Antenatal care utilization and associated factors among Syrian women attending an enhanced migrant health center in Bursa, Türkiye: a cross-sectional study

Abstract

This study examined antenatal care (ANC) utilization and associated factors among Syrian women attending an Enhanced Migrant Health Center (EMHC) in Bursa, Türkiye. A facility-based cross-sectional study was conducted between January and April 2026 among Syrian women who had given birth within the previous 12 months and spent their entire pregnancy in Türkiye ( n = 825). Data were collected face-to-face by native Arabic-speaking nurses. Late initiation of the first visit (> 12 weeks) was examined using logistic regression, and the total number of visits using Poisson regression. Most women initiated ANC at ≤ 12 weeks (93.6%), and 72.4% reported eight or more ANC visits (compared descriptively with the World Health Organization [WHO] eight-contact recommendation); however, because more than half of participants reported the timing of the first visit in months rather than weeks, the early-initiation estimate carries important uncertainty and should be interpreted with caution. The association of social insurance with late presentation was sensitive to the conversion method, whereas the associations with pregnancy planning and health literacy were not. Reported receipt of tetanus vaccination during the index pregnancy (71.5%) was substantially lower than other pregnancy-care services (> 98%). In multivariable models, social insurance was associated with a greater number of visits (incidence rate ratio [IRR] = 1.11, 95% confidence interval [CI] 1.06–1.17, p < 0.001). Planned pregnancy was strongly associated with lower odds of late presentation (odds ratio [OR] = 0.26, 95% CI 0.14–0.44, p < 0.001). Higher education was associated with more visits (IRR = 1.09, 95% CI 1.03–1.15, p = 0.005), and higher health literacy with lower odds of late presentation (OR = 0.92, 95% CI 0.85–0.99, p = 0.025). The inverse association of education and income with tetanus vaccination was attenuated after adjustment for facility of delivery. ANC utilization was high among Syrian women attending this EMHC, but the findings are limited to women able to access EMHC services and are not generalizable to the wider Syrian population. Social insurance, pregnancy planning, and health literacy were associated with utilization; the lower reported tetanus vaccination in women delivering privately warrants further study with detailed immunization histories.