Fear of childbirth among antenatal care attendees in a primary care setting in Kumasi, Ghana: Prevalence and parity-stratified determinants.

BACKGROUND: Previous studies on Fear of Childbirth (FoC) across sub-Saharan Africa have typically reported prevalence separately by parity or treated it as a covariate in multivariable analyses, with little attention given to identifying parity-specific determinants. However, first-time mothers and those with previous birth experiences may require different forms of antenatal support. To address this gap, we assessed the prevalence of FoC and identified parity-specific determinants among antenatal care attendees in Ghana to inform targeted interventions. METHODS: A facility-based cross-sectional study was carried out among pregnant women attending antenatal care (ANC) at a primary healthcare facility in Kumasi. Data were collected using an interviewer-administered questionnaire. The primary outcome of the study, FoC, was assessed using the English version of the Wijma Delivery Expectation/Experience Questionnaire (W-DEQ). Additional data included sociodemographic and obstetric characteristics. Stratified multivariable linear regression models were applied to identify parity-specific determinants among the participants. RESULTS: Of the 282 women who participated in the study, 22% had high-to-severe FoC. Nulliparous women (median: 46.0, IQR: 37.0-66.0) reported significantly higher median W-DEQ scores than parous women (median: 39.0, IQR: 32.0-58.5). In a parity-stratified analysis, among nulliparous women, factors such as a history of family abuse (adjusted Β = 16.32, 95% CI: 2.50 to 30.14) and late ANC booking (adjusted Β = 13.13, 95% CI: 1.43 to 24.84) were significantly associated with FoC. Among parous women, factors such as secondary education (adjusted Β = -7.63, 95% CI: -14.88 to -0.37), intimate partner violence (adjusted Β = 10.87, 95% CI: 0.69 to 21.04), unplanned pregnancy (adjusted Β = 8.38, 95% CI: 2.51 to 14.26), and strong family support (adjusted Β = -27.94, 95% CI: -38.77 to -17.11) were significantly associated with FoC. CONCLUSION: FoC is common among this cohort of pregnant women, and its determinants differed by parity and across parity-specific factors. The parity-stratified determinants underscore the need for parity-tailored psychosocial care at ANC, incorporating targeted screening and support procedures aligned with parity-associated risk pathways to enhance maternal well-being.