A cross-sectional study to evaluate access to antenatal care services in Twifo Hemang Lower Denkyira district of Ghana

Background Antenatal care (ANC) supports skilled delivery and maternal survival, but evidence on how Ghana’s Community-Based Health Planning and Services (CHPS) policy influences ANC access is limited. This study assessed factors associated with ANC access in the Twifo Hemang Lower Denkyira District, Central Region, Ghana. Methods In a cross-sectional study, we examined 310 women aged 15–49 years, having children less than 12 months, using a structured questionnaire administered through interviews. ANC initiation was defined as early when the first ANC visit occurred at 0–12 weeks’ gestation (first trimester) and late when it occurred at 13 weeks or later. We performed univariate and multivariate logistic regression analyses in Stata 17 and reported adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results ANC attendance was 93.9%, and 69.1% of women initiated ANC early. Unmarried women (AOR = 0.125, 95%CI:0.012–0.926, p = 0.047) and women who delivered at home (AOR = 0.013, 95%CI:0.001–0.176, p = 0.001) had lower odds of attending at least one ANC visit. Late ANC initiation was associated with household size of 11 or more members (AOR = 3.848, 95%CI:1.914–6.211, p = 0.046), fewer than four ANC contacts (AOR = 6.332, 95% CI: 2.049–9.571, p = 0.001), and CHPS staff home visits (AOR = 1.813, 95%CI:1.014–3.243, p = 0.045). Higher monthly income was associated with lower odds of late ANC initiation (AOR = 0.123, 95%CI:0.024–0.630, p = 0.012). ANC and pregnancy knowledge, receiving care in a CHPS zone, and distance to a CHPS zone were not significantly associated with ANC attendance or timing after adjustment. Conclusions ANC attendance and early initiation were relatively high. However, marital status, place of delivery, household size, income, ANC contacts, and CHPS home visits were associated with ANC access. Strengthening community-based and multisectoral interventions may improve timely ANC use and maternal health outcomes.