Content-qualified antenatal care coverage in Lesotho: An ordinal logistic regression analysis of the 2023–2024 demographic and health survey

Background: Despite high antenatal care contact coverage in Lesotho, the content and quality of care remains suboptimal. This study assessed the level and determinants of content-qualified antenatal care coverage using the 2023–2024 Lesotho Demographic and Health Survey. Methods: Data were analyzed from 1,112 women aged 15–49 who had a live birth or stillbirth in the 2 years preceding the survey. Content-qualified antenatal care was constructed as a composite score (0–16) incorporating the timing of initiation, number of contacts, attendance of skilled providers, and receipt of 10 key content components. The score was categorized into ordered tertiles (low: 0–12, moderate: 13, high: 14–16). Survey-weighted ordinal logistic regression was used to identify factors associated with receiving higher content-qualified antenatal care. Results: Overall, 28.1% of women had low, 32.4% moderate, and 39.5% high content-qualified antenatal care scores. Higher coverage was significantly associated with being married or living with a partner (AOR = 1.78, 95% CI: 1.12–2.83), having secondary (AOR = 2.05, 95% CI: 1.34–3.14) and higher education (AOR = 1.90, 95% CI: 1.21–2.98), using the internet at least once per week (AOR = 1.61, 95% CI: 1.08–2.40), wanted pregnancy (AOR = 2.87, 95% CI: 1.65–5.01), a smaller household (AOR = 1.36, 95% CI: 1.05–1.76), and higher community education (AOR = 1.38, 95% CI: 1.09–1.75). Conclusion: Although antenatal care contact coverage is high in Lesotho, content-qualified coverage remains low and inequitable. Targeted interventions to improve maternal and community education, internet access, and pregnancy planning are essential to close the quality-coverage gap.