Antenatal care utilisation among pregnant adolescents in urban Ghana: a qualitative study of individual, family and health system influences

BACKGROUND: Adolescent pregnancy remains an important public health concern in Ghana and other low- and middle-income settings. Pregnant adolescents often initiate antenatal care later than recommended or attend irregularly, increasing the risk of adverse maternal and newborn outcomes. While determinants of antenatal care use have been widely studied, less is known about how individual, family, and health system factors interact to shape adolescents' care seeking experiences. This study explored influences on antenatal care utilisation among pregnant adolescents in an urban municipality in southern Ghana. METHODS: A qualitative descriptive study was conducted in the La Nkwantanang Madina Municipality in the Greater Accra Region of Ghana. Data were collected through in-depth interviews, focus group discussions, and key informant interviews with pregnant adolescents, caregivers, midwives, and community members. Interviews were conducted in English or Twi, audio recorded, transcribed verbatim, and analysed thematically. RESULTS: Forty-two participants were included: 15 pregnant adolescents, 6 caregivers, 5 midwives, and 16 community members. Three interrelated themes shaped antenatal care utilisation: individual influences, family influences, and health system influences. Delayed pregnancy recognition, stigma, and financial constraints contributed to late initiation of care. Family responses, including support or disapproval, influenced attendance patterns. Health system factors such as provider attitudes, waiting time, privacy concerns, and out of pocket costs also shaped utilisation, although supportive care experiences encouraged continued attendance. CONCLUSION: Antenatal care utilisation among pregnant adolescents is shaped by interacting individual, family, and health system influences. Strengthening adolescent responsive services, supportive family engagement, and reducing structural barriers may improve timely and consistent antenatal attendance.