Background: Timely initiation of antenatal care (ANC) is essential for reducing maternal and neonatal mortality and achieving Sustainable Development Goal 3. In Sub-Saharan Africa, and particularly in Somalia, delays remain widespread. The median time for first ANC in Somalia is about 5 months, well beyond the World Health Organization recommendation of the first trimester. Late ANC initiation compromises early detection and management of pregnancy complications. This study examined the timing of first ANC and its predictors among Somali women using survival analysis. Methods: This retrospective analysis used data from the 2020 Somalia Demographic and Health Survey, including 7,100 women aged 15–49. Survival analysis defined the event as initiating ANC within the first trimester (≤12 weeks). Kaplan–Meier curves illustrated survival probabilities, log-rank tests compared groups, and a multivariate Cox Proportional Hazards model identified independent predictors, adjusting for sociodemographic and obstetric characteristics. Results: Higher maternal education increased the likelihood of timely initiation (primary: AHR = 1.26, 95% confidence interval CI: 1.12–1.41; higher: AHR = 1.35, 95% CI: 1.02–1.78). Prior delivery in a health facility was strongly predictive (AHR = 2.24, 95% CI: 2.04–2.46). Delayed initiation was associated with rural (AHR = 0.82, 95% CI: 0.74–0.92) and nomadic residence (AHR = 0.32, 95% CI: 0.27–0.39), certain regions (Hiraan: AHR = 0.33, 95% CI: 0.25–0.44), not watching television (AHR = 0.84, 95% CI: 0.73–0.96), and husband’s unemployment (AHR = 0.77, 95% CI: 0.70–0.84). The magnitude of these effects was substantial; for instance, prior delivery in a health facility more than doubled the likelihood of timely ANC initiation, while nomadic residence reduced this likelihood by 68% compared with urban residence. Wealth status was not significant after adjustment. Conclusion: Delays in ANC initiation remain widespread in Somalia. Independent predictors include maternal education, prior delivery location, residence type, region, media exposure, and husband’s socioeconomic status. Interventions should focus on rural and nomadic populations, strengthen health education, and leverage facility-based experiences to improve timely ANC uptake.
Hussein et al. (Thu,) studied this question.