Factors Associated with Late Antenatal Care Initiation for Pregnant Women Aged 15-49 Years in Sierra Leone Using the 2019 Demographic Health Survey

Background: Antenatal care (ANC) is acknowledged as a critical maternal service in improving a wide variety of health outcomes for women and children as a result of better awareness of the importance of women being braced physically, mentally, and even logistically for delivery. Therefore, the timely initiation of ANC is critical to women. Objective: This study seeks to identify the factors affecting the timely initiation of ANC among women aged 15-49 in Sierra Leone. Methodology: This study adopted an analytical cross-sectional study using secondary data from the Sierra Leone Demographic and Health Survey. Frequencies and percentages were used to describe the explanatory variables. A multivariate logistic regression was conducted to identify the factors influencing the timely initiation of ANC in Sierra Leone. Results: The prevalence of timely initiation of antenatal care was 55.42%. Women residing in the northern (aOR=1.51, 95%CI 1.09-2.09), northwestern (aOR=1.87, 95%CI 1.33-2.61), southern (aOR=1.64, 95%CI 1.22-2.20) and western regions (aOR=2.00, 95%CI 1.38-2.89) had a high likelihood of starting antenatal late compared to those residing in the eastern region. Furthermore, women from the Limba (aOR=3.10, 95%CI 1.25-7.69), Sherbo (aOR=2.80, 95%CI 1.02-7.69) and Korankoh (aOR=2.79, 95%CI 1.13-6.85) ethnic groups had a higher likelihood of starting antenatal late compared to women from the creole ethnic group. Women who had no problem seeking for permission from their husbands for healthcare (aOR=0.71, 95%CI 0.55-0.89) and women who took healthcare decisions together with their husbands (aOR=0.83, 95%CI 0.70-1.00) had a lower likelihood of late initiation of antenatal care compared to those who had a big problem seeking for permission from their husbands for healthcare and respondents who took healthcare decisions alone. Conclusion: Findings from this study reveal that the timely initiation of antenatal care among women aged 15-49 years in Sierra Leone is low. Also, region of residence, ethnicity, husband’s authorization for seeking healthcare and decision making on healthcare are the factors influencing the timely initiation of antenatal care in Sierra Leone among women aged 15-49. It is recommended that women empowerment programs be organized regularly to educate women on the need to make their personal healthcare decisions. Government must also build more health facilities in the other regions of the country, with more skilled maternal healthcare training in the country to ensure equal distribution of health workers.