Predictors of Antenatal Care Utilization Among the Rohingya Population in the Refugee Camps of Cox's Bazar, Bangladesh

Background While studies in both high- and low-income settings have demonstrated the importance of early and regular antenatal care (ANC) utilization, evidence from crisis-affected populations remains limited. Rohingya refugees in Cox’s Bazar, Bangladesh, face unique barriers to healthcare; previous studies have found low rates of ANC utilization. This study examines the predictors of number of visits and timing of initiation of ANC among pregnant Rohingya women in Cox’s Bazar. Methods Data come from a prenatal birth cohort study of "Intergenerational Risk and Resilience of Rohingya in Displacement" (iRRRd). A total of 2,322 pregnant Rohingya women were recruited between February 2023 and March 2024. ANC utilization was assessed via surveys at the birth follow-up visit. Primary outcomes included the number of ANC visits and the timing of the first visit. Predictors were categorized using the Andersen-Newman model (predisposing, enabling, and need factors). We used Poisson regression for number of visits, and logistic regression to analyze timing of first visit. Results The average number of ANC visits was 6.9 (SD = 2.6), with 80.5% of women initiating care within the first trimester. Women with one to three children reported fewer visits (IRR = 0.94, p = 0.004), as did those with more than three (IRR = 0.90, p = 0.015). Higher self-rated health predicted delayed initiation (OR = 1.21, p = 0.004). More years of formal education reduced the odds of delayed initiation (OR = 0.88, p = 0.048) but did not affect the number of visits. Greater mobility was linked to earlier initiation (OR = 0.84, p = 0.010). Socioeconomic indicators and education of relatives were not associated with ANC use. Receiving information via radio was unexpectedly associated with delayed initiation (OR = 1.52, p = 0.038). Location of residence explained minimal variance (2%). Conclusions ANC coverage in the Rohingya camps appears high, yet some groups remain at risk for delayed care. Feeling healthy, high parity, and restricted mobility contributed to late initiation. Conventional predictors like formal education and SES showed limited relevance in this context. Findings point to the need for tailored health communication strategies and deeper examination of the quality of ANC services and associations with maternal and neonatal outcomes.