Determinants of Antenatal Care Attendance among Pregnant Women Living in Endemic Malaria Settings: Experience from the Democratic Republic of Congo.

Background . Antenatal care (ANC) attendance helps pregnant women to benefit from preventive and curative services. Methods . Determinants for ANC attendance were identified through a cross-sectional survey in the Democratic Republic of Congo. Sociocultural bottlenecks were assessed via focus groups discussion of married men and women. Results . In this survey, 28 of the 500 interviewed pregnant women (5.6%) did not attend ANC services and 82.4% booked over the first trimester. The first visit is positively influenced by the reproductive age (OR: 0.52, 95% CI(0.28-0.95), p < 0.04), the educational level (OR: 0.41,95% CI(0.17-0.97), p < 0.04), the nearby health center (OR: 0.43, 95% CI(0.2-0.92), p < 0.03), and the presence of a male partner (OR: 10.48, 95% CI(2.1-52.23), p < 0.001). The barriers to early booking were (i) the cost of service; (ii) the appearance or individual income; (iii) the geographical inaccessibility or distance to health facilities; (iv) social and religious prohibitions; (v) the stigmatization from other women when conceiving in the late ages or young or while still lactating (parity); (vi) the time for waiting for services. Conclusion . The early ANC attendance is delayed among poor women with little education and living alone.