Why Do First Time Mothers in Sub‐Saharan Africa Delay Their First Antenatal Care Visit? Evidence From Demographic and Health Surveys (2019–2022) From 18 Countries—A Cross‐Sectional Study

Background and Aims Delayed initiation of antenatal care (ANC) among primigravida (first time pregnancy) women poses serious health risks for both mothers and infants, especially in sub‐Saharan Africa. Early ANC is crucial for identifying and managing potential health issues during pregnancy, yet many women in this region delay their first ANC visits. Our study examines factors contributing to delays in the initiation of first antenatal care (ANC) visits among primigravida women in sub‐Saharan Africa. Methods We analyzed data from the Demographic and Health Surveys (2019–2022) from 18 sub‐Saharan African countries. The study focused on women aged 15–49 ( n = 114, 956) with no prior pregnancy experience, using logistic regression models to identify socio‐demographic predictors of delayed ANC visits. Data analysis accounted for the complex survey design to ensure representativeness at national and regional levels. Results The study found that 41.7% of primigravida women in the sampled sub‐Saharan African countries delayed their first ANC visit beyond the recommended 12 weeks. Younger women (≤ 18 years; reference group: ≥ 19 years) were significantly more likely to delay ANC visits, with an Adjusted Odds Ratio (AOR) of 1.35 (95% CI: 1.22–1.52) after adjusting for socio‐demographic variables. Living in a rural area was associated with higher odds of delayed ANC (COR: 1.60, 95% CI: 1.45–1.78; AOR: 1.50, 95% CI: 1.35–1.70). Women with only primary education had a COR of 1.40 (95% CI: 1.25–1.56) and an AOR of 1.32 (95% CI: 1.18–1.47) compared to those with secondary or higher education. Additionally, lower socioeconomic status was a strong predictor, with women in the lowest wealth quintile showing a COR of 1.75 (95% CI: 1.58–1.92) and an AOR of 1.63 (95% CI: 1.48–1.80). Conversely, women exposed to health information through mass media were less likely to delay ANC (AOR: 0.72, 95% CI: 0.65–0.80). Also, higher levels of education were associated with a lower likelihood of delay (AOR: 0.68, 95% CI: 0.60–0.76). Conclusion A significant proportion of primigravida women in sub‐Saharan Africa delay their first ANC visit, with delays most pronounced among younger, less educated, and economically disadvantaged women. Public health strategies aimed at improving ANC initiation should prioritize outreach for these high‐risk groups, emphasize the role of education, and enhance accessibility to maternal health information and services.