title: Gestational Age at First Antenatal Care Visit in Malawi.
abstract: OBJECTIVE
  This paper examines the gestational age at first antenatal care (ANC) visit and factors associated with timely initiation of ANC in Malawi in a context where maternal and child health services are generally provided for free.
  
  
  METHODS
  Lognormal survival models are applied to Demographic and Health Survey data from a nationally representative sample of women (n = 13,588) of child-bearing age.
  
  
  RESULTS
  The findings of this study show that less than 30 % of pregnant women initiate ANC within the World Health Organization recommended gestational timeframe of 16 weeks or earlier. The hazard analysis shows a gradient in the initiation of ANC by maternal education level, with least educated mothers most likely to delay their first ANC visit. However, after adjusting for variables capturing intimate partner violence in the multivariate models, the effect of maternal education attenuated and lost statistical significance. Other significant predictors of gestational age at first ANC include media exposure, perceived distance from health facility, age, and birth order.
  
  
  CONCLUSIONS
  The findings of the study link domestic violence directly with the gestational age at which mothers initiate ANC, suggesting that gender-based violence may operate through delayed initiation of ANC to undermine maternal and child health outcomes.
authors.affiliation: Institute of Interdisciplinary Studies, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, USA. Paul.Mkandawire@carleton.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Mkandawire
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Antenatal care; Education; Gender relations; Gestational age; Malawi; Policy