Prevalence and risk factors for delayed antenatal care visits in Rwanda: an analysis of secondary data from Rwanda demographic health survey 2019-2020

Introduction: antenatal care (ANC) delivers services to prevent pregnancy complications and provides counseling for birth, and emergency preparedness. Having ANC on time has life-saving potential for the child and mother. Despite improvements in health infrastructure, human resources, and health insurance, hindrances to early ANC visits still exist in Rwanda. This study aimed to investigate the burden and factors associated with delayed ANC visits in Rwanda so that policymakers can develop strategies to promote early ANC visits. Methods: this is a cross-sectional study using Rwanda demographic health survey (RDHS) 2019-2020 that included 6,039 women that had had a pregnancy in the 5 years preceding the survey. Descriptive analysis was used to determine the prevalence and a multivariable logistic regression model using manual backward stepwise regression was used to identify risk factors for delayed ANC in Rwanda. STATA 16 statistical software was used for all the analyses. Results: the prevalence of delayed ANC in Rwanda was 41% and the risk factors include: the number of children 4-6 (AOR = 1.4, 95% CI: 1.2-1.6) and 7 or more children (AOR = 1.5, 95% CI: 1.5-2.1) versus less than 3 children, unwanted pregnancy (AOR = 1.7, 95% CI: 1.5-2.0), not covered by health insurance (AOR = 14, 95% CI: 1.2-1.6), woman??s education level: no education (AOR 2.6, 95% CI: 1.6-4.1), primary education (AOR 2.5, 95% CI: 1.6-3.7), secondary education (AOR 2.2, 95% CI: 1.5-3.2), woman??s occupation: informal (AOR 2.3 95% CI: 1.5-3.7) and unemployment (AOR 2.3. 95% CI: 1.4-3.7). Conclusion: based on the findings from our study, family planning services should be made available to all women of childbearing age to prevent unwanted pregnancies; female education should be considered a priority, promotion of health insurance coverage and community-based education about reproductive health to encourage the early seeking of care among women of childbearing age.