Determinants of antenatal care utilization in Uganda

Abstract

Despite ongoing efforts to improve maternal health in Uganda, antenatal care (ANC) utilization remains suboptimal, particularly among women in rural and low-income settings. With a maternal mortality ratio of 336 deaths per 100,000 live births (UDHS, 2016), Uganda continues to face significant challenges in ensuring safe motherhood. This study examined the determinants of ANC utilization among women of reproductive age using data from the 2016 Uganda Demographic and Health Survey (UDHS). A total of 10,219 women aged 15–49 years who had a live birth in the five years preceding the survey were analysed. Adequate ANC utilization was defined as attending at least four visits during pregnancy, consistent with previous World Health Organization guidelines. Descriptive, bivariate, and multivariate analyses were performed, with a modified Poisson regression model applied to identify independent predictors of adequate ANC attendance. Results showed that 60.1% of women attended at least four ANC visits, while only 1.7% met the newer WHO recommendation of eight visits. Higher education, formal employment, belonging to higher wealth quintiles, and access to health insurance were significantly associated with increased ANC attendance. In contrast, older maternal age, marital instability, and residence in regions such as Bugisu and Bunyoro were associated with lower utilization. The findings highlight persistent socio-economic and geographic inequities in maternal health access particularly ANC utilization. Strengthening women’s education, expanding health insurance access, and addressing regional disparities are essential to improving ANC attendance and achieving equitable maternal health outcomes in Uganda.