Trends in Adolescent Pregnancy and Early ANC: Implications for Cervical Cancer Prevention in Zambia.

BackgroundEarly initiation of antenatal care (ANC) is a cornerstone of maternal and child health, enabling timely detection of complications and delivery of preventive interventions, including education about cervical cancer. However, coverage of early ANC remains uneven across low-resource settings. This study assessed patterns and predictors of early antenatal care initiation in Zambia by analysing data from the 2007, 2013/14, and 2018 Demographic and Health Surveys, with an emphasis on equity-related disparities. MethodsWe analyzed pooled cross-sectional DHS data from 20,548 women aged 15-49 who had a recent live birth and received at least one ANC visit. Early ANC was defined as the first visit occurring during the first trimester. We generated weighted descriptive statistics, plotted trends over time, and used multivariable logistic regression to identify factors associated with early ANC initiation. Analyses accounted for complex survey design. ResultsEarly ANC coverage rose from 19.7% in 2007 to 37.2% in 2018. Adolescents (15-19 years) made up 9.2% of the sample and had lower early ANC rates (26.3%) compared to older women (28.4%). Multivariable models revealed a consistent rise in early ANC over time, with each subsequent survey year associated with increased odds (AOR: 1.09; 95% CI: 1.08- 1.11; p < 0.001). Older maternal age (AOR: 1.16; 95% CI: 1.01-1.32; p = 0.039), higher educational attainment (AOR: 1.06; 95% CI: 1.00-1.13; p = 0.049), and greater household wealth (AOR: 1.05; 95% CI: 1.01-1.09; p = 0.039) were all associated with significantly greater odds of initiating ANC early. Urban residence was linked to decreased odds (AOR: 0.71; 95% CI: 0.63-0.80; p < 0.001). ConclusionWhile early ANC coverage has improved in Zambia, gaps persist across age, education, wealth, and residence. Targeted interventions addressing adolescent needs and integrating cervical cancer prevention into ANC services may enhance timely care and promote health equity.