Factors Affecting Utilization of Antenatal Care Services in Public Primary Health Care Centers in Sana'a City, Yemen

Abstract Background Antenatal care (ANC) is essential for reducing preventable maternal and neonatal deaths. In 2023, the World Health Organization reported approximately 260000 maternal deaths worldwide, with over 90% occurring in low- and lower-middle-income countries. Yemen has one of the highest maternal mortality ratios in the region (about 500 per 100000 live births). While global coverage of at least four ANC contacts is 62% and 84% in the Arab region, ANC utilization in Yemen remains extremely low at 25%. Aim This study aims to identify the factors affecting the utilization of antenatal care services in public primary health care centers in Sana'a city, Yemen. Methods A cross-sectional quantitative study was conducted in five districts of Sana’a city. A total of 422 women aged 15--49 years who had delivered within the previous two years were selected through multistage random sampling. Data were collected using a validated self-administered questionnaire between 1 September and 30 November 2024. Results Overall, 85.5% of women reported using ANC services. Utilization was significantly lower in rural districts (7.6%) compared with urban districts (74.9%). Literate women (74.6%) were more likely to use ANC than illiterate women (7.8%). Women without health insurance (77.3%) had higher utilization than those with insurance (5.2%). Limited access to a car (74.4%) and residence in rented housing (59.5%) were associated with reduced uptake. Encouragement from husbands or the community increased ANC utilization (69.9%) compared with women who experienced discouragement (12.6%). Restrictions on leaving home decreased utilization to 27.3%, compared with 55.2% among women with freedom of movement. Health system barriers were common: 67% reported drug unavailability, 40% walked to facilities, and 55% experienced long waiting times. Knowledge of delivery danger signs (43%) and post-delivery danger signs (47%), as well as receiving information on family planning (44%), dietary practices (46%), and breastfeeding (57%), were positively associated with ANC use. Conclusion Geographic, socioeconomic, cultural, and health system factors significantly influence ANC utilization in Sana’a city. Addressing these barriers and strengthening women’s knowledge and access to maternal health services are essential to improving ANC uptake and maternal and neonatal outcomes in Yemen.