Determinants of Early Antenatal Care Utilization among Pregnant Women at Bule Hora University Teaching Hospital, West Guji Zone, Oromia, Ethiopia: An Unmatched Case-Control Study

<ns3:p>Background Antenatal care (ANC) is vital for improving pregnancy outcomes and reducing maternal and neonatal mortality. Despite global and national efforts, Ethiopia still below the WHO’s recommendation for early ANC initiation due to barriers in access, awareness, and service quality. Understanding this factor is essential for designing targeted interventions that enhance continuity of care. Therefore, this study aimed to identify determinants of early ANC utilization among pregnant women attending Bule Hora University Teaching Hospital, West Guji Zone, Oromia, Ethiopia. Methods A facility-based unmatched case–control study was conducted in 2025 among 456 pregnant women, including 114 early ANC initiators (cases) and 342 late initiators (controls). Systematic random sampling was used to choose the participants. Data was collected via a pre-tested questionnaire using the KoboCollect app and analyzed with SPSS v27. Descriptive statistics and binary logistic regression were applied, with significance level at P &lt; 0.05. Results Of 448 respondents (98.2% response rate), 112 initiated ANC before 12 weeks and 336 after 12 weeks. Early ANC initiation was associated with younger age (AOR = 2.79, 95% CI: 1.12–6.96), poor ANC knowledge (AOR = 4.19, 95% CI: 2.24–7.82), long waiting times (AOR = 4.02, 95% CI: 2.23–7.24), polygamous marriage (AOR = 3.74, 95% CI: 1.53–9.16), and limited community support (AOR = 3.63, 95% CI: 1.44–9.17). Conclusion Early ANC utilization was influenced by maternal age, knowledge, service accessibility, marital structure, and social support. Promoting timely ANC initiation requires improving community engagement, decreasing delays, and bolstering education.</ns3:p>