Abstract
BACKGROUND: Timely initiation of antenatal care is critical for reducing maternal and neonatal morbidity and mortality. Despite this, late initiation remains a significant public health challenge in rural Zimbabwe. This study aimed to assess the determinants of late antenatal care bookings among pregnant women in Mangwe District in 2025. METHODS: A facility-based cross-sectional study was conducted between August 2024 and June 2025 among 171 pregnant women selected through systematic random sampling from five clinics. Data on socio-demographics, accessibility, and maternal factors were collected using a structured questionnaire deployed on Kobo Collect. The outcome variable was the timing of the first antenatal care visit, categorized as "late" (>20 weeks gestation). Data was analyzed in STATA version 15, using chi-square tests and multiple logistic regression to identify factors associated with late booking. RESULTS: The prevalence of late antenatal care bookings was 50.9%. Significant determinants included lower educational attainment (p = 0.009), unemployment (p = 0.030), and a lack of knowledge about the importance of early antenatal care (p = 0.001). While not statistically significant in the final model, logistical barriers were highly prevalent, with 47.8% of late bookers reporting challenges in accessing care, primarily due to long distances and lack of transportation. CONCLUSION: Five in 10 women had late antenatal care bookings in Mangwe District, which is predominantly driven by educational, economic, and knowledge-based barriers. To decrease late antenatal care bookings, interventions must prioritize targeted community health education, economic empowerment initiatives, and practical solutions to overcome transport and distance challenges.