Predictors of Late Antenatal Care Initiation: A Multicentre Cross-Sectional Study in Ghana

Despite free maternal healthcare, about 50% of pregnant women in Ghana initiate their antenatal clinic (ANC) late.

This study aimed to identify the factors that contribute to the late initiation of ANC among pregnant women in the Jasikan District, Ghana.

A cross-sectional study was conducted between December 2021 and May 2022 in multiple health facilities. Multistage sampling was employed to select 352 pregnant women attending ANC in selected health facilities. A structured questionnaire was used to collect the data. The data was analyzed using Stata version 14.0. Descriptive statistics was used to describe the study variables and multivariable logistic regression models were performed to determine the predictors of late ANC initiation at p < .05 and 95% confidence interval (CI).

Approximately 45.7% of the participants initiated ANC late. Age less than 20 years, older age groups (40-49 [odds ratio (OR): 18.0, 95%CI: 3.68-88.0, p < .001]; 30-39 [OR: 6.4, 95%CI: 1.76-22.87, p = .005] and 20-29 [OR: 4.6, 95%CI: 1.30-15.98, p = .018]) were associated with late initiation of ANC. Having a higher number of children (4 [OR: 2.8, 95%CI: 1.36-5.79, p = .005] and 3 [OR: 2.5, 95%CI: 1.33-4.58, p = .004]) were predictors of late ANC initiation as compared to having one child. Women who sought for advice from women leaders (OR: 3.5, 95%CI: 1.18-10.12, p = .02) were about three (3) times more likely to initiate ANC late as compared to those who sought for advice from friends. Women who felt poorly received at ANC (OR: 7.7, 95%CI: 2.188-27.078, p = .001) were about eight (8) times more likely to initiate ANC late as compared to those who felt well received. Again, those who spent over six (6) hours during ANC visits (OR: 18.4, 95%CI: 4.246-79.734, p < .001) had an 18 times higher risk of initiating ANC late relative to those who spent less than 3 h.

The study findings highlight the need for interventions that addresses the social and cultural factors, negative perceptions of ANC, and long waiting times at health facilities to improve early initiation of ANC. Such interventions can assume health education and promotion to address the sociocultural and unfavorable perceptions toward ANC. The sector ministry and the health facilities may consider expanding ANC service centers to reduce long waiting times.