Predictors of antenatal care utilization among the Rohingya population in the refugee camps of Cox's Bazar, Bangladesh.

backgroundWhile studies in both high- and low-income settings have demonstrated the importance of early and regular antenatal care (ANC) utilization, evidence from crisis-affected populations remains limited. Rohingya refugees in Cox's Bazar, Bangladesh, face unique barriers to healthcare; previous studies have found low rates of ANC utilization. This study examines the predictors of number of visits and timing of initiation of ANC among pregnant Rohingya women in Cox's Bazar.

methodsData came from a prenatal birth cohort study of "Intergenerational Risk and Resilience of Rohingya in Displacement" (iRRRd). Women (N = 2,322) were recruited during pregnancy between 2023 and 2024. ANC utilization was assessed via surveys at the birth follow-up visit with 2,065 new mothers. Primary outcomes included the number of ANC visits and the timing of the first visit. Predictors were categorized using the Andersen-Newman model (predisposing, enabling, and need factors). We used Poisson regression for number of visits, and logistic regression to analyze timing of first visit.

resultsThe average number of ANC visits was 6.9 (SD = 2.6), with only 19.2% of women delaying care until after the first trimester. Women with one to three children reported fewer visits (IRR = 0.94, p = 0.01), as did those with more than three (IRR = 0.91, p = 0.02). Women with more years of education also showed higher number of visits (IRR = 1.015, p = 0.02) and higher likelihood of first trimester initiation (aOR = 0.891, p = 0.02) of ANC. More freedom of movement was associated with lower likelihood of delaying care (aOR = 0.871, p = 0.03), whereas higher self-rated health predicted delayed initiation (aOR = 1.187, p = 0.01). Socioeconomic indicators and education of relatives were not associated with ANC use. Receiving information via radio was unexpectedly associated with delayed initiation (aOR = 1.534, p = 0.03). Location of residence explained minimal variance (2%).

conclusionsANC coverage in the Rohingya camps appears high, yet some groups remain at risk for delayed care. Feeling healthy, high parity, and restricted mobility contributed to late initiation. Conventional predictors like household resources showed limited relevance in this context. Further work is needed to better understand the quality of services and effective communication strategies to address remaining underutilization of ANC.