Many health problems in pregnant women can be prevented, detected and treated by trained health workers during antenatal care visits. The World Health Organization (WHO) recommends a minimum of four antenatal visits, comprising interventions such as tetanus toxoid vaccination, screening and treatment for infections, and identification of warning signs during pregnancy . The main objectives of antenatal care are: prevention and treatment of any complications; emergency preparedness; birth planning; satisfying any unmet nutritional, social, emotional and physical needs of pregnant woman; provision of patient education, including successful care and nutrition of the newborn; identification of high risk pregnancy; encouragement of (male) partner involvement in antenatal care . The first of such antenatal visits should be conducted in the first trimester (before 14 weeks of gestation) . Identification of complications or risk factors for complications on such early visits enables early institution of interventions to alleviate or mitigate the effects of such complications on the mothers and unborn babies .
Research has indicated that antenatal education for expectant mothers results in sustained improvement in knowledge of newborn care . Another study done in Enugu, Nigeria showed that the prevalence of anaemia in pregnancy at booking was high (40.4%) and recommended that early antenatal booking and improved antenatal care are necessary for early diagnosis and treatment of the condition . These studies emphasize the importance of early antenatal care in insuring a good outcome for both the mother and her baby.
Several factors affecting the utilization of antenatal care in developing countries have been identified . These include: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. From a systematic review of the literature on factors that affect utilization of antenatal care, mothers who are educated, and those whose husbands are educated, are more likely to utilize antenatal care. Availability, affordability and easy accessibility of health units where antenatal care is offered increase utilization of antenatal care. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use, in that they may lead to mothers attending antenatal care late or not attending at all. Parity had a statistically significant negative effect on adequate attendance, where by women of a high parity tend not to attend antenatal care, attend late for the first antenatal visit or have few antenatal care visits. The quality of antenatal care might have an influence on utilization of antenatal care, leading to infrequent or late first visits to antenatal care. Whilst women of higher parity tend to use antenatal care less, this might be a result of an influence of women’s age or religious beliefs.
Globally, during the period 2000–2010, about 53% of pregnant women attended the recommended minimum four times antenatal care. The proportion of pregnant women in developing countries who attended at least one antenatal care visit has increased from approximately 64% in 1990 to about 81% in 2009 but, in low-income countries, only 39% of pregnant women attended four times or more antenatal care during 2000–2010 . According to Uganda clinical guidelines of 2010, for normal (uncomplicated) pregnancies, four routine antenatal care visits are recommended as follows: the first visit between 10–20 weeks of pregnancy; the second visit between 20–28 weeks of pregnancy; the third antenatal care visit between 28–36 weeks and fourth antenatal care visit after 36 weeks . The guidelines also recommend more frequent visits and early antenatal care visits for mothers with pregnancy complications, or those with identifiable risk factors for such complications, such as complications in a prior pregnancy .
The findings of the Uganda Demographic and Health survey 2011 showed that though over 90% of pregnant women attend antenatal care at least once, only 48% make four or more antenatal care visits during their entire pregnancy, only 21% of women made their first antenatal care visit before the fourth month of pregnancy, only 52% of women deliver under the care of a skilled birth attendant, and the maternal mortality ratio is 438 per 100,000 live births . This implies that 79% of pregnant women come late for their first antenatal care visit. However, the actual gestation age at which they come and the reasons for coming late are not documented. The objectives of this study were to determine the time of gestation at which pregnant women who come late (at 20 weeks of gestation or beyond) make their first antenatal care visit and the reasons they give for this late coming to the first antenatal care visit. Knowledge of the information, particularly reasons behind coming late for the first antenatal care visit by some pregnant women, will enable development of recommendations to the concerned authorities (policy makers, health professionals and pregnant women) aimed at encouraging pregnant women to make their first antenatal care visit at the times recommended in the Uganda Ministry of Health guidelines.