Late antenatal care initiation and its associated factors among pregnant women attending antenatal care at public hospitals of Kellem Wollega zone, Western Ethiopia: a facility-based cross-sectional study

BACKGROUND: Late antenatal care initiation refers to the beginning of antenatal care for the first time during pregnancy after 12 weeks of gestation. Beginning antenatal care services after the first trimester misses opportunities to offer preventive measures, screening, and effective interventions early in the pregnancy. There is limited evidence on the magnitude of late antenatal care initiation in the Kellem Wollega Zone, Western Ethiopia. OBJECTIVE: The objective of this study was to assess the magnitude of late antenatal care initiation and its associated factors among pregnant women attending antenatal care at public hospitals in the Kellem Wollega Zone from August 10 to September 10, 2023. METHODOLOGY: A facility-based cross-sectional study was conducted in public hospitals of Kellem Wollega Zone from August 10 to September 10, 2023. Four public hospitals were selected for this study. A total of 410 pregnant women participated in the study. A structured questionnaire was used to collect data on sociodemographic characteristics, obstetric and medical history, ANC-related factors, and health facility-related factors. The statistical analysis comprised descriptive statistics, and multivariable logistic regression was used to assess late antenatal care initiation and its associated factors. Statistical significance was determined using multivariable logistic regression analysis with a p-value of < 0.05. RESULTS: Among 410 pregnant women, the magnitude of late first antenatal care initiation was 61.7% (95% CI 57.1-66.3%) with a mean gestational age of 17.27 weeks. Rural residence (AOR = 1.83; 95% CI: 1.01-3.30), perceived appropriate time of first ANC initiation after 12 weeks of gestation (AOR = 6.89; 95% CI: 3.44-13.8), means of pregnancy recognition by missed period (AOR = 2.6; 95% CI: 1.25-5.40), and lack of decision-making power for ANC services (AOR = 5.2; 95% CI: 2.86-9.5) were significantly associated with increased odds of late ANC initiation. CONCLUSION AND RECOMMENDATIONS: The magnitude of late antenatal care initiation was high. Rural residence, perceived appropriate time of first ANC initiation after 12 weeks of gestation, means of pregnancy recognition, and lack of decision-making power for ANC services were significantly associated with increased late ANC initiation. Stakeholders working in maternal and child healthcare need to focus on creating awareness of the recommended ANC starting time, empowering women to decide by themselves about antenatal care initiation.