Timing of the first Antenatal Care Visit (ANC) and its associated factors among adolescent mothers aged 10-19 years in Wakiso District, Uganda

Abstract

Background: Timely antenatal care (ANC) is critical for maternal and neonatal health, yet late ANC is common among adolescent mothers in Wakiso District, Uganda, where only 26.6% start in the first trimester. Understanding factors influencing early ANC can guide targeted interventions. Objective: This study examined the timing of the first ANC visit and its associated factors among adolescent mothers aged 10–19 in Wakiso District, Uganda. Methods: A mixed-methods design was used, combining a cross-sectional survey of 384 adolescent mothers aged 10–19 years with 12 in-depth interviews with the mothers and 8 key informant interviews with health workers. Quantitative data from structured questionnaires were analyzed using descriptive statistics and logistic regression; qualitative data from interviews were thematically analyzed. Results: Among 389 adolescent mothers aged 10–19 years in Wakiso District, 233 (59.9%) initiated their first ANC visit late, mostly in the second (weeks 13-26; 214, 55.0%) or third trimester (weeks 27 and above; 19, 4.9%), while only 156 (40.1%) attended within the first trimester (weeks 1-12). Adolescents who were single or separated were 24% more likely to initiate ANC late compared to those cohabiting or married (aPR = 1.24, 95% CI: 1.01–1.53, p = 0.036), receiving community-based peer education about ANC reduced late initiation by 20% (aPR = 0.80, 95% CI: 0.68–0.95, p = 0.010), and fear of being judged or stigmatized increased the likelihood of late initiation by 86% (aPR = 1.86, 95% CI: 1.01–3.43, p = 0.045). Qualitative findings highlighted stigma, financial constraints, limited awareness, health system challenges, and lack of family support as barriers, while adolescent-friendly services, perceived health risks, and health education facilitated timely initiation. Adolescents and healthcare workers recommended financial support and community sensitization to reduce stigma and promote early ANC attendance. Conclusion: Many adolescents delayed their first ANC visit beyond the first trimester due to stigma, limited knowledge, financial constraints, lack of decision-making power, and delayed recognition of pregnancy. The adolescent and healthcare workers recommended strengthening adolescent-friendly services, raising community awareness on first-trimester ANC, and addressing financial and sociocultural barriers as key strategies to improve early 1st ANC initiation among adolescent mothers.