Factors influencing early initiation of antenatal care among pregnant women in northern Ghana

Background/Aims Delayed initiation of antenatal care remains a major public health concern in Ghana, contributing to high maternal and neonatal mortality. This study investigated factors influencing early initiation among pregnant women in northern Ghana. Methods This descriptive cross-sectional survey was conducted among 317 pregnant women at Tamale Teaching Hospital, recruited through systematic random sampling. Data were collected using a structured questionnaire and analysed using logistic regression. Results Overall, 69.1% of participants attended antenatal care in the first 12 weeks of pregnancy. Most had planned pregnancies (92.1%), and nearly half (49.8%) recognised that they were pregnant after experiencing symptoms. Satisfaction with antenatal care services was high (97.5%), and most participants had health insurance (90.9%) and access to mass media (94.6%). Binary logistic regression showed that occupation ( P =0.001), household income ( P =0.001), previous antenatal care attendance ( P =0.038) and pregnancy recognition ( P =0.006) were significantly associated with early initiation, as was knowledge of their expected delivery date ( P =0.010), the ideal time to initiate antenatal care ( P <0.001) and the benefits of early antenatal care ( P <0.001). In multivariate analysis, only pregnancy recognition remained significant, with participants who recognised that they were pregnant after experiencing symptoms ( P =0.014) or not until later in pregnancy ( P <0.001) being less likely to attend antenatal care early than those who received confirmation from a doctor. Conclusions The timing of when women recognise that they are pregnant significantly influenced antenatal care initiation, highlighting the need for increased awareness and education on early pregnancy detection. Enhancing health literacy and promoting early recognition will help to improve maternal healthcare use and reduce maternal and neonatal mortality. Implications for practice Education and community outreach on early pregnancy recognition should be strengthened to promote timely antenatal care initiation, improve maternal health literacy and reduce preventable maternal and neonatal complications.