Initiation of Antenatal Care Among Pregnant Women in Saudi Arabia: An Application of Andersen’s Behavioral Model Using a Cross-Sectional Study

<b>Background/Objectives</b>: Timely initiation of antenatal care (ANC) services is crucial for ensuring maternal and fetal well-being. Despite the importance of ANC, research regarding its initiation remains limited in the Jazan region of Saudi Arabia, an area with notable adverse birth outcomes. Therefore, this study aimed to assess pregnant women's initiation of ANC and identify associated factors and significant barriers for timely initiation. <b>Methods</b>: A cross-sectional study was conducted among 369 Saudi pregnant women in their third trimester attending ANC clinics in the Jazan region in 2024. A structured questionnaire was used to collect data. Andersen's behavioral model of healthcare utilization provided the framework for the study. Descriptive statistics, chi-square tests, and binary logistic regression were used to analyze the data. <b>Results</b>: The majority of women (78.9%) initiated ANC in the first trimester. Higher maternal education was positively associated with early ANC initiation (aOR = 2.369, 95% CI: 1.154-4.901), whereas higher paternal education was negatively associated with early ANC initiation (aOR = 0.350, 95% CI: 0.175-0.699). When modeled independently, the positive association of higher maternal education was attenuated but was not significant, while the negative association of higher husband's education remained the same. Those living more than three km from health facilities (aOR = 0.510, 95% CI: 0.276-0.941) and seeking care for reasons other than routine follow-up were less likely to initiate ANC early. Most women received essential services, but only 37.1% had ultrasound tests. <b>Conclusions</b>: While ANC initiation in Jazan showed promising trends, factors like geographical accessibility remain a significant barrier. Targeted interventions should address these identified barriers, which fall within predisposing, enabling, need, and external environmental factors. Further investigations of pregnant women's familial decision-making and low ultrasound test utilization in relation to ANC are recommended.