Strategies to Improve Early Antenatal Care, insights fron crosssectional study

Recently published research looked at a common problem in many African countries: pregnant women waiting too long to see a doctor for their first prenatal checkup. In Benin, they studied over 3,500 pregnant women to understand why this happens and who is most affected.

The Main Finding

The study discovered that about 42% of pregnant women in Benin didn't visit a doctor until after 16 weeks of pregnancy. This is concerning because early prenatal care helps catch problems before they become serious and can prevent complications for both mother and baby. The World Health Organization recommends that women should see a doctor much earlier—ideally by 12 weeks.

Who Was More Likely to Start Care Late

Several factors made women more likely to delay their first visit. Women without formal education were significantly more likely to wait longer than those who had gone to school. Interestingly, women who had been pregnant before were also more likely to delay care compared to first-time mothers, possibly because they felt more confident based on previous experience.

Religious beliefs played a surprisingly strong role. Women practicing traditional indigenous religions were seven times more likely to delay care compared to Christians, suggesting that cultural beliefs about pregnancy and medical care influence decision-making.

Women from certain ethnic backgrounds, particularly the Otamari and Adja groups, were more likely to delay care than women from the Fon ethnic group. Additionally, women with diabetes were nearly three times more likely to start prenatal care late, possibly because they were focusing on managing their diabetes rather than pregnancy monitoring.

A Surprising Finding

One unexpected discovery was that women who had experienced previous pregnancy complications like gestational diabetes or preeclampsia (dangerous high blood pressure during pregnancy) tended to delay care even more. However, women who had previously lost a pregnancy were more likely to seek early care, possibly because they were more motivated to ensure a healthy pregnancy.

Why This Matters

This research highlights that improving prenatal care isn't just about building more clinics or providing transportation. Success requires understanding local cultures and beliefs, improving communication between healthcare providers, and ensuring that women managing chronic conditions like diabetes can access comprehensive care that includes pregnancy support.

Major points -

• Prevalence and Sociodemographic Factors of Late ANC Initiation: Among 3,528 pregnant women in Benin, 41.6% initiated antenatal care (ANC) after the 16th week of gestation, exceeding national recommendations. Significant sociodemographic predictors of late ANC initiation included lack of formal education (adjusted odds ratio [aOR] ~1.6), belonging to the Otamari or Adja ethnic groups compared to Fon (aOR ~1.5-1.7), and adherence to indigenous religions as opposed to Christianity or Islam, which posed the highest risk (aOR ~7.0). Multiparity (parity ≥ 1) was also associated with delayed ANC initiation (aOR ~1.3).

• Impact of Chronic and Obstetric History on ANC Timing: Women with pre-existing diabetes were substantially more likely to delay ANC initiation (aOR ~2.8), potentially due to fragmented care pathways or prioritization of chronic disease management over pregnancy monitoring. Among multigravida women, prior pregnancy complications influenced ANC timing: history of gestational diabetes (aOR ~4.2) and preeclampsia (aOR ~1.7) were associated with increased odds of late initiation, whereas a history of fetal loss was linked to earlier ANC attendance (aOR ~0.7), possibly reflecting heightened pregnancy awareness and care-seeking behavior.

• Implications for Public Health Interventions and Research: The study highlights the need for culturally tailored health promotion strategies involving faith and community leaders to address ethnic and religious barriers. Integration of chronic disease and antenatal services is critical to manage pregnant women with conditions like diabetes effectively. Future research should explore sociocultural beliefs influencing ANC behavior through qualitative methodologies and assess interventions in randomized trials, aiming to improve timely antenatal care uptake, especially among high-risk and underserved groups in low-resource settings.

Reference –

Tchibozo, E., Gado, T., Sonou, Y. et al. Late initiation of antenatal care and its associated factors among pregnant women in Benin: a facility based cross-sectional study. BMC Pregnancy Childbirth 25, 1008 (2025). https://doi.org/10.1186/s12884-025-08170-2