Determinants of Late Initiation of Antenatal Care Among Pregnant Women in Sub-Saharan Africa: A Qualitative Systematic Review

Introduction Antenatal care utilization serves as an essential metric for tracking the progress of maternal and neonatal health outcomes. Commencing antenatal care promptly facilitates the timely addressing and treatment of pregnancy complications, thus mitigating maternal mortality rates. Generally, antenatal care utilization is very low in Sub Saharan Africa (SSA). Further, delayed initiation of care is very common, despite efforts in advocating for early antenatal attendance. Objective. To establish factors associated with delayed initiation of antenatal care in SSA. Design. Following the Joanna Briggs methodology, we conducted a Systematic Review by searching PubMed, EMBASE, Scopus, Web of Science, SCINAHL and Google Scholar. Two researchers independently screened the identified studies against predefined eligibility criteria. Results. A total of 2,113 studies were identified. After screening, 8 studies met the inclusion criteria. Barriers were mostly personal, accessibility, social cultural and health system in nature. These included lack of knowledge, negligence, unplanned pregnancy, long waiting time, long distances, transport costs, fear of witchcraft, midwives’ attitude and lack of resources regarding antenatal care. Facilitators of initiation of ANC services were mostly personal in nature which included pregnancy confirmation, testing for diseases, social support and community network. Conclusion. Lack of knowledge about the existence and benefits of ANC services, cultural barriers such as the belief in witch craft and costs associated with attending ANC were some of the prominent barriers. The review therefore recommends that SSA governments should implement culturally tailored interventions, improve on communication strategies, and provide more resources to boost attendance.