Factors associated with the uptake of early antenatal care visits among pregnant women in Zambia: 2007-2019

OBJECTIVE To describe the adoption of at least four early ANC (ANC4+) visits among women of reproductive age in Zambia between 2007 and 2019. METHODS We used Zambia Demographic and Health Survey data gathered between 2007 and 2019. Early ANC4+ was the desired result and was defined as having at least four ANC visits with the first ANC visit occurring during the first four months of pregnancy. Weighted univariate, bivariate, and multivariate logistic regression analyses were performed. RESULTS A total of 11633 (56%) of the 20661 women enrolled in our study had received early initiation of ANC4+. We saw an increase in the proportion of women who started ANC4+ early, from 55% in 2007 to 63% in 2018/19. There was a decreasing trend in the odds of early ANC4+ initiation with parity, but an increasing trend in the odds of early ANC4+ initiation with a higher level of education. Being a member of a wealthier household was associated with a lower risk of ANC4+ (OR= 0.81, 95%CI: 0.66-0.99, P=0.03). 27% of the 12,333 women who had at least four ANC visits, regardless of the timing of their first visit, reported being late for ANC. CONCLUSION Early ANC4+ uptake increased in Zambia between 2007 and 2019. We found that 27% of women who were misclassified as having at least ANC4+ using conventional analysis were actually late for ANC. We provide some key considerations for ensuring that Zambia and other similar settings achieve universal antenatal care coverage by 2030.