Determinants of the Use of Prenatal Care in Rural China: the Role of Care Content Bright I. Nwaru • Zhuochun Wu • Elina Hemminki Published online: 25 December 2010 Ó Springer Science+Business Media, LLC 2010 Abstract Several maternal demographic factors have been identified to influence the timing of starting prenatal care and its adequate use. However, how the content of prenatal care modifies these factors has not been studied previously. Using a representative sample collected for other purposes in rural China, we examined the factors predicting the uptake of prenatal care by taking into account the content of care (advice: on nutrition during pregnancy, diseases and pregnancy-related problems, and on child care after birth; and routine tests: blood pressure, blood tests, and ultrasound). We studied 1,479 women who answered a house-hold KAP (knowledge, attitude, and practice) survey (97% response rate) collected after a prenatal care intervention from 2001 to 2003 in 20 town- ships located in a county in Anhui Province. A multinomial logistic regression was used for the analysis. The most prominent factors that predicted late start of prenatal care and inadequate care were younger age, low maternal income, and having more than one child. When we adjusted for the content of care, the influence of these factors on the use of prenatal care attenuated to varying degrees: in some cases there was up to 20% reduction in the values of the risk estimates, while in other cases the statistical significance of the estimates were lost. It is important to take into account the content of prenatal care when assessing the factors predicting women’s use of prenatal care. Keywords Maternal demographic factors Á Prenatal care attendance Á Content of prenatal care Á China Introduction Patterns of prenatal care utilization have been shown to predict several birth outcomes [1–5], as well as a number of postpartum child care practices [6–9]. Several socio- demographic and socio-economic variables have been found to influence the timing of prenatal care initiation and its adequate use [8, 10–12]. However, how the content of prenatal care determines the initiation or amount of pre- natal care, or modifies the effects of the noted maternal factors, has not been examined in previous studies. Failure to take into account the content of prenatal care when assessing the factors predicting the timing of initiation and adequate utilization of prenatal care may under- or over- estimate the role of these factors. Along this line, it is reasonable to contend, on one hand, that women’s antici- pation of the quality of care may influence the timing of initiation of prenatal care, and on the other hand, satis- faction with care during the first prenatal care sessions may influence further use of prenatal care. In the present study, we used the opportunity offered by a representative sample collected previously for other purposes [13] to assess and identify the factors correlating with the initiation and adequate use of prenatal care in a B. I. Nwaru (&) Tampere School of Public Health, University of Tampere, 33014 Tampere, Finland e-mail: bright.nwaru@uta.fi Z. Wu Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, China Z. Wu Department of Public Health, University of Helsinki, Helsinki, Finland E. Hemminki National Institute for Health and Welfare, Helsinki, Finland 123 Matern Child Health J (2012) 16:235–241 DOI 10.1007/s10995-010-0734-0