Determinants of antenatal care service utilisation in sub-Saharan Africa: an analysis of demographic and health surveys data (2015-2022).

Abstract

Background: Antenatal care (ANC) is crucial for maternal and neonatal health, facilitating early complication management, health education, and promoting skilled birth assistance. Despite global ANC recommendations, implementation remains suboptimal in sub-Saharan Africa, where maternal and neonatal mortality rates remain high. Assessing ANC prevalence and its determinants can help address gaps and improve health outcomes.

Methods: This study utilised data from recent Demographic and Health Surveys (DHS) conducted between 2015 and 2022 across SSA countries, using a weighted sample of 196,459 women. ANC service use during pregnancy was classified as no ANC visits, one to three ANC visits, or four or more visits. Multinomial logistic regression was used to estimate explanatory variable effects, reported as relative risk ratios with 95% confidence intervals.

Results: Among participants, 11.2% received no ANC, 30.5% had one to three visits, and 58.4% attended four or more visits. ANC utilisation varied by region, with 54.7% of women in East Africa and 60.3% in West Africa receiving four or more visits. Having health insurance showed one of the strongest positive associations with ANC attendance for both one to three visits (RRR = 2.81, 95% CI: 2.37, 3.34; p < 0.001) and four or more visits (RRR = 2.95, 95% CI: 2.48, 3.51; p < 0.001). Women who did not consider obtaining permission to visit a health facility as a problem also had a higher likelihood of attending one-three visits (RRR = 1.66, 95% CI: 1.53, 1.81; p < 0.001) or ≥ four visits (RRR = 1.92, 95% CI: 1.77, 2.09; p < 0.001). Higher maternal education, longer preceding birth intervals, and an improved wealth index were significantly associated with a greater probability of attending ≥ four ANC visits (p < 0.001). In contrast, living in a rural area was associated with lower odds of attending ≥ four visits (RRR = 0.65, 95% CI: 0.58, 0.72; p < 0.001).

Conclusion and recommendations: This study highlights disparities in ANC utilisation in SSA, with many women receiving insufficient or no ANC visits. Individual, household, and community-level factors, such as education, health insurance, income, geographic access, and others, strongly influence ANC service use. Strengthening maternal health insurance schemes can alleviate financial barriers, and community-based outreach programs and educational campaigns can enhance access and awareness, and improve access and continuity of care, particularly in rural or remote areas. Integrating these strategies into broader health policies and fostering collaboration between healthcare providers, policymakers, and local communities allows for narrowing existing gaps in ANC utilisation and ultimately improving maternal and neonatal outcomes across the region.