Factors associated with utilisation of antenatal care visit services in Nepal: evidence from Demographic and Health Survey 2016-2022.

Abstract

Antenatal care (ANC) visits play a vital role in protecting women's health and their unborn babies. This study aimed to examine the associated factors with utilisation of ANC visits by using Andersen's behavioural model based on predisposing, enabling and need factors. Cross-sectional study using secondary datasets from the Nepal Demographic and Health Survey 2016 and 2022 was appended for analysis. The analysis accounted for the stratified two-stage cluster sampling design of the survey by applying sampling weights and adjusting for clustering and stratification. A multivariable ordinal logistic regression analysis was conducted, reporting results in an adjusted OR (AOR) at a 95% CI. Nepal. This study included 3909 women aged 15-49, who were pregnant and possibly used ANC visit services within the 2 years preceding the survey. ANC visits. Among the 3909 women aged 15-49, 3.18% never attended ANC, 21.20% did not complete the recommended ANC visits, while 75.63% completed the recommended ANC visits. In predisposing factors, women from the Madhesi ethnic group (AOR=0.397, p<0.001), with no education (AOR=0.528, p<0.010), non-internet user (AOR=0.451, p<0.001) and no exposure to health programme (AOR=0.601, p<0.050) had lower odds of completing recommended ANC visits. Among enabling factors, women from the Terai region (AOR=0.163, p<0.001), Karnali province (AOR=0.277, p<0.001), poorest households (AOR=0.139, p<0.001) and those without health insurance enrolment (AOR=0.484, p<0.050) showed lower odds of completing recommended ANC visits. Regarding need factors, women who visited a health facility for the last 12 months (AOR=0.414, p<0.001) and multiparous women with parity 6+ (AOR=0.143, p<0.001) were less likely to complete recommended ANC visits compared with the reference category. Enhancing women's education, access to internet use and health programme exposure, as well as addressing caste-based, provincial and economic disparities, are crucial for improving ANC utilisation. Furthermore, promoting health insurance enrolment and raising awareness of pregnancy-related risk among multiparous women are essential for the utilisation of recommended ANC visits to enhance the health of mothers and newborn babies.