Prevalence and Determinants of Health Care Utilization Among Dutch Women in the First Year Postpartum.

The study is cross-sectional and self-reported, so it cannot show that any factor caused women to use or not use health care. Participants were recruited mainly through online advertising and midwifery-related channels, so women more connected to services or more interested in postpartum care may have been overrepresented. Women recalled health problems and provider contacts over up to 30 months postpartum, with a median of 19 months, so recall may be incomplete or biased. The sample was more highly educated than the Dutch maternal population, which may limit generalizability. Findings reflect the Dutch health care and insurance system, so they may not transfer to other countries. Health problems and care use were self-reported, not diagnosed or verified in records. Religion was recorded as yes or no, which cannot capture beliefs or cultural norms.

Do not read the 94.2% utilization rate as proof that women received appropriate care. The study only asked whether women had at least one contact, and its associations are cross-sectional, so they cannot show cause or treatment benefit.