The impact of obstetric risk factors and socioeconomic characteristics on utilization of antenatal care

Abstract

Background: The objective of the study is to assess the impact of obstetric risk status and defined risk factors on utilization of antenatal care in a Swedish county. Methods: An area-based, population study was carried out with retrospective review of standardized patient records before (n=2008) and after (n=1874) the introduction of a reduced schedule for surveillance of pregnancy. For assessment of individual risk factors a multiple regression model is used. Results: Overall the number of contacts per pregnancy decreased from 13.2 to 11.4. With the reduced routine programme the difference between low-risk and high-risk women increased from 1.1 to 2.7 visits on average. In the multiple regression model socioeconomic characteristics had little influence on the use of antenatal care. Previous obstetric complications increased compliance to the schedule after the programme change. Complications during current pregnancy were important for the number of extra visits planned by the staff. Self referrals were most influenced by symptoms but in-patient care was influenced by multiple factors. The total explanatory ability of the regression model was low for time of first visit to the antenatal care unit and referrals for ultrasound examinations. Conclusion: With a reduced routine programme the surveillance became better apportioned to obstetric risk. Even a combination of medical or obstetric risk factors with socioeconomic characteristics explain only part of the variation in utilization of antenatal care. © 1998, Oxford University Press.