Abstract
BACKGROUND: Timely initiation and adequate number of antenatal care (ANC) visits are crucial for ensuring the health and well-being of both pregnant women and their unborn children. Despite recent progress, Bangladesh continues to face challenges in achieving sustainable development goal (SDG-3) related to maternal and neonatal health. This study examines the factors contributing to delayed initiation and a low number of ANC visits, while also evaluating the association between the timing and overall number of ANC visits. DATA: Nationally representative data from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 2007 (n = 3050) and 2017-18 (n = 4544) on women aged 15-49 years. METHODS: We investigated two binary outcome variables: late ANC, defined as the initiation of ANC visits after 12 weeks of gestation, and low ANC, defined as having less than four ANC visits. Geospatial mapping was employed to visualize spatial patterns, followed by survey-weighted logistic regression to identify risk factors associated with late initiation of ANC and low ANC visit frequency. Additionally, classification tree analysis was utilized to explore interactions between predictors and outcomes. RESULTS: Logistic regression modeling revealed that late ANC was associated with a more than fourfold increase in the odds of having fewer than four ANC visits (AOR: 4.60 [95% CI: 3.69-5.73] in 2007 and AOR: 4.68 [95% CI: 4.00-5.48] in 2017-18). Classification tree analysis further confirmed that late ANC initiation was the most critical predictor of total number of ANC attendance, underscoring the necessity of early ANC initiation to ensure sufficient coverage. CONCLUSION: Early initiation of ANC is essential for achieving an adequate number of ANC visits. Notably, the same set of sociodemographic factors remained statistically significant predictors in both 2007 and 2017, highlighting the persistent nature of these disparities and underscoring the urgent need for targeted policies and health interventions.