Pregnant women's perspectives on antenatal care utilization in Cameroon: a cross- sectional mixed-methods study

Antenatal care (ANC) is essential for improving maternal and fetal health outcomes, yet utilization remains suboptimal in Cameroon. This study explored pregnant women's perspectives on determinants of ANC utilization and perceived quality of care in the Buea and Limbe Health Districts, conceptualizing satisfaction both as an outcome of service quality and a contextual influence on continued utilization. An explanatory sequential mixed-methods design was employed, comprising a cross-sectional survey of 410 pregnant women attending public, private, and faith-based health facilities, followed by 20 in-depth interviews. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, while qualitative data were thematically analyzed and integrated through side-by- side comparison. Only 45.6% of participants achieved the World Health Organization-recommended minimum of eight ANC contacts. Adequate utilization was significantly associated with receiving care in public facilities, formal employment, lower parity, and timing of ANC initiation. The association between second-trimester initiation and adequate utilization reflects cumulative attendance patterns rather than optimal timing and should therefore be interpreted cautiously. Key barriers to ANC use included financial constraints, long waiting times, negative provider attitudes, and delayed disclosure of pregnancy. Although overall satisfaction with ANC services was relatively high, dissatisfaction persisted regarding waiting times, indirect costs, and the quality of health education. Qualitative findings highlighted the importance of respectful, nonjudgmental provider behavior, partner support, privacy during consultations, and clear communication in shaping women's engagement with ANC services. Improving ANC utilization and quality in Cameroon requires woman-centered, multisectoral strategies that address financial barriers, promote respectful maternity care, and strengthen community-based health education to encourage early initiation and sustained engagement.