Late initiation of antenatal care and its associated factors among pregnant women in Benin: a facility based cross-sectional study

Initiation of Antenatal Care (ANC) after 16th gestational weeks (GW) influences the course of pregnancy and childbirth. It is a risk factor for maternal, perinatal morbidity and mortality in Sub-Saharan Africa. The objective was to investigate the rate of late initiation of ANC and to document its associated factors in a Beninese pregnant women population. A cross-sectional study was conducted in 30 Beninese maternities from January 2020 to November 2021. All pregnant women ≥ 15 years old who attended ANC contact were included. Data were collected through structured face-to-face interviews, review of medical records and maternal cards. Binary and multivariable logistic regression analysis were performed by using 95% Confidence Interval (CI) and significance was declared at P < 0.05. The sample consisted of 3,528 pregnant women, of whom 1,469 (41.6%) initiated their first antenatal care (ANC) visit after the 16thGW. Factors significantly associated with late ANC initiation included having no formal education compared to having at least one level of education (Odd ratio (OR) = 1.6; 95%IC) [1.3–3.0]), and belonging to the Otamari or Adja ethnic groups compared to the Fon ethnic group (OR = 1.7; 95% CI [1.1–2.4] and OR = 1.5; 95% CI [1.1–1.9], respectively). Women practicing a religion other than Christianity or Islam had a significantly higher likelihood of late ANC initiation compared to Christians (OR = 7.0; 95% CI [4.4–11.5]). Parity of one or more was also associated with late ANC use compared to nulliparous women (OR = 1.3; 95% CI [1.1–1.6]), as was having pre-existing diabetes before the index pregnancy compared to non-diabetic women (OR = 2.8; 95% CI [1.7–4.7]). Among women with previous pregnancies, a history of fetal loss was associated with a lower likelihood of late ANC initiation compared to those without such a history (OR = 0.7; 95% CI [0.6–0.9]). In contrast, a history of gestational diabetes (OR = 4.2; 95% CI [2.2–8.8]) and a history of preeclampsia (OR = 1.7; 95% CI [1.1–2.5]) were both associated with increased odds of initiating ANC late. A high rate of late initiation of ANC in this population was documented. In addition to socio-demographic risk factors, largely described in the literature, chronic disease like diabetes or previous pregnancy complications could positively or negatively influence initiation of ANC.