Timing of first antenatal care initiation and associated factors among pregnant women attending antenatal clinics in Hargeisa, Somaliland.

BACKGROUND

Early initiation of antenatal care (ANC) is critical for identifying pregnancy-related risks and improving maternal and neonatal outcomes. The World Health Organization recommends the first ANC contact to occur at or before 12 weeks of gestation. However, timely initiation of ANC remains suboptimal in many low-income settings, including Somaliland. This study assessed the timing of first ANC initiation and associated factors among pregnant women attending antenatal clinics in Hargeisa, Somaliland.

METHODS

A facility-based cross-sectional study was conducted in July 2023 among 365 pregnant women attending antenatal clinics in selected Maternal and Child Health centers in Hargeisa. Data were collected using a pretested structured questionnaire adapted from the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO). Timely ANC initiation was defined as the first ANC visit occurring at or before 12 weeks of gestation. Bivariate and multivariate logistic regression analyses were performed, and statistical significance was declared at p < 0.05.

RESULTS

Only 36.2% of pregnant women initiated ANC within the recommended time. Timely ANC initiation was significantly associated with prior use of modern family planning (AOR = 2.1, 95% CI: 1-4.6; p = 0.043), accompaniment by spouse (AOR = 3.2, 95% CI: 1.6–6.6; p = 0.002), being informed about the benefits of early ANC (AOR = 2.7, 95% CI: 1.4–5.3; p = 0.003), and good knowledge of key danger signs of pregnancy (AOR = 8.0, 95% CI: 3.7–17.5; p < 0.001).

CONCLUSION

Timely initiation of ANC in Hargeisa remains low. Interventions focusing on improving women’s knowledge, strengthening family planning services, promoting male partner involvement, and enhancing counselling on early ANC during community and facility-level contacts may improve early ANC uptake.