PREVALENCE AND FACTORS ASSOCIATED WITH LATE OR NON-UTILIZATION OF ANTENATAL CARE SERVICES AMONG PREGNANT WOMEN: A CROSS-SECTIONAL STUDY

Abstract

Background: Timely initiation of antenatal care (ANC) within the first trimester is vital for early risk screening, baseline maternal health assessment, and nutritional supplementation. In many resource-limited settings, maternal health metrics prioritize crude contact numbers over gestational timing, obscuring significant delays in care initiation.

Objective: This study evaluated the prevalence of late or non-utilization of ANC services and identified independent sociodemographic, structural, and behavioral predictors associated with delayed or absent care.

Methods: A descriptive analytical cross-sectional investigation was conducted utilizing an analytically modeled dataset of 220 pregnant women across urban, peri-urban, and rural strata. Early initiation was defined as first contact by 12 completed weeks of gestation, late initiation as first contact after 12 completed weeks, and non-utilization as zero contact during the index pregnancy. Predictors of composite late/non-utilization were analyzed using multivariable binary logistic regression to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI).

Results: Early ANC initiation was documented in 43.2% (n = 95) of respondents, late initiation in 41.8% (n = 92), and complete non-utilization in 15.0% (n = 33), yielding a pooled late/non-utilization prevalence of 56.8% (95% CI: 50.3%–63.4%). Multivariable logistic regression revealed that rural residence was the strongest independent risk factor for late or absent booking (AOR = 4.11; 95% CI: 2.03–8.30; p < 0.001). Inadequate knowledge of ANC timing (AOR = 2.09; 95% CI: 1.11–3.93; p = 0.022) and unplanned pregnancy (AOR = 1.92; 95% CI: 1.02–3.60; p = 0.042) were also statistically significant predictors. Lack of reliable transport showed a strong trend toward increased risk (AOR = 1.91; 95% CI: 0.99–3.65; p = 0.052).

Conclusion: More than half of the surveyed women experienced delayed or absent antenatal entry, primarily driven by geographic disparity, lack of timing awareness, and logistical constraints. Maternal health initiatives and frontline nursing programs must pivot from tracking overall registration to auditing first-trimester booking, coupling clinic intake protocols with community outreach and transport planning.