T1_V1-eng.pdf. Accessed 15 November 2014.

  21. Dzakpasu S, Kaczorowski J, Chalmers B, Heaman M, Duggan J, Neusy E et al. The Canadian maternity experiences survey: design and methods. JOGC 2008; 30: 207–216.

    PubMed  Google Scholar 

  22. Liang YW, Chang HP, Lin YH, Lin LY, Chen WY . Factors affecting adequate prenatal care and the prenatal care visits of immigrant women to Taiwan. J Immigr Minor Health 2014; 16 (1): 44–52.

    Article  Google Scholar 

  23. Paredes I, Hidalgo L, Chedraui P, Palma J, Eugenio J . Factors associated with inadequate prenatal care in Ecuadorian women. Int J Gynecol Obstet 2005; 88 (2): 168–172.

    Article  CAS  Google Scholar 

  24. Heaman MI, Green CG, Newburn-Cook CV, Elliott LJ, Helewa ME . Social inequalities in use of prenatal care in Manitoba. J Obstet Gynaecol Can 2007; 29 (10): 806–816.

    Article  Google Scholar 

  25. Jarvis C, Munoz M, Graves L, Stephenson R, D’Souza V, Jimenez V . Retrospective review of prenatal care and perinatal outcomes in a group of uninsured pregnant women. JOGC 2011; 33 (3): 235–243.

    PubMed  Google Scholar 

  26. Boerleider AW, Manniën J, van Stenus CM, Wiegers TA, Feijen-de Jong EI, Spelten ER et al. Explanatory factors for first and second-generation non-western women’s inadequate prenatal care utilization: a prospective cohort study. BMC Pregnancy Childbirth 2015; 15 (1): 98–102.

    Article  Google Scholar 

  27. Higginbottom GM, Morgan M, Alexandre M, Chiu Y, Forgeron J, Kocay D et al. Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis. Syst Rev 2015; 4 (1): 13–17.

    Article  Google Scholar 

  28. Ng C, Newbold KB . Health care providers’ perspectives on the provision of prenatal care to immigrants. Cult Health Sex 2011; 13 (5): 561–574.

    Article  Google Scholar 

  29. Downe S, Finlayson K, Walsh D, Lavender T . ‘Weighing up and balancing out’: a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG 2009; 116: 518–529.

    Article  CAS  Google Scholar 

  30. Bernardes AC, da Silva RA, Coimbra LC, Alves MT, Queiroz RC, Batista RF et al. Inadequate prenatal care utilization and associated factors in São Luís, Brazil. BMC Pregnancy Childbirth 2014; 14 (1): 266.

    Article  Google Scholar 

  31. Heaman MI, Gupton AL, Moffatt ME . Prevalence and predictors of inadequate prenatal care: a comparison of Aboriginal and non-Aboriginal women in Manitoba. JOGC 2005; 27: 237–246.

    PubMed  Google Scholar 

  32. Joshi C, Torvaldsen S, Hodgson R, Hayen A . Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth 2014; 14 (1): 94.

    Article  Google Scholar 

  33. Asundep NN, Carson AP, Turpin CA, Tameru B, Agidi AT, Zhang K et al. Determinants of access to antenatal care and birth outcomes in Kumasi, Ghana. J Epidemiol Glob Health 2013; 3 (4): 279–288.

    Article  Google Scholar 

  34. Raynes-Greenow CH, Roberts CL, McCaffery K, Clarke J . Knowledge and decision- making for labour analgesia of Australian primiparous women. Midwifery 2007; 23 (2): 139–145.

    Article  Google Scholar 

  35. Hulsey TM . Association between early prenatal care and mother's intention of and desire for the pregnancy. Journal Obstet Gynecol Neonatal Nurs 2001; 30 (3): 275–282.

    Article  CAS  Google Scholar 

  36. Bassani DG, Surkan PJ, Olinto MTA . Inadequate use of prenatal services among Brazilian women: the role of maternal characteristics. Int Perspect Sex Reprod Health 2009; 35: 15–20.

    Article  Google Scholar 

  37. Gipson JD, Koenig MA, Hindin MJ . The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann 2008; 39: 18–38.

    Article  Google Scholar 

  38. Miles-Doan R, Brewster KL . The impact of type of employment on women's use of prenatal- care services and family planning in urban Cebu, the Philippines. Stud Fam Plann 1998; 29: 69–78.

    Article  CAS  Google Scholar 

  39. Passey ME, Sanson-Fisher RW, D’Este CA, Stirling JM . Tobacco, alcohol and cannabis use during pregnancy: clustering of risks. Drug Alcohol Depend 2014; 134: 44–50.

    Article  Google Scholar 

  40. Hayeems RZ, Campitelli M, Ma X, Huang T, Walker M, Guttmann A . Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study. CMAJ Open 2015; 3 (2): E236–E243.

    Article  Google Scholar 

  41. Heaman MI, Sword W, Elliott L, Moffatt M, Helewa ME, Morris H et al. Barriers and facilitators related to use of prenatal care by inner-city women: perceptions of health care providers. BMC Pregnancy Childbirth 2005; 15 (1): 2.

    Article  Google Scholar 

  42. Wiegers TA . General practitioners and their role in maternity care. Health Policy 2003; 66 (1): 51–59.

    Article  CAS  Google Scholar 

  43. The Chief Public Health Officer of Canada: The Chief Public Health Officer’s Report on the State of Public Health in Canada 2009: Growing Up Well – Priorities for a Healthy Future [http://publichealth.gc.ca/CPHOreport].

Download references

Acknowledgements

This research was supported by funds to the Canadian Research Data Centre Network (CRDCN) from the Social Science and Humanities Research Council (SSHRC), the Canadian Institute for Health Research (CIHR), the Canadian Foundation for Innovation (CFI) and Statistics Canada. We would like to thank the Maternity Experiences Survey (MES) Study Group of the Public Health Agency of Canada’s Canadian Perinatal Surveillance System, and Statistics Canada who developed and implemented the MES survey. Although the research and analysis are based on data from Statistics Canada, the opinions expressed in this paper do not represent the views of Statistics Canada. We would like to thank Dr Hugh McCague (Data Analyst and Statistical Consultant at the Institute for Social Research, York University) for his analytic help and advice. We are also grateful for the analytic support of Ms Sara Tumpane (Data Analyst, York Region-Statistics Canada Research Data Centre) and Ms Carmina Ng (Data Analyst, Toronto Region-Statistics Canada Research Data Centre). No funding was available for this project.

Author contributions

YD contributed to data interpretation, manuscript drafting and write-up. CC contributed to data analysis and interpretation, manuscript drafting and write-up; HT contributed to hypothesis conception, supervision of data analysis and interpretation, drafting and write-up of the paper. MR and MES critically reviewed drafts of the manuscript. All authors provided critical insight and revisions to the manuscript; all authors read and approved the final version of the manuscript submitted for publication.

Author information

Authors and Affiliations

  1. School of Kinesiology and Health Science, Bethune College, York University, Toronto, ON, Canada

    Y Debessai, C Costanian & H Tamim

  2. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    M Roy & M El-Sayed

Authors
  1. Y Debessai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Costanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M El-Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Tamim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C Costanian.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Debessai, Y., Costanian, C., Roy, M. et al. Inadequate prenatal care use among Canadian mothers: findings from the Maternity Experiences Survey. J Perinatol 36, 420–426 (2016). https://doi.org/10.1038/jp.2015.218

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2015.218

This article is cited by

Search

Advanced search

Quick links