Factors associated with early initiation of antenatal care in Bangladesh: a survival analysis using Bangladesh Demographic and Health Survey 2022

OBJECTIVES: This study aims to identify factors associated with early antenatal care (ANC) initiation using a survival analysis approach applied to nationally representative data. DESIGN, SETTING AND PARTICIPANTS: This study used a cross-sectional design based on data from the nationally representative 2022 Bangladesh Demographic and Health Survey. The survey was conducted at the community level across all administrative divisions of Bangladesh. A total of 5128 ever-married women aged 15-49 years who had a live birth within 5 years prior to the survey were included in the analysis. Women with missing or incomplete information regarding the timing of their first ANC visit were excluded from the study. OUTCOME: The primary outcome was early initiation of ANC, defined as the first ANC contact within the first trimester. MATERIALS AND METHODS: The study applied survival analysis methods, including Kaplan-Meier survival curves, log-rank tests and an Accelerated Failure Time model, to assess the determinants of early ANC initiation. FINDINGS: Only 37.9% (95% CI 36.0% to 39.9%) of women in Bangladesh initiated ANC within the first trimester. Early ANC initiation was associated with higher maternal age, education, skilled employment, wealthier households, media exposure, higher decision-making autonomy, higher husband's education and urban residence. Women who reported that distance to a health facility was not a big problem had initiated ANC earlier than those who considered distance a major barrier. Regional disparities were also evident, with women from Barishal, Chattogram, Rajshahi, Khulna and Rangpur accessing ANC later than those in Dhaka. CONCLUSIONS: Persistent inequalities in early ANC initiation highlight the need for targeted policies to reduce financial barriers, improve healthcare accessibility and strengthen awareness campaigns to ensure equitable maternal healthcare in Bangladesh.