1.1 Background of the study

Antenatal care (ANC) is a cornerstone of safe pregnancy and healthy newborn outcomes: early, repeated and high-quality ANC contacts allow early detection and management of complications, provision of preventive services (e.g., tetanus immunization, malaria chemoprevention), and counselling that increases the likelihood of skilled birth attendance (Abdo et al., 2023). Despite global recommendations that the first ANC contact occur within the first trimester and that pregnant women receive the recommended number of contacts, many women in low- and middle-income countries initiate ANC late or attend fewer visits than advised (Fagbamigbe et al., 2021; Solanke et al., 2022). Primiparous (first-time) pregnant women are an important subgroup: they face specific informational, psychosocial and social-norm barriers (uncertainty about pregnancy signs, stigma for adolescent pregnancies, or limited autonomy) that can delay or reduce ANC uptake, and because they lack previous pregnancy experience they may be less able to navigate service systems (Solanke et al., 2022; Abdo et al., 2023).

Barriers to ANC are multi-level. Individual and household factors include low knowledge of the timing/importance of early ANC, unplanned pregnancy, younger maternal age, low education and poverty (Solanke et al., 2022; Abdo et al., 2023). Interpersonal and community drivers include male partner attitudes and control of resources, stigma around adolescent or out-of-wedlock pregnancies, and local norms that value traditional rather than facility-based care (Eke et al., 2021; Dahab & Sakellariou, 2020). Health-system barriers — long distances, transport costs, clinic opening hours that conflict with work, stockouts, long waiting times, poor provider attitude and lack of privacy — further reduce timely attendance and repeat visits (Fagbamigbe et al., 2021; Eke et al., 2021; multiple reviews). In Nigeria, state-level analyses show wide geographic variation in timing and coverage of ANC, indicating that national averages obscure locality-specific gaps that matter for program design (Fagbamigbe et al., 2021). Rural and peri-urban communities in Southeastern Nigeria — including local government areas such as Ugwunagbo in Abia State — face a mix of these barriers together with contextual challenges: limited facilities per population, intermittent commodities, and livelihood constraints that make time away from work costly (Eluwa & Ajike, 2024). For first-time pregnant women in particular, fear, uncertainty, and lack of social support (or male partner opposition) frequently interact with system barriers to produce late or no ANC attendance (Solanke et al., 2022; Eke et al., 2021). Systematic reviews from Africa confirm that only a minority of women initiate ANC in the first trimester, and that education, residence (urban vs rural), planned pregnancy and proximity to services are consistent predictors (Abdo et al., 2023). Understanding which of these drivers are dominant for first-time mothers in a specific community is therefore essential to design feasible, locally-targeted interventions (community outreach, adolescent-friendly hours, male engagement, transport vouchers, or provider training to improve interpersonal quality).

1.2 Statement of the problem

Although ANC services are formally available across Abia State, evidence suggests substantial gaps in timeliness and continuity of care that are concentrated in particular communities (Fagbamigbe et al., 2021; Eluwa & Ajike, 2024). First-time pregnant women in many Nigerian settings show particularly high rates of delayed ANC initiation and under-utilization, which increases risks for undetected hypertensive disorders, malaria in pregnancy, inadequate counselling on birth preparedness, and reduced uptake of preventive commodities (Solanke et al., 2022; Abdo et al., 2023). Local program managers and primary health care staff often lack fine-grained, community-level data on the barriers specific to primigravidae — e.g., whether the dominant constraints in a given ward are (a) knowledge and cultural beliefs, (b) practical costs and opening hours, (c) male partner opposition, or (d) negative experiences with providers — and that lack of locality-specific evidence can lead to misdirected efforts. In Umuodo community (Ugwunagbo LGA), program reports and related community studies in the LGA indicate recurrent service problems (clinic hours, occasional stockouts) and socioeconomic vulnerabilities among women of reproductive age that plausibly impede ANC uptake (Eluwa & Ajike, 2024). However, there is no focused, recent investigation of first-time pregnant women in Umuodo that quantifies the prevalence of late or missed ANC and disentangles which individual, interpersonal and service factors most strongly predict non-attendance or late attendance. Without such evidence, interventions (for example, extending clinic hours or starting community education) risk being inefficient or ineffective if they do not target the actual local drivers (Eke et al., 2021; Solanke et al., 2022). This study therefore addresses a practical gap: producing locally-granular data to inform pragmatic, community-aligned strategies to increase early ANC uptake and continuity among primigravidae in Umuodo.

1.3 Aim and Objectives of the Study

Aim: To identify and quantify barriers to antenatal care attendance among first-time pregnant women in Umuodo Community, Ugwunagbo LGA, Abia State, and to recommend locally feasible interventions to improve timely ANC uptake.

Specific objectives:

1. To determine the proportion of first-time pregnant women in Umuodo who initiate ANC within the first trimester, by 20 weeks, and those who do not attend at all.
2. To describe first-time pregnant women’s knowledge about ANC timing, perceived benefits and perceived barriers.
3. To identify household and socio-demographic predictors (age, education, marital status, employment, household wealth, pregnancy plannedness) of delayed or non-attendance.
4. To document service-level constraints (clinic opening hours, waiting times, perceived provider attitude, distance and transport cost, stockouts) and estimate their association with ANC attendance.
5. To explore interpersonal and community drivers (partner support, stigma, normative beliefs) that influence ANC decisions among first-time pregnant women.
6. To produce practical recommendations — co-designed with local stakeholders — for interventions (e.g., adolescent/primi-friendly clinic hours, male engagement strategies, transport support, community health worker outreach) tailored to Umuodo.

1.4 Research Questions

1. What proportion of first-time pregnant women in Umuodo Community initiate ANC within the first trimester, initiate after the first trimester, or do not attend at all?
2. What do first-time pregnant women in Umuodo know and believe about ANC (timing, benefits, perceived risks)?
3. Which socio-demographic factors predict delayed or non-attendance among first-time pregnant women?
4. Which health-service factors (facility hours, waiting time, stockouts, staff attitude, distance) are reported as barriers and which of these are associated with ANC attendance behaviour?
5. How do interpersonal and community influences (partner support, stigma, traditional beliefs, social norms) affect the ANC decisions of first-time pregnant women in Umuodo?

1.5 Scope of the Study

Study design: Cross-sectional, mixed-methods study combining a household survey of first-time pregnant women and a facility assessment of the primary health facility(ies) serving Umuodo Community.

Study population: First-time pregnant women (primigravidae) currently resident in Umuodo Community, Ugwunagbo LGA, Abia State, who have lived in the community for ? 6 months. Adolescents (aged 15–19) as well as older first-time mothers (20+) will be included; minors will be enrolled only following local ethical approvals and guardian assent where required.

Sampling & sample size (indicative): A household listing will identify pregnant women; for the quantitative survey a sample will be calculated to estimate the proportion initiating ANC in the first trimester with a desired precision (for example, ±5%) and design effect to account for clustering by neighborhood. The qualitative component will purposively sample women with varied ANC behaviour (early, late, none) and key informants (midwives, community leaders, male partners) until thematic saturation.

Data collection instruments:

• Interviewer-administered structured questionnaire capturing socio-demographics, pregnancy wantedness, ANC knowledge, timing and number of contacts, transport/time/cost barriers, partner support and perceived provider-related barriers.

• Facility checklist and staff interview to document opening hours, typical waiting times, stockouts in past 3 months, staff complement, and any adolescent/primi-friendly services.

• In-depth interviews and focus group discussions with a purposive subsample to explore norms, stigma, fears, and decision pathways.

Data analysis (outline): Descriptive statistics for prevalence/time-to-first ANC; logistic regression to model predictors of delayed/non-attendance (adjusted odds ratios); thematic analysis for qualitative data to explain pathways and to identify actionable local barriers.

Ethical considerations: Local ethics approval will be sought; informed consent (and parental/guardian assent where required) obtained; confidentiality maintained; referral pathways for clinical or social needs will be established.

Geographic/Area of study: Umuodo Community, Ugwunagbo Local Government Area, Abia State. The study will focus on households and the public primary health facility(ies) that serve Umuodo.

References

Abdo, R., Demelash, M., Seid, A. M., Mussema, A., et al. (2023). First trimester antenatal care contact in Africa: A systematic review and meta-analysis of prevalence and contributing factors. BMC Pregnancy and Childbirth, 23, 742. https://doi.org/10.1186/s12884-023-06034-1

Dahab, R., & Sakellariou, D. (2020). Barriers to accessing maternal care in low-income countries in Africa: A systematic review. International Journal of Environmental Research and Public Health, 17(12), 4292. https://doi.org/10.3390/ijerph17124292

Eluwa, A. A., & Ajike, S. O. (2024). Knowledge, attitude, and preventive measures of mothers towards cholera in a selected southeastern community, Nigeria: A cross-sectional study. ASFI Research Journal, 1(1), e15669. https://doi.org/10.7004/asfirj-yede-s7z9

Eke, P. C., Ossai, E. N., Eze, I. I., & Ogbonnaya, L. U. (2021). Exploring providers’ perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi State, Nigeria: A qualitative study. PLOS ONE, 16(5), e0252024. https://doi.org/10.1371/journal.pone.0252024

Fagbamigbe, A. F., Olaseinde, O., & Fagbamigbe, O. S. (2021). Timing of first antenatal care contact, its associated factors and state-level analysis in Nigeria: A cross-sectional assessment of compliance with the WHO guidelines. BMJ Open, 11(9), e047835. https://doi.org/10.1136/bmjopen-2020-047835

Solanke, B. L., Oyediran, O. O., Opadere, A. A., Bankole, T. O., Olupooye, O. O., & Boku, U. I. (2022). What predicts delayed first antenatal care contact among primiparous women? Findings from a cross-sectional study in Nigeria. BMC Pregnancy and Childbirth, 22, 750. https://doi.org/10.1186/s12884-022-05079-y