Factors Affecting Utilization of Antenatal Care Services in Public Primary Health Care Centers in Sana'a City, Yemen

Factors Affecting Utilization of Antenatal Care Services in Public Primary Health Care Centers in Sana'a City, Yemen | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Affecting Utilization of Antenatal Care Services in Public Primary Health Care Centers in Sana'a City, Yemen Kholoud Alsaeedi, Kawkab Al-Haddad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8176299/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Antenatal care (ANC) is essential for reducing preventable maternal and neonatal deaths. In 2023, the World Health Organization reported approximately 260000 maternal deaths worldwide, with over 90% occurring in low- and lower-middle-income countries. Yemen has one of the highest maternal mortality ratios in the region (about 500 per 100000 live births). While global coverage of at least four ANC contacts is 62% and 84% in the Arab region, ANC utilization in Yemen remains extremely low at 25%. Aim This study aims to identify the factors affecting the utilization of antenatal care services in public primary health care centers in Sana'a city, Yemen. Methods A cross-sectional quantitative study was conducted in five districts of Sana’a city. A total of 422 women aged 15--49 years who had delivered within the previous two years were selected through multistage random sampling. Data were collected using a validated self-administered questionnaire between 1 September and 30 November 2024. Results Overall, 85.5% of women reported using ANC services. Utilization was significantly lower in rural districts (7.6%) compared with urban districts (74.9%). Literate women (74.6%) were more likely to use ANC than illiterate women (7.8%). Women without health insurance (77.3%) had higher utilization than those with insurance (5.2%). Limited access to a car (74.4%) and residence in rented housing (59.5%) were associated with reduced uptake. Encouragement from husbands or the community increased ANC utilization (69.9%) compared with women who experienced discouragement (12.6%). Restrictions on leaving home decreased utilization to 27.3%, compared with 55.2% among women with freedom of movement. Health system barriers were common: 67% reported drug unavailability, 40% walked to facilities, and 55% experienced long waiting times. Knowledge of delivery danger signs (43%) and post-delivery danger signs (47%), as well as receiving information on family planning (44%), dietary practices (46%), and breastfeeding (57%), were positively associated with ANC use. Conclusion Geographic, socioeconomic, cultural, and health system factors significantly influence ANC utilization in Sana’a city. Addressing these barriers and strengthening women’s knowledge and access to maternal health services are essential to improving ANC uptake and maternal and neonatal outcomes in Yemen. Antenatal care Factors Health facility Maternal related Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 21 Jan, 2026 Editor assigned by journal 19 Jan, 2026 Editor invited by journal 28 Dec, 2025 Submission checks completed at journal 23 Dec, 2025 First submitted to journal 23 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8176299","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578958388,"identity":"7762d4ac-fd07-42a3-bab6-30f310a48446","order_by":0,"name":"Kholoud 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Yemen","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antenatal care, Factors, Health facility, Maternal related","lastPublishedDoi":"10.21203/rs.3.rs-8176299/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8176299/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAntenatal care (ANC) is essential for reducing preventable maternal and neonatal deaths. In 2023, the World Health Organization reported approximately 260000 maternal deaths worldwide, with over 90% occurring in low- and lower-middle-income countries. Yemen has one of the highest maternal mortality ratios in the region (about 500 per 100000 live births). While global coverage of at least four ANC contacts is 62% and 84% in the Arab region, ANC utilization in Yemen remains extremely low at 25%.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThis study aims to identify the factors affecting the utilization of antenatal care services in public primary health care centers in Sana'a city, Yemen.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional quantitative study was conducted in five districts of Sana\u0026rsquo;a city. A total of 422 women aged 15--49 years who had delivered within the previous two years were selected through multistage random sampling. Data were collected using a validated self-administered questionnaire between 1 September and 30 November 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOverall, 85.5% of women reported using ANC services. Utilization was significantly lower in rural districts (7.6%) compared with urban districts (74.9%). Literate women (74.6%) were more likely to use ANC than illiterate women (7.8%). Women without health insurance (77.3%) had higher utilization than those with insurance (5.2%). Limited access to a car (74.4%) and residence in rented housing (59.5%) were associated with reduced uptake. Encouragement from husbands or the community increased ANC utilization (69.9%) compared with women who experienced discouragement (12.6%). Restrictions on leaving home decreased utilization to 27.3%, compared with 55.2% among women with freedom of movement. Health system barriers were common: 67% reported drug unavailability, 40% walked to facilities, and 55% experienced long waiting times. Knowledge of delivery danger signs (43%) and post-delivery danger signs (47%), as well as receiving information on family planning (44%), dietary practices (46%), and breastfeeding (57%), were positively associated with ANC use.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eGeographic, socioeconomic, cultural, and health system factors significantly influence ANC utilization in Sana\u0026rsquo;a city. Addressing these barriers and strengthening women\u0026rsquo;s knowledge and access to maternal health services are essential to improving ANC uptake and maternal and neonatal outcomes in Yemen.\u003c/p\u003e","manuscriptTitle":"Factors Affecting Utilization of Antenatal Care Services in Public Primary Health Care Centers in Sana'a City, Yemen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 09:05:25","doi":"10.21203/rs.3.rs-8176299/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-01-21T10:12:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T10:13:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-28T14:36:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T16:40:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-12-23T16:24:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c09a29f8-d13f-4309-bb91-0ef683358b23","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T09:05:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 09:05:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8176299","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8176299","identity":"rs-8176299","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}