Delayed Initiation of the 2016 World Health Organization Antenatal Care Contact and Associated Factors among Pregnant Women at Public Health Facilities of Kamba Zuria District South Ethiopia

Abstract

Introduction

Antenatal care involves specialized expert care for pregnant women from the onset of pregnancy until delivery.

Objective

To examine delayed initiation of the 2016 WHO antenatal care contact and associated factors among pregnant women at public health facilities of Kamba Zuria district, south Ethiopia, 2023.

Methods

A facility-based cross-sectional study was conducted among 380 systematically selected pregnant women from May 1 to May 30, 2023. Data were entered using Epi-Data 7.1 Version and exported to SPSS version 25 for analysis. Binary logistic regression was performed and all variables with a p < .25 in bivariable analysis have been shifted in multivariable logistic regression evaluation. Statistical significance was declared at a p < .05 in adjusted odds ratio with a 95% confidence interval.

Result

The magnitude of delayed initiation of the 2016 WHO antenatal care contact was 43.4% [95% CI: 38.4–48.4%]. Being a rural residence [AOR: 2.12, 95% CI: 1.24–3.62], having a history of abortion [AOR: 0.27, 95% CI: 0.14–0.45], unplanned being pregnant [AOR: 2.56, 95% CI: 1.50–4.35], having illness during present-day pregnancy [AOR: 0.20, 95% CI:0.09–0.39], now not being a member of women’s health development army [AOR: 2.73, 95% CI: 1.63–4.57], transportation get entry to hassle [AOR: 1.97, 95% CI: 1.18–3.29] and own family length of 1–2 [AOR: 0.38, 95% CI: 0.17–0.85], and 3–5 [AOR: 0.43, 95% CI: 0.22–0.84] have been appreciably associated.

Conclusion

Two in five pregnant women are not on time receiving their first antenatal care services. Being a rural resident, having a record of abortion, unplanned pregnancy, infection at some stage in pregnancy, transportation troubles, being a member of the women's health development army, and circle of relatives length were substantially related. Therefore, providing health education during early antenatal contact, proper gynecological and obstetric care, and strengthening women's health development might enhance the initiation of antenatal care.

Keywords

delayed initiation 2016 WHO antenatal care contact pregnant women Kamba Zuria district

Introduction

Antenatal care (ANC) involves specialized expert care presented to pregnant women from the onset of pregnancy until delivery. Its utilization ensures the prevention of maternal health risks, safe shipping, and excellent health of the newborn child. It is one of the four key techniques for reducing maternal and adolescent morbidity and mortality (Gurol-Urganci et al., 2021; Murphy, 2020). The components of ANC consist of risk identity; prevention and control of being pregnancy-related or concurrent sicknesses, health schooling, and health promotion (Ademuyiwa et al., 2020; Dahl et al., 2020; WHO, 2018).

ANC reduces maternal and prenatal morbidity and mortality directly, via the detection and remedy of pregnancy-related headaches, and indirectly, via the identification of women and women at improved chance of growing headaches all through labor and shipping, thereby ensuring referral to the best level of care (Geltore & Anore, 2021; Jayaratnam et al., 2019; Roos et al., 2021; Tanimia et al., 2016). Antenatal care is much more likely to be powerful during pregnancy (Adere & Tilahun, 2020; Moron-Duarte et al., 2021).

In 2016, the World Health Organization (WHO) advanced a new ANC version to improve the coverage of antenatal care. It recommends that each pregnant woman must start her ﬁrst ANC consultation before the gestational age of 12 weeks. This new ANC version increased the number of contacts from four to eight, proceeding to lessen prenatal mortality and enhance pregnancy effects. Recent evidence shows that eight or more ANC contacts can decrease prenatal deaths by eight per 1000 births in assessment to four contacts (De Masi et al., 2017; Ekholuenetale et al., 2020; Tuncalp et al., 2017; WHO, 2016). The contact is used to group pregnant women into two corporations based on the previous records of pregnancy, contemporary pregnancy country, and trendy clinical situations at the contact (Ekholuenetale et al., 2020; Magee et al., 2022; Tufa et al., 2020).

In regions with the highest rates of maternal mortality, which includes Western and Central Africa and South Asia, even fewer women obtain at least four antenatal care contacts (Eltilib, 2022; Tegegne et al., 2019; Sarker et al., 2020). In developing countries, 24% of women start follow-up ANC before 16 weeks of gestation (Moller et al., 2017). The Ethiopian government, in its health sector transformation plan (2015/16–2019/20), set an aim to achieve 95% ANC utilization of at least four contacts and followed the WHO-centered ANC model along with the 2016 WHO new guideline of eight contacts to relieve the troubles (Aragaw et al., 2023; Manyazewal, 2017; Weldemariam et al., 2018). Despite this policy improvement by the government, the proportion of pregnant women starting their first ANC follow-up in the early weeks and continuing has remained low. In Ethiopia, in line with the Ethiopian Demography Mini Health Survey Report 2019, 43% of pregnant women had four or more contacts and only 20% of pregnant women started the primary ANC at the recommended time (Ashemo et al., 2023). The Federal Democratic Republic of Ethiopian Ministry of Health launched it in its national guideline in February 2022 (Federal Ministry of Ethiopia, 2022). Since then, it has been steadily disseminated to health facilities.

Review of Literature

Having poor knowledge about antenatal care, being a housewife, self-employment, travel expenses, and unplanned pregnancy are found to have the potential to delay the initiation of antenatal care for pregnant women (Ewunetie et al., 2018; Wolde et al., 2019). Being poorly educated and having low family income levels are determined as significant factors in delaying the initiation of antenatal care (Gebrekidan & Worku, 2017). Similarly, the distance from home to the health facility was found to be a significant factor in delaying the initiation of antenatal care (Debelo & Danusa, 2022).

Pregnant women who encountered an unplanned pregnancy delay initiating antenatal care (Tadele et al., 2022). The previous experience of antenatal care for multigravida women determines the initiation of the antenatal care contact time in the current pregnancy (Girma et al., 2023). The participation of women in the community (being a member of the women's health development army) can decide the time for initiation of antenatal care (Tola et al., 2021).

However, the previous studies have been carried out using the focused ANC visit and the cut-off point was 16 weeks of gestation and considered four visits (Aragaw et al., 2023; Battu & Kassa 2023; Bhardwaj et al., 2023; Ejeta et al., 2017; Solanke et al., 2022). However, the current study used the 2016 WHO ANC contacts, the cut-off point of 12 weeks of gestation for initiation, and eight contacts (WHO, 2018). Therefore, this study assessed the delayed initiation of the 2016 World Health Organization antenatal care contact and associated factors among pregnant women at public health facilities of Kamba Zuria district south Ethiopia.

Method and Materials

Study Area and Period

The study was performed at public health facilities in Kamba Zuria district, Gamo zone, south Ethiopia. It is located 559 km from Addis Ababa, and 125 km away from Arba Minch, the capital town of Gamo Zone. The district has one primary hospital, seven health centers, 26 private clinics, and 12 drug stores. There are 25 rural kebeles and three semi-urban kebeles in the district. Each kebele has its health posts, and health extension workers work in every health post. The overall population of the district was 137,500, of which 3.46% (4,758) are reproductive-age women and 3.2% (4,400) are pregnant women. The study was conducted from May 1 to May 30, 2023.

Study design. A facility-based cross-sectional study design was conducted.

Population. All pregnant women attending ANC at public health facilities in the Kamba Zuria district were the source population and all randomly selected pregnant women attending ANC at public health facilities in the Kamba Zuria district in the study period were the study population of this study.

Eligibility Criteria

All pregnant women attending ANC at public health facilities in Kamba Zuria district during the study period were included. However, pregnant women who did not recognize their last normal menstruation period have been excluded.

Sample Size Determination

The sample size was determined using a single population proportion formula. The assumptions used to calculate the maximum sample size had been the population proportion, which was 0.34%, taken from a preceding examination (Yezengaw, 2022), a 95% confidence interval, and a margin error of 5, as follows:

n = {(\frac{z α}{2})}^{2} \frac{p (1 - p)}{d^{2}} = (1.96)^{2} \frac{(0.34) (0.66)}{{(0.05)}^{2}} = 345

With a 10% nonresponse rate, the final pattern size was 380.

Sampling Technique

Kamba Zuria district has seven public health facilities that provide ANC services. The three-month report of pregnant women who visited a public health facility before the data collection period showed the number of women who visited a health facility as follows: 190 at Balta Health Center, 59 at Bola Anko Health Center, 95 at Kamba Primary Hospital, 180 at Otha Health Center, 135 at Zulo Health center, 185 at Maze health center, and 210 at Kamba health center. Then, by using proportional allocation, 69 from Balta Health Center, 21 from Bola Anko Health Center, 34 from Kamba Primary Hospital, 64 from Otha Health Center, 49 from Zulo Health Center, 67 from Maze Health Center, and 76 from Kamba Health center attended a health facility. Finally, a systematic random sampling technique was used to include the pregnant women for interview using the constant value of 3 that was obtained by dividing the total source population by the total sample size. The first client was identified by using the lottery method and then, every fourth pregnant woman was interviewed. (Figure 1).

Figure 1.

Schematic presentation of the sampling procedure of delayed initiation of the 2016 World Health Organization Antenatal Care Contact and Associated Factors among pregnant women at public health facilities of Kamba Zuria District South Ethiopia, 2023.

Study Variables

Outcome variable. Delayed initiation of the 2016 WHO antenatal contact

Independent Variables

Sociodemographic factors. Age, residence, marital status, religion, ethnicity, educational status, occupational status, own family size, husband's educational status, and husband's occupation

Obstetric factors. Gravidity, parity, history of abortion, type of abortion, ANC compliance with-up in preceding pregnancies, and complications in a previous pregnancy

Current pregnancy-associated factors. Means of identifying pregnancy, status of being pregnant, decision plan included husband, contamination present at some point of pregnancy, and conventional remedies used

ANC contact time and associated factors. Got recommendation approximately the primary ANC initiation, consisting of time of ANC initiation, recommended time to initiate first ANC, advisor for first ANC initiation, member of women’s health development army (1–5 network), and decision maker for present-day ANC contact.

Healthcare facility-related factors. Transportation right of entry to the problem, distance to reach home to the health facility, comfortability of service, and approach of health professionals.

Operational Definition

Delayed initiation of the 2016 World Health Organization ANC contact. It is measured by figuring out the gestational age at the first ANC contact of pregnant women and dichotomized as no (if the women initiate ANC within 12 weeks of gestation) and yes (if the women initiate ANC after 12 weeks of gestation) (Tuncalp et al., 2017; Yezengaw, 2022).

Women's Health Development Army. Enormous voluntary structural association that entails women's development crew and one-to-five connections to develop population health (Yitbarek et al., 2019).

Illness during pregnancy. Medical or obstetric diseases that arise throughout pregnancy consisting of malaria, HIV infection, urinary tract infection, hepatitis, fever, and decreased fetal motion (Ogunbode & Ogunbode, 2021).

Data Collection Tool and Procedure

A structured tool was adapted from various related previous literature (Battu & Kassa 2023; Tesfaye et al., 2017; Wolde et al., 2019; Yezengaw, 2022). To make it coherent and manageable, the tool consists of variables under the category of sociodemographic variables, obstetric variables, current pregnancy-related variables, antenatal care contact time-related variables, and healthcare facility-related variables. The data were collected through face-to-face interviews with women. Five midwives and three epidemiologists were recruited for data collection and supervision respectively. The interview was conducted in a private and calm room in the health facilities. The medical document record was reviewed to get clinical-related statistics.

Data Quality Control

The tool was prepared in English and then translated into Amharic (the official language of Ethiopia). A one-day training was given for records creditors and supervisors regarding the goal of the study ways of statistics series, and retaining confidentiality. The pre-test was performed on 5% of the total sample size (19 women) at the Garda Health Center and the necessary modification was performed based on the pre-test result earlier than using it for the real facts series. The supervisors performed day-by-day supervision and vital comments were given for the day after today. Each questionnaire was checked for completeness each day by supervisors. To determine the inner validity, the Cronbach’s alpha test was done and it was 0.831.

Statistical analysis

The data were entered into Epi-data Version 7.1 and exported to SPSS model 25.0 for analysis. Descriptive information was computed for all variables according to the sort of variables. Categorical variables were assessed by using computing frequency and proportions. A binary logistic regression model was used to determine the good-sized association between based and unbiased variables. First, bivariable logistic regression analysis was conducted among every independent variable and dependent variable. A crude odds ratio (COR) along with a 95% confidence interval (CI) was used to offer the outcomes of the bivariable evaluation. All variables with affiliation in bivariable analysis at p ≤ .25 have been entered right into a multivariable logistic regression model to assess the adjusted affiliation among dependent and independent variables. An input method was used to match a multivariable logistic regression model to pick out factors closing inside the model. The adjusted odds ratio (AOR) along with a 95% CI and p < .05 was used to determine the strength of the association and to declare statistical significance in the final model. Multi-collinearity between independent variables was checked for all candidate variables by considering variable inflation factor and tolerance. The Hosmer–Lemeshow goodness of fit test was used to check model health and was satisfied (p > .05). Finally, the locating turned into offering the usage of texts, tables, and figures.

Results

Sociodemographic Characteristics of Pregnant Women

In all, 380 pregnant women gave responses that made the overall response rate as 100%. The age of 147 (38.7%) pregnant women had been in the age institution of 20–24 years old and the house of 227 (59.7%) pregnant women became rural. A majority, 261 (87.9%), had been married and 248(65.3%) followed the Protestant religion. More than half, 261 (68.7%), had attended primary school and 291 (76.6%) were housewives (Table 1).

Table 1.

Sociodemographic Characteristics of Pregnant Women Attending ANC Contact at Public Health Facilities in Kamba Zuria District, South Ethiopia, 2023.

Variables (n = 380)	Category	Frequency	%
Age (in years)	15–19	32	8.4
	20–24	147	38.7
	25–29	87	22.9
	30–34	73	19.2
	≥35	41	10.8
Residence	Urban	153	40.3
Residence	Rural	227	59.7
Marital status	Single	14	3.6
	Married	334	87.9
	Divorced	23	6.1
	Widowed	9	2.4
Religion	Protestant	248	65.3
	Muslim	23	6.1
	Orthodox	109	28.7
Ethnicity	Gamo	348	91.6
	Gofa	15	3.9
	Wolayta	17	4.5
Educational status	Not attended formal education	24	6.3
	Grade 1–8	261	68.7
	Grade 9–12	50	13.2
	College and above	45	11.8
Occupational status	Housewife	291	76.6
	Daily laborer	6	1.6
	Merchant	13	3.4
	Gov`t employee	26	6.8
	Private employee	10	2.6
	Student	34	8.9
Family size	1–2	77	20.3
	3–5	228	60.0
	> 5	75	19.7
Husband's educational status (n = 366)	Not attended formal education	27	7.4
	Grade 1–8	243	66.4
	Grade 9–12	36	9.8
	College and above	60	16.4
Husband's occupational status (n = 366)	Farmer	126	34.4
	Daily laborer	57	15.6
	Government employee	72	19.7
	Private employee	44	12.0
	Merchant	55	15.0
	Student	12	3.3

Obstetric Factors of Pregnant Women

Of the total 380 pregnant women, 188 (49.5%) were multigravida, and 168 (44.2%) were multipara. More than half, 284 (75.0%), of them had no records of abortion (Table 2).

Table 2.

Obstetrics Factors of Pregnant Women Attending ANC Contact at Public Health Facilities in Kamba Zuria District, South Ethiopia, 2023.

Variables (n = 380)	Category	Frequency	%
Gravidity	Primigravida	92	24.2
	Multigravida	188	49.5
	Grand multigravida	100	26.3
Parity	Null Para	33	8.7
	Primipara	133	35.0
	Multipara	168	44.2
	Grand multipara	46	12.1
History of abortion	Yes	96	25
History of abortion	No	284	75
Type of abortion (n = 96)	Spontaneous	64	67
Type of abortion (n = 96)	Induced	32	33
ANC follow-up in previous pregnancies (n = 347)	Yes	258	74.4
ANC follow-up in previous pregnancies (n = 347)	No	89	25.6
Complications in previous pregnancy, labor, or delivery (n = 347)	Yes	91	26
	No	256	74

Current Pregnancy-Related Factors of Pregnant Women

More than half of pregnant women, 277 (59.7%), diagnosed their pregnancy because of missing periods, and the reputation of pregnancy for 211 (55%) became unplanned, and 59 (34.9%) pregnant women covered their husbands in the decision plan for modern being pregnant. Only 74 (20.0%) had contamination present during the current pregnancy and of them 24 (32%) used traditional medicine (Table 3).

Table 3.

Current Pregnancy-Related Factors of Pregnant Women Attending ANC Contact at Public Health Facilities of Kamba Zuria District, South Ethiopia, 2023.

Variables (n = 380)	Category	Frequency	Percent
Means of the pregnancy recognized	Missing period	227	59.7
Means of the pregnancy recognized	Urine test	153	40.3
Status of pregnancy	Planned	169	45.0
Status of pregnancy	Unplanned	211	55.0
The decision plan for pregnancy included the husband (n = 169)	Yes	59	34.9
	No	110	65.1
Illness present during the current pregnancy	Yes	74	20.0
Illness present during the current pregnancy	No	306	80.0
Traditional medicine used for the illness (n = 74)	Yes	24	32.0
Traditional medicine used for the illness (n = 74)	No	50	68.0

Antenatal Care Contact Time and Related Factors of Pregnant Women

More than half of pregnant women, 222 (59.0%), got recommendations about their first ANC initiation and out of them, 128 (58%) have been cautioned on the time of ANC initiation. About 56 (43.0%) pregnant women had been advised to initiate the first ANC follow-up earlier than or at 12 weeks and the counselors for 99 (45.0%) pregnant women have been health workers. About 178 (47.0%) of pregnant women had been a member of the Women's Health Improvement Military and 159 (41.8%) pregnant women’s husbands decided on modern-day ANC follow-up. (Table 4).

Table 4.

Antenatal Care Contact Time and Related Factors of Pregnant Women Attending Antenatal Care at Public Health Facilities in Kamba Zuria District, South Ethiopia, 2023.

Variables (n = 380)	Category	Frequency	%
Got advice about the first ANC contact initiation	Yes	222	59
Got advice about the first ANC contact initiation	No	158	41
Advice included time of ANC contact initiation (n = 222)	Yes	129	58
Advice included time of ANC contact initiation (n = 222)	No	93	42
The advised time to initiate the first ANC contact (n = 129)	Before or on 12 weeks	56	43
	After 12 weeks	73	57
Advisor for first ANC initiation (n = 222)	Mass media	55	25
	Friends/relatives	68	30
	Health workers	99	45
Number of contacts for current ANC contact	One	55	14.5
	Two	85	22.4
	Three	69	18.2
	Four	65	17.1
	Five	48	12.6
	Six	37	9.7
	Seven	16	4.2
	Eight	5	1.3
Member of women's health development army (1–5 network)	Yes	178	47
Member of women's health development army (1–5 network)	No	202	53
Decision maker for current ANC follow-up	Women alone	118	31.1
	Husband	159	41.8
	Both jointly	103	27.1

Health Provider-Related Factors of Pregnant Women

Almost half of the members, 188 (49.5%), had transportation to get admission to health facilities, and more than half, 252(66.3%), spent more than 30 minutes to attain domestic to a clinic. The majority of pregnant women, 232 (61.1%), had engaged well with the provider given by health experts and 318 (83.7%) pregnant women responded that the approach of health specialists was correct (Table 5).

Table 5.

Health Provider-Related Factors of Pregnant Women Attending ANC Contact at Public Health Facilities in Kamba Zuria District, South Ethiopia, 2023.

Variables (n = 380)	Category	Frequency	%
Transportation access to health institutions	No problem	188	49.5
Transportation access to health institutions	Moderate problem	192	50.5
Distance to reach home to health facility	≤30 min	128	33.7
Distance to reach home to health facility	>30 min	252	66.3
Comfortable with the service given by health professionals	Yes	232	61.1
Comfortable with the service given by health professionals	No	148	38.9
The approach of health professionals	Good	318	83.7
The approach of health professionals	Not good	62	16.3

Magnitude of the Delayed Initiation of the 2016 World Health Organization ANC Contact

Of the total 380 pregnant women, 165 (43.4%) had delayed initiation. On the other hand, 215 (56.6%) had no delayed initiation (Figure 2).

Figure 2.

Magnitude of the delayed initiation of the 2016 World Health Organization ANC contact among pregnant women attending ANC at public health facilities in Kamba Zuria district, South Ethiopia, 2023.

Factors Associated With Delayed Initiation of the 2016 World Health Organization ANC Contact

In bivariable logistic regression analysis, residence, records of abortion, the popularity of present-day being pregnant, illness present at some stage in modern being pregnant, advice while to provoke ANC, member of women's health improvement military, transportation get entry to trouble, own family size, and gravida have been appreciably related to delayed initiation of ANC contact. However, in multivariable logistic regression analysis being rural residence [AOR: 2.12, 95% CI: 1.24–3.62], having records of abortion [AOR: 0.27, 95% CI: 0.14–0.45], unplanned pregnancy [AOR: 2.56, 95% CI: 1.50–4.35], having illness in the course of modern pregnancy [AOR: 0.20, 95% CI: 0.09–0.39], no longer being a member of women health development military, [AOR: 2.73, 95% CI: 1.63–4.57], transportation access problem [AOR: 1.97, 95%: 1.18–3.29] and a family size of 1–2 [AOR: 0.38, 95% CI: 0.17–0.85] and 3-five [AOR: 0.43, 95%: 0.22–0.84], respectively, have been drastically associated with not on-time initiation. (Table 6).

Table 6.

Bivariable and Multivariable Evaluation of the Delayed Initiation of the 2016 World Health Organization ANC Contact Among Pregnant Women Attending Public Health Facilities in Kamba Zuria District, South Ethiopia, 2023.

Variables (n = 380).	Category	Delayed Initiation		COR (95% CI)	AOR (95% CI)	p
Variables (n = 380).	Category	No	Yes	COR (95% CI)	AOR (95% CI)	p
Residence	Urban	110 (28.9%)	43 (11.3%)	1	1
Residence	Rural	105 (27.6%)	122 (32.1%)	2.97 (1.92–4.61)	2.12 (1.24–3.62)	.006*
History of abortion	Yes	72 (18.9%)	24 (6.3%)	0.16 (0.10–0.27)	0.27 (0.14–0.45)	.000*
History of abortion	No	93 (24.5%)	191 (50.3%)	1	1
Status of current pregnancy	Planned	124 (32.6%)	45 (11.8)	1	1
Status of current pregnancy	Unplanned	91 (23.9)	120 (31.6%)	3.63 (2.35–5.62)	2.56 (1.50–4.35)	.001*
Illness present during the current pregnancy	Yes	16 (4.2%)	58 (15.3%)	0.15 (0.08–0.27)	0.20 (0.09–0.39)	.000*
Illness present during the current pregnancy	No	199 (52.4%)	107 (28.2%)	1	1
Got advice on when to initiate the first ANC	Yes	111 (29.2%)	111 (29.2%)	1	1
Got advice on when to initiate the first ANC	No	104 (27.2%)	54 (14.2%)	0.52 (0.34–0.79)	0.62 (0.37–1.03)	.066*
Member of Women Health Development army	Yes	107 (28.2)	71 (18.7%)	1	1
Member of Women Health Development army	No	58 (15.8%)	144 (37.9%)	3.74 (2.44–5.74)	2.73 (1.63–4.57)	.000*
Transportation access problem	No problem	118 (31.1%)	70 (18.4%)	1	1
Transportation access problem	Moderate	97 (25.5%)	95 (25.0%)	1.65 (1.10–2.49)	1.97 (1.18–3.29)	.010*
Family size	1–2	52 (13.7%)	25 (6.6%)	0.39 (0.21–0.77)	0.38 (0.17–0.85)	.019*
	3–5	129 (33.9%)	99 (26.1%)	0.64 (0.38–1.08)	0.43 (0.22–0.84)	.013*
	>5	34 (8.9%)	41 (10.8%)	1	1
Gravida	Primigravida	50 (13.2%)	42 (11.1%)	0.76 (0.46–1.25)	1.41 (0.65–3.05)	.380
	Multigravida	115 (30.3%)	73 (19.2%)	1.19 (0.68–2.10)	1.06 (0.54–2.06)	.874
	Grand multigravida	50 (13.2%)	50 (13.2%)	1	1

Hint: “*” p < .05, “1”= reference.

Discussion

In this study, the magnitude of delayed initiation of the 2016 World Health Organization ANC contact was found to be 43.4% [95% CI: 38.4–48.4]. It was in line with research conducted in Mekelle town (48.0%) (Berhe et al., 2014) and Jimma Zone (48.0%) (Tadele et al., 2022). However, it was lower than a study performed in Rwanda (61%) (Manzi et al., 2014), in Nigeria (82.6%) (Aliyu & Dahiru, 2017), and Addis Ababa (59.8%) (Yilala, 2015). However, this result became additionally too low as compared to the advice of WHO which states that each pregnant woman ought to start the first ANC within the first trimester of being pregnant (WHO, 2016). This is probably because of sociodemographic, socioeconomic, and cultural variations among societies. The different viable explanation was the development of health fame from time to time. In addition, it is probably because of on account of the difference within the time of the studies.

This study revealed that the residence of pregnant women was substantially associated with not on-time initiation of ANC contact. Pregnant women whose houses were rural were 2.12 instances more likely to delay initiation of ANC contact compared to pregnant women whose houses had been urban. This became clear in other studies as mothers from an urban house initiated ANC contact at and before 12 weeks of gestation (Geta & Yallew 2017; Paudel et al., 2017). It was much like a study achieved in Gambia which stated that pregnant ladies who live in rural regions have better odds of past-due initiation of ANC service than a city (Nigatu & Birhan, 2023). It was also supported by a study conducted out amongst reproductive-age women in Ethiopia which discovered that a girl who was living in a rural changed 1.66 instances much more likely to delay initiation than a female who resided in a city (Teshale & Tesema, 2020). This is probably due to the similarities within the level of expertise and degree of recognition about ANC contact initiation among pregnant ladies in city and rural settings. The different feasible clarification changed into the access distinction in health offerings among rural and concrete settings.

This study confirmed that a pregnant woman who have a record of abortion in a preceding pregnancy changed into statistically related to not on-time initiation of ANC contact. Pregnant women who have a history of a previous abortion are 73% less likely to postpone initiation of the first ANC in comparison with pregnant women who have no history of abortion. This study was supported by way of a look achieved with the aid of Abha South Arabia (Siddiqui, 2016) which indicated that pregnant women who had a record of abortion in a preceding pregnancy were 15% less probably to put off initiation for the first ANC compared with pregnant women who had no records of abortion. This might be the fear of losing the pregnancy due to abortion. The other possible explanation was that pregnant women who had abortions in previous pregnancies were given health education about future pregnancies and had excellent recognition of the significance of early initiation of ANC contact.

This study indicated that the reputation of the present day being pregnant of pregnant women changed significantly related to behind behind-schedule initiation of ANC compliance. Pregnant women whose modern pregnancy turned into unplanned were 2.56 times more likely to put off initiation of ANC contact as compared to pregnant women whose status of currently being pregnant turned into planned. This change much like any other look at that become conducted in Jimma region public hospitals indicated that pregnant women who perceived that their current being pregnant changed into not desired or unplanned had been 11 instances much more likely to begin their ANC late as compared to those ladies who desired their being pregnant (Tadele et al., 2022). This is probably due to the fact moms who no longer have a plan for his or her pregnancies may understand their being pregnant status is overdue, or do not want to reveal their being pregnant popularity.

This takes a look at the discovery that illness gift at some stage in modern pregnancy becomes statistically associated with not on-time initiation of ANC contact. So, pregnant women who had an illness for the duration of the cutting-edge pregnancy were 80% less in all likelihood to delay initiation for ANC than women who did not have an illness for the duration of the modern pregnancy. This locating changed similarly with an examination done in the Axum metropolis Tigray (Gebresilassie et al., 2019), which indicated that having any hassle in contemporary being pregnant is to aspect of well-timed initiation of ANC amongst pregnant women. This might be due to the fact ANC care turned into perceived by pregnant women as curative as opposed to preventive for the infection in the course of pregnancy in addition to the worry of illness extended institutional care.

This examination showed that members of the women's health development army were notably related to behind-schedule initiation of ANC comply with-up. Pregnant women who have been not contributors to the Women's Health Development Army were 2.73 instances more likely to delay initiation of ANC in comparison to pregnant women who have been individuals of the Women's Health Development Army. This look became additionally supported by using a have a look at accomplished among pregnant women in Ilu Ababor Zone, southwest Ethiopia (Tola et al., 2021) confirmed that ladies who were no longer members of the Women Health Development Army had been 3.3 times more likely behind schedule initiation of ANC as compared to ladies who have been individuals of women health development army. This may be due to authorities-dependent networks working closely with health extension workers and striving to create a call for health now not handiest for women of reproductive age but also for the network as a whole.

In this study, transportation value problems for pregnant ladies become appreciably associated with not on-time initiation of ANC follow-up. Pregnant women who had transportation value problems were 1.65 times more likely to delay the initiation of ANC as compared to pregnant women who had no transportation value troubles to visit health institutions. This observation was supported by a take look conducted at Addis Zemen Primary Hospital, the percentage of booking ANC overdue expanded by 72% among mothers who paid for transport to get to ANC carrier compared to folks who did not pay (Wolde et al., 2019). This might be because of geographical-associated situations and the socioeconomic fame of the mothers about present-day existence inflation.

In this observation, having a family size of 1–2 and 3–5 became appreciably related to the behind-schedule initiation of ANC compliance. Pregnant women who had a family size of 1–2 and 3–5 were 62% and 57% respectively less possibly to delay initiation for first ANC than women who had a family size of more than five. This examination changed inversely supported by way of a look at accomplished in the Ilu Ababor Zone, Southwest Ethiopia (Tola et al., 2021), Rwanda (Schmidt et al., 2021). This may be explained, by way of women who had a restrained wide variety of kids who were financially sufficient to care about their present-day pregnancy due to reduced family size. The different possible clarification might be women who had a limited number of kids spent less time on their care of youngsters and had enough time to take care of their present-day pregnant.

Limitations of the Study

The study might be prone to recall bias as some questions ask for past obstetric and gynecological information.

Implication for Practice

It is known that the WHO is encouraging all nations to launch the 2016 WHO antenatal care contact guideline for all nations. The primary aim of the new antenatal care contract is to prevent complications for mothers and their fetus. To accomplish this goal, the guideline pushed the cut point of the first initiation time of antenatal care contact from 16 to 12 weeks and the number of contacts from four to eight. Identifying the magnitude of the delayed initiation of the 2016 World Health Organization antenatal care contact and its associated factors is imperative for healthcare stakeholders and healthcare policymakers to design strategies, and it gives clues for healthcare workers in managing pregnant women to detect any complication at an early stage and prevent further complications.

Conclusion

Two in five pregnant women had delayed initiation of antenatal care contact. Being a rural resident, having a history of abortion, unplanned pregnancy, infection during pregnancy, transportation problems, being a member of the women's health development army, and family size were considerably related. Therefore, the availability of health training on early antenatal contact, giving appropriate gynecological and obstetric care, and strengthening the women's health development army may alleviate behind-schedule initiation of antenatal care.

Footnotes

Acknowledgments

We would like to thank the study participants for their openness to participate and for kindly providing the vital records, and sparing their precious time.

Availability of Information

The data used for analysis are available on secure and affordable request.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Consideration

Institutional Research Ethical Review Board of Arba Minch University approved the proposal of this research (IB/1487/2023).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Informed Consent

Written informed consent was obtained from each participant before initiation of the study, as the information obtained from them would not have been disclosed to a third person and it was only for investigation purposes.

ORCID iD

Elias Ezo

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