The antenatal care (ANC) provision or regular check-ups during pregnancy through the public health services in modern obstetrics was started during the late 1930s in the United Kingdom and Northern Ireland [1]. ANC is important for the survival and wellbeing of both the mother and the infant. Skilled care during pregnancy is an important intervention in reducing maternal and neonatal morbidity and mortality [2].
World Health Organization (WHO) recommends a minimum of eight contacts: five contacts in the third trimester, one contact in the first trimester, and two contacts in the second trimester, While many African countries are still struggling to achieve high coverage of four antenatal visits [3].
Antenatal care is more likely to be effective if women begin receiving care in the first trimester of pregnancy and continue to receive care throughout pregnancy, according to accepted standards of periodicity [4]. The universal recommendation for the first ANC initiation is in the first trimester. According to WHO the first trimester is the best time for a mother to book her pregnancy [5].
WHO ANC model states that every pregnant woman is at risk of complications and recommends early ANC visits. The visit is used to segregate pregnant women into two groups based on the previous history of pregnancy, current pregnancy state, and general medical conditions. Those eligible to receive routine ANC (basic component) and those who need special care based on their specific health conditions or risk factors on average account for 25% of all pregnant women initiating ANC [6].
Worldwide there's an enormous discrepancy within the prevalence lately ANC follow up among pregnant mothers, starting from 27.5 to 88% in developed and developing countries respectively [7]. In Latin America, the Caribbean, the Middle East, and North Africa, two-thirds of women present for antenatal care visit in the first trimester, while in sub-Saharan Africa, where women presenting for antenatal care are most likely to wait until the second trimester and a relatively substantial proportion present only in the third trimester. Although women in sub-Saharan Africa make their first antenatal visit rather late in pregnancy, they nonetheless tend to report more than one visit [8].
The South African National Department of Health recommended that women should visit the ANC clinic as soon as they realize that they are pregnant and definitely before 20 weeks of gestation. The ANC services should start with women’s first visit irrespective of gestational age. Antenatal Care guidelines recommend that pregnant women should start their ANC visit at 12 weeks of gestation. Despite the provision of free ANC services, South Africa is still performing poorly compared to other middle-income countries [9].
In Ethiopia, only 20% of women had their first ANC during the first trimester, 26% during their fourth to the fifth month of pregnancy, and 14% during their sixth to the seventh month of pregnancy. Two percent of women did not receive any ANC until the eight months of pregnancy or later [2].
Poor and inadequate quality of care was a strong predictor for late ANC initiation, community-based information, health education and communication on ANC services, socio-economic and individual perception and knowledge of ANC services are major contributors to start ANC visit late in time [10].
Maternal knowledge on early ANC visit, planned pregnancy and parity were factors associated with early ANC visit, mothers of age, media access, advise to initiate ANC during the recommended time after amenorrhea, residence, husband’s occupation, [11–14].
The maternal mortality ratio in Ethiopia was estimated at 412 deaths per 100,000 live births in 2016 (17). These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality antenatal care (ANC) (it includes early initiation of antenatal care). Sixty percent of the stillbirths (1.46 million) occurred during the antepartum period and mainly due to untreated maternal infection, hypertension, and poor fetal growth [6].
Pregnant women should be offered infection early in ANC since appropriate ANC interventions can reduce mother-to-child transmission of HIV infection due to offered screening for HIV at ANC. Screening for syphilis should be offered to all pregnant women at an early stage. In pregnant women with untreated syphilis, 70–100% of infants will be infected and one third will be stillborn [6]. Pregnant women also offered iron and folic acid supplementation in early pregnancy for those who are at risk of nutritional deficiency until 12 weeks of gestation reduces the risk of a baby born with neural tube defects such as anencephaly and spinal bifida [15].
Despite ANC is provided free of charge and there is increased accessibility; low utilization and late booking is still a major problem [16, 17]. According to the Ethiopian Demographic Health Survey 2016 (EDHS), only 20% of mothers start ANC early as per the recommendation [18].
Even though there is good health service coverage in Ethiopia, women come late for ANC follow up. Besides, there is a scarce study on magnitude and associated factors for late ANC among women attending ANC at Woldia town public health institutions, Northern Ethiopia. Therefore, this study aimed to assess the magnitude and factors associated with late initiation of ANC visit at Woldia public health institutions.