It was revealed that the majority (84%) of the mothers obtained the recommended ANC visits. This national prevalence is similar to findings at the district level. For instance, a study in the Yendi Municipality found a prevalence of 83.9% among adolescent mothers . However, the prevalence in this study is higher than findings in Nigeria (35.1%) , Bangladesh (30%)  and India (22.9%) . The differences in findings can be attributed to the implementation of the Free Maternal Health Care Policy (FMHCP) by the government of Ghana in 2008. With this policy, pregnant women who enrol on the National Health Insurance Scheme (NHIS) have access to free maternal healthcare services, including ANC.
On the other hand, a substantial proportion (16%) of adolescent and young mothers did not obtain the recommended ANC visits. This is higher than findings in developed countries (5%) . This may be attributed to differences in contextual factors, such as socio-cultural norms and health system factors. For instance, adolescents may delay in accessing ANC due to fear of stigmatization and being expelled from school . Also, negative attitudes of health providers towards adolescent mothers coupled with distance to health facilities might have accounted for the differences in the findings [11, 26].
The salient factors associated with obtaining the recommended ANC visits were higher educational status, higher socio-economic status, exposure to the internet and geographical region. It was revealed that adolescent and young mothers who had junior high school education were more likely to obtain 4 or more ANC visits. This finding is consistent with prior studies in Low-and Middle-Income Countries [22, 27]. For instance, a study revealed that Indonesian adolescents and young mothers with higher educational attainment were more likely to utilize ANC services compared with those with lower educational status . Also, a systematic review of studies from sub-Saharan Africa showed that women with higher education were more likely to obtain the recommended ANC visits during pregnancy . Educated mothers have more access to health information, appreciate the causes of adverse pregnancy outcomes and the importance of ANC to the wellbeing of the mother and the unborn baby . In addition, educated mothers have greater autonomy to make decisions and financial access to quality healthcare .
In addition, it was revealed that adolescent and young mothers in the second wealth quintile were more likely to obtain the recommended ANC visits. This finding is consistent with previous studies in developing countries where economic inequities were observed in maternal healthcare service utilization . Evidence shows that socio-economic status significantly affects ANC utilization among adolescent mothers [12, 22, 25, 27, 32]. This finding is understandable because young mothers from poor households are less likely to have financial access to maternal healthcare compared with those from rich households . A previous study reported that pregnant women in Ghana still pay for some maternal health services such as drugs and ultrasound scans despite the Free Maternal Healthcare Policy .
Exposure to the internet was also associated with ANC utilization. This finding is consistent with previous studies in Nigeria, India and Bangladesh [22, 24, 27]. For instance, adolescent mothers in Bangladesh with exposure to the mass media were more likely to obtain the recommended ANC visits compared with those with no exposure . Evidence shows that the mass media is effective in information dissemination which increases awareness about available healthcare services. It also fosters inter-personnel communication, which can facilitate the use of ANC services . The geographical region was another salient factor associated with ANC utilization . Adolescent and young mothers in the Upper East Region were more likely to obtain the recommended ANC visits. The Upper East Region has the highest ANC coverage in Ghana  and hence could account for this finding.
Implications And Recommendations Of Findings
The findings of this study provide relevant information for maternal health policy and programming. For instance, a substantial proportion of adolescents and young mothers did not obtain the recommended ANC visits. These young mothers are, therefore, at a higher risk of pregnancy and childbirth complications as well as negative birth outcomes. It is, therefore, necessary for stakeholders, including the Ministry of Health and Ghana Health Services, to invest resources in increasing ANC coverage among young mothers. Stakeholders can leverage existing youth-friendly initiatives such as the Adolescent Health and Development (ADHD) programme. Currently, the ADHD programme does not cover maternal health services, hence, stakeholders should consider incorporating these services. Also, the Ghana Health Service should consider separating young mothers from adult mothers during ANC visits coupled with strengthening efforts towards providing Focused Antenatal Care. This may help increase the utilization of ANC among adolescent and young mothers in Ghana.
Further, adolescent and young mothers from poor households; with lower education; and no internet exposure were less likely to obtain optimal ANC visits. This suggests that poor mothers still face financial barriers to accessing ANC services despite the Free Maternal Health Care Policy. This has the potential to delay progress towards improving maternal and child health outcomes. Therefore, the National Health Insurance Scheme needs to liaise with health service providers to eliminate all unauthorized charges on maternal healthcare services. In addition, stakeholders must invest resources in promoting girl child education. Hence, Ghana’s free basic and secondary education policy is commendable. The internet may provide a golden opportunity for stakeholders to increase ANC coverage among young mothers. With the rapid increase in internet penetration in the country, stakeholders can leverage the internet to raise awareness and educate adolescents and young women about the importance of ANC and danger signs in pregnancy and childbirth.