Socioeconomic and Cultural Influences on Antenatal Care Utilization: A Multilevel Analysis

Antenatal care (ANC) is critical to reducing maternal and neonatal morbidity and mortality. Despite the global promotion of ANC, disparities in utilization persist, especially in low- and middle-income countries (LMICs), where socioeconomic and cultural dynamics profoundly shape health behaviors. This study employs a multilevel analysis to explore how individual and community-level socioeconomic and cultural factors influence ANC utilization across selected LMICs. Data from the most recent Demographic and Health Surveys (DHS) of five Sub-Saharan African countries were analyzed, involving 67,842 women aged 15–49 who had a live birth within five years preceding the survey. Multilevel logistic regression models assessed the effects of maternal education, household wealth, employment status, community literacy, and cultural norms on ANC uptake. The results indicate that both individual-level factors and community-level factors significantly predict ANC use. Women in communities with high female literacy and gender-equitable norms were more likely to utilize ANC services adequately, regardless of their personal socioeconomic status. These findings underscore the importance of addressing broader structural and cultural inequalities to enhance maternal healthcare access. Policies that integrate socioeconomic empowerment and culturally sensitive health promotion are crucial to improving ANC coverage in LMICs.