What predicts delayed first antenatal care contact among primiparous women? Findings from a cross-sectional study in Nigeria

BACKGROUND: Delayed first antenatal care contact refers to first antenatal care contact occurring above twelfth weeks of gestation. Studies in Nigeria and in other countries have examined the prevalence and predictors of delayed first antenatal care contact. Nevertheless, existing studies have rarely examined the predictors among primiparous women. In addition, the evidence of higher health risks associated with primigravida emphasizes the need to focus on primiparous women. This study, therefore, examined the predictors of delayed first antenatal care contact among primiparous women in Nigeria. METHODS: The study was a descriptive cross-sectional design that analyzed data extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a weighted sample of 3,523 primiparous women. The outcome variable was delayed first antenatal care contact. explanatory variables were grouped into predisposing, enabling, and need factors. The predisposing factors were maternal age, education, media exposure, religion, household size, The knowledge of the fertile period, and women’s autonomy. The enabling factors were household wealth, employment status, health insurance, partner’s education, financial inclusion, and barriers to accessing healthcare. The need factors were pregnancy wantedness and spousal violence during pregnancy. Data were analyzed using Stata 14. Two multivariable logistic regression models were fitted. Statistical significance was set at p < 0.05. RESULTS: Nearly two-thirds (65.0%) of primiparous women delayed first antenatal care contact. Maternal age, maternal education, media exposure, religion, household membership, and knowledge of the fertile period were predisposing factors that significantly influenced the likelihood of delayed first antenatal care contact. Also, household wealth, employment status, health insurance, partner’s education, perception of distance to the health facility, and financial inclusion were enabling factors that had significant effects on delayed first antenatal care contact. Pregnancy wantedness was the only need factor that significantly influenced the likelihood of delayed first antenatal care contact. CONCLUSION: The majority of primiparous women in Nigeria delayed first antenatal care contact and the delay was predicted by varied predisposing, enabling, and need factors. Therefore, a public health education program that targets women of reproductive age especially primiparous women is needed to enhance early antenatal care contact in the country.