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Article

Initiation of Antenatal Care Among Pregnant Women in Saudi Arabia: An Application of Andersen’s Behavioral Model Using a Cross-Sectional Study

by
Ajiad Alhazmi
1,
Hassan N. Moafa
2,
Seham A. Habeeb
3,
Reham Bakhsh
2,
Manal Almalki
2,
Jobran Moshi
4,*,
Ali Saad R. Alsubaie
1,
Hammad Ali Fadlalmola
5,
Mohammed Ali Qassem Ghazwani
6 and
Abdulrhman Mohammad Salim
7
1
Department of Public Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
2
Department of Public Health, College of Nursing and Health Sciences, Jazan University, Jazan 82912, Saudi Arabia
3
Public Health Department, Jazan Branch, Ministry of Health, Jazan 82611, Saudi Arabia
4
Department of Medical Laboratory Technology, College of Nursing and Health Science, Jazan University, Jazan 82911, Saudi Arabia
5
Nursing College, Taibah University, Madinah 42351, Saudi Arabia
6
Health Administration, Primary Health Care, Ministry of Health, Jazan 82721, Saudi Arabia
7
Gazan Health Sector, Infectious Disease Directorate, Ministry of Health, Jazan 82611, Saudi Arabia
*
Author to whom correspondence should be addressed.
Healthcare 2025, 13(19), 2449; https://doi.org/10.3390/healthcare13192449
Submission received: 14 July 2025 / Revised: 30 August 2025 / Accepted: 16 September 2025 / Published: 26 September 2025
(This article belongs to the Section Women’s and Children’s Health)
Review Reports Versions Notes

Abstract

Background/Objectives: Timely initiation of antenatal care (ANC) services is crucial for ensuring maternal and fetal well-being. Despite the importance of ANC, research regarding its initiation remains limited in the Jazan region of Saudi Arabia, an area with notable adverse birth outcomes. Therefore, this study aimed to assess pregnant women’s initiation of ANC and identify associated factors and significant barriers for timely initiation. Methods: A cross-sectional study was conducted among 369 Saudi pregnant women in their third trimester attending ANC clinics in the Jazan region in 2024. A structured questionnaire was used to collect data. Andersen’s behavioral model of healthcare utilization provided the framework for the study. Descriptive statistics, chi-square tests, and binary logistic regression were used to analyze the data. Results: The majority of women (78.9%) initiated ANC in the first trimester. Higher maternal education was positively associated with early ANC initiation (aOR = 2.369, 95% CI: 1.154–4.901), whereas higher paternal education was negatively associated with early ANC initiation (aOR = 0.350, 95% CI: 0.175–0.699). When modeled independently, the positive association of higher maternal education was attenuated but was not significant, while the negative association of higher husband’s education remained the same. Those living more than three km from health facilities (aOR = 0.510, 95% CI: 0.276–0.941) and seeking care for reasons other than routine follow-up were less likely to initiate ANC early. Most women received essential services, but only 37.1% had ultrasound tests. Conclusions: While ANC initiation in Jazan showed promising trends, factors like geographical accessibility remain a significant barrier. Targeted interventions should address these identified barriers, which fall within predisposing, enabling, need, and external environmental factors. Further investigations of pregnant women’s familial decision-making and low ultrasound test utilization in relation to ANC are recommended.
Keywords: antenatal care; maternal health; healthcare utilization; Saudi Arabia; Andersen’s behavioral model; pregnancy; barriers to care; healthcare accessibility antenatal care; maternal health; healthcare utilization; Saudi Arabia; Andersen’s behavioral model; pregnancy; barriers to care; healthcare accessibility

Share and Cite

MDPI and ACS Style

Alhazmi, A.; Moafa, H.N.; Habeeb, S.A.; Bakhsh, R.; Almalki, M.; Moshi, J.; Alsubaie, A.S.R.; Fadlalmola, H.A.; Ghazwani, M.A.Q.; Salim, A.M. Initiation of Antenatal Care Among Pregnant Women in Saudi Arabia: An Application of Andersen’s Behavioral Model Using a Cross-Sectional Study. Healthcare 2025, 13, 2449. https://doi.org/10.3390/healthcare13192449

AMA Style

Alhazmi A, Moafa HN, Habeeb SA, Bakhsh R, Almalki M, Moshi J, Alsubaie ASR, Fadlalmola HA, Ghazwani MAQ, Salim AM. Initiation of Antenatal Care Among Pregnant Women in Saudi Arabia: An Application of Andersen’s Behavioral Model Using a Cross-Sectional Study. Healthcare. 2025; 13(19):2449. https://doi.org/10.3390/healthcare13192449

Chicago/Turabian Style

Alhazmi, Ajiad, Hassan N. Moafa, Seham A. Habeeb, Reham Bakhsh, Manal Almalki, Jobran Moshi, Ali Saad R. Alsubaie, Hammad Ali Fadlalmola, Mohammed Ali Qassem Ghazwani, and Abdulrhman Mohammad Salim. 2025. "Initiation of Antenatal Care Among Pregnant Women in Saudi Arabia: An Application of Andersen’s Behavioral Model Using a Cross-Sectional Study" Healthcare 13, no. 19: 2449. https://doi.org/10.3390/healthcare13192449

APA Style

Alhazmi, A., Moafa, H. N., Habeeb, S. A., Bakhsh, R., Almalki, M., Moshi, J., Alsubaie, A. S. R., Fadlalmola, H. A., Ghazwani, M. A. Q., & Salim, A. M. (2025). Initiation of Antenatal Care Among Pregnant Women in Saudi Arabia: An Application of Andersen’s Behavioral Model Using a Cross-Sectional Study. Healthcare, 13(19), 2449. https://doi.org/10.3390/healthcare13192449

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