Antenatal care (ANC) is a healthcare for pregnant women provided by skilled healthcare professionals. Every pregnant woman who book ANC early (before 12 weeks) of gestation are benefited from early detection and treatment of potential complications during pregnancy, Early ANC is pivotal time in the course of their lives. In the other hand women who start ANC late, have increased risk of maternal and neonatal mortality. Especially it is significant in sub-Saharan Africa where most pregnant women are adolescents and start their ANC in the second and third trimester. ANC is one of the key strategies for reducing almost all of the maternal mortality (99%) and child mortality (98%) occurred in low- and middle-income countries through access quality and timely ANC. A variety of predisposing, enabling and need factors affect ANC utilization in sub-Saharan Africa. There is a critical need to strengthen health education of women on the benefits of early initiating to ANC services focusing family and community participation to deal with the barriers that affect early booking. Though there are significant variations in the use of ANC services across the regions of Ethiopia, Generally the magnitude of timely antenatal care visit is low and remains a major public health issue. Thus, this study aimed to identify associated factors of late antenatal attendance among pregnant women in Ethiopia.

Methods: Secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) were conducted. A total of 4740 pregnant women who had at least one ANC visit in the last five years were included. The main outcome variable of this study was late ANC visit, and independent variables were categorized into individual and community level factors. Multi-level logistic regression analysis technique was used to identify the factors associated with late ANC initiation. The analysis was adjusted for different individual and community level factors affecting late ANC initiation. Data analysis was conducted using STATA -14 software.

Results: The prevalence of women who started ANC lately in 2016 EDHS was 67.3%, p-value = < 0. 0001.The highest percentage of participant were from rural areas (82%). The odds of late ANC were higher pregnant women who gave birth of > 5 (AOR=1.25;95 % CI:1.05,1.49, p-value < 0.01). Those who lived in the rural (AOR=1.50; 95% CI: 1.19,1.90, p-value < 0.001), Those who do not have intention to use contraceptive (AOR=1.37;95% CI:1.13,1.67, p-value < 0.001), those who live in Addis Ababa (AOR=0.27;95% CI:0.18,0.40, p-value < 0.001), who live in Benshangul (AOR=1.82;95% CI:1.28,2.59, p-value < 0.001).

Conclusion: There were significant variations in late ANC attendance across the different regions of Ethiopia. Region, residence, parity history of contraceptive usage or intention to use and educational level were factors associated significantly with late ANC attendance.

Keywords: late antenatal care, multilevel, associated factors, Ethiopia