Prenatal care is pivotal for both maternal and fetal health, enabling early issue detection, providing health education, and offering psychological support for a positive pregnancy experience (Shi et al., 2017; Sword, 1999; Zong et al., 2018). The World Health Organization emphasizes increasing the quantity and quality of contact between women and healthcare providers throughout pregnancy to identify risks, reduce complications, and mitigate health disparities (WHO, 2018). In China, the government, as per the “Outline for the Development of Chinese Women (2021–2030)," prioritizes women's health by emphasizing maternal and child health system development, network enhancement, and improved service capacity and quality. This commitment reflects a broader dedication to maternal and child health.

Extensive research has delved into the multifaceted behaviors of pregnant women in the realm of prenatal care. These investigations aim to illuminate various dimensions, encompassing healthcare-seeking patterns, adherence to medical advice, and the impact of socio-cultural factors on the overall prenatal care experience (Donabedian and Rosenfeld, 1961; Liang et al., 2014; Phillippi, 2009). For instance, studies have explored preferences for healthcare providers, investigating whether women choose obstetricians, midwives, or other professionals, along with the underlying reasons (John and Winston, 1989). Other research scrutinizes the timing and frequency of prenatal visits, probing into whether women seek care promptly or delay, and discerning the influencing factors. Social support emerges as a key enabler, offering informational and emotional assistance, while economic hardships, inflexible work policies, and insufficient maternity leave can impede access to prenatal care, affecting its frequency (Zong et al., 2018). Recent studies highlight structural barriers, including clinic location and hours, wait times, service costs, payment options, and care quality, reported by pregnant women in their prenatal care experiences (Bidner et al., 2023; Penman et al., 2023; Rosa et al., 2014).

Notably, scant research has approached prenatal care-seeking behavior from a geographical standpoint, overlooking factors like transportation convenience, healthcare facility accessibility, and hospital levels, which significantly influence such behavior. Scholars suggest that robust transport accessibility and high-level healthcare facilities enhance prenatal care frequency and service comprehensiveness (Harrington et al., 2014; Kim et al., 2020; Tang et al., 2018). Distinct challenges emerge for pregnant women in urban versus rural and remote areas, impacting medical accessibility from a demand perspective (Yin, 2019; Zong et al., 2018). Rural residents, situated farther from healthcare facilities, may face limited prenatal care accessibility. On the supply side, the size and availability of hospitals profoundly impact medical service quality. Facility attributes, staff qualifications, and service quality directly influence women's access to prenatal care services (Liu and Chen, 2004; Phillippi, 2009). Surprisingly, the literature largely neglects the association between these geospatial features and prenatal care-seeking behavior (Huang et al., 2018).

Further, research into prenatal care behavior among pregnant women has focused more on straightforward connections with influencing factors. However, decisions about prenatal care are influenced by a mix of factors like income, culture, healthcare access, and personal preferences, making the decision-making process more complicated. These factors work together and affect one another, forming intricate relationships that don't follow simple linear patterns. Also, past decisions affecting future choices create feedback loops that make the process even less straightforward. Recognizing these complex dynamics is essential for creating interventions and support systems that cater to the varied needs of pregnant women and improve the health outcomes for both mother and child.

From this, this study investigates the correlation between transport accessibility, hospital attributes, and prenatal care seeking behaviors of pregnant women. By using extensive prenatal care data collected from Wuhan and employing non-linear models, it specifically explores how these factors impact the number of prenatal care visits in a nonlinear way. Then, spatial variations are considered, highlighting regional differences in how women are encouraged or impeded by transport accessibility and hospital attributes. The results of the study demonstrate the intricate effects of transport accessibility and hospital attributes on women's prenatal care seeking behavior, highlighting threshold effects and spatial heterogeneity in their impact. It offers unique and valuable insights for enhancing policies and practices related to women's prenatal care services.