Timing of the First Antenatal Care Visit and Associated Risk Factors in Rural Parts of Ethiopia

Background

Pregnancy-related deaths and diseases remain unacceptably high worldwide, around 303,000 women and adolescent girls and 2.7 million babies during the first 28 days of life, died due to pregnancy and childbirth related complications and 2.6 million babies were stillborn in 2015 (Alkema L, 2016). An increased access to and use of higher-quality health care during pregnancy and childbirth can prevent many deaths and diseases, as well as improve women and adolescent girls’ experience of pregnancy and childbirth (WHO, 2020). According to WHO reports in 2017, 295, 000 women worldwide lost their lives during and following pregnancy and childbirth, about 86% of those deaths occurred in sub-Saharan Africa and South Asia (World health statistics, 2020).

Nearly 99% maternal mortality and 98% child mortality occurred in low and middle-income countries. If the pregnant women or adolescent girls had been able to visit antenatal care (ANC) properly, the maternal death could be preventable (WHO, 2016). In 2016, WHO developed new model for the antenatal care visits, which recommends pregnant women to have their first contact during the first 12 weeks’ gestation, and then follow the time schedule as 20, 26, 30, 34,36, 38 and 40 weeks’ gestation. ANC visit brings positive pregnancy outcomes when the booking starts within the recommended pregnancy period and if the frequencies of contacts are adequate (WHO, 2016). Giving attention for maternal and fetal assessments to detect complications, improving support and communication between healthcare providers and pregnant women, increases the likelihood of positive pregnancy outcomes (Tuncalp Ӧ, 2017).

Several studies indicated that women, not empowered in household decision-making or exposed to any form of mass media, have lower ANC utilization (Assefa E, 2017), (Acharya D, 2015), (Collins Z, 2015). Women from rural communities have had fewer ANC visits with significant variations in the number of ANC visits compared to urban, Muslim women had fewer ANC visits than Christian women across all survey years (Ousman SK, 2019).

Mothers who visited antenatal care timely in their pregnancy period had enough time for essential and feasible interventions, prevention of complications and early identification of underlying conditions (FMOH, 2014). Study conducted in Debre Markos indicated that women from rural areas are more likely to delay on first ANC visit (Ewunetie et al., 2018). According to Ethiopian Demographic Health Survey report of 2016, about 37% of women were not visited ANC service during their pregnancy time. Most of women (41%) from rural were more likely to have had no ANC visits compared to women from urban (10%) and only 20% of women had their first ANC during the first trimester of pregnancy (CSA, 2016). As shown in the reports of Ethiopian Demographic health survey a few women were experienced the timely ANC visit and most women from rural area not visited timely. Therefore, this study intended to investigate the timing of the first antenatal care utilization and associated risk factors in rural parts of Ethiopia.