Factors associated with late ANC initiation among pregnant women in select public health centers of Addis Ababa, Ethiopia: unmatched case–control study design

BACKGROUND: Although Ethiopia has shown remarkable achievements in reducing maternal mortality in the last 10 years, the prevalence of late antenatal care (ANC) initiation is still high in the country. OBJECTIVE: The primary purpose of this study was to identify the factors related to late ANC initiation among pregnant women in selected public health centers in Addis Ababa, Ethiopia. SUBJECTS AND METHODS: A total of 402 pregnant women (cases=134, controls=268) were recruited using multistage sampling. The design selected for the study was unmatched case–control. EpiData version 3.02 and SPSS version 20.0 were used for data entry and statistical analysis, respectively. Binary logistic regression model was used to model the odds of late ANC initiation. RESULTS: The odds of attending ANC late were significantly higher for mothers with a monthly household income of <US$45.5 (AOR=6.67; 95% CI: 2.40, 18.60), who were educated up to eighth grade or below (AOR=2.17; 95% CI: 1.03, 4.60), who had unplanned pregnancy (AOR=2.73; 95% CI: 1.03, 7.23), who did not receive advice from health extension workers or TV/radio (AOR=5.21; 95% CI: 2.49, 10.88), who stayed for <5 years in Addis Ababa (AOR=3.93; 95% CI: 1.89, 8.12), and who was charged >$8.50 to start the ANC service (AOR=3.04; 95% CI: 1.98, 4.67). CONCLUSION: Low educational level, low income of the household, unplanned pregnancy, stay for <5 years in Addis Ababa, not getting advice from health extension workers or local TV/radio and higher cost associated with initiation of the first ANC service were the main predictors of late ANC initiation. Therefore, any intervention which would need to improve early ANC initiation should focus on economic empowerment of women, and tailored health education for migrant women should be strengthened.