Timely initiation of antenatal care (ANC) is a key determinant of maternal and newborn health and reflects the responsiveness of health systems to women’s needs. Using a systems and complexity thinking perspective, this study examined how interacting sociodemographic, reproductive, and service-related factors influence the timing of ANC initiation among postpartum women in the Nkongsamba Health District, Cameroon. A facility-based cross-sectional study was conducted among postpartum women attending four health facilities in the Nkongsamba Health District from September 2020 to December 2021. All eligible women present during the data collection period were included. Data were collected using a semi-structured questionnaire and verified with antenatal records. ANC was considered timely if the first visit occurred within 12 weeks of gestation. Factors associated with timely ANC initiation were analysed using bivariate and multivariable logistic regression, with statistical significance set at p < 0.05. A total of 1,074 women were included. The proportion initiating ANC timely was 30.35% (95% CI: 27.68–33.17), with a mean gestational age at booking of 17.10 ± 8.08 weeks. Women aged over 30 years (AOR = 1.73; 95% CI: 1.15–2.59), those with intended pregnancies (AOR = 1.53; 95% CI: 1.01–2.33), and those with a history of hypertension in pregnancy were more likely to initiate ANC early. Conversely, prior modern contraceptive use (AOR = 0.67; 95% CI: 0.45–0.99) and being unmarried (AOR = 0.60; 95% CI: 0.41–0.88) were associated with delayed initiation. Timely ANC initiation is shaped by complex interactions between individual, social, and reproductive factors. Improving early ANC uptake requires systems-level interventions that strengthen women’s empowerment, integrate reproductive health and maternity services, and enhance health system responsiveness.

Merveilles Leukegang Njampa is a PhD candidate in Nursing (Healthcare specialty) at the University of Dschang, Cameroon, and is currently in the final stage of her doctoral studies. Her academic and clinical background is grounded in nursing practice, with a strong focus on advancing healthcare delivery and improving patient outcomes. Her research interests lie at the intersection of nursing science and women’s health, with particular emphasis on maternal care, reproductive health, and the improvement of healthcare services for women in diverse clinical and community settings. She is passionate about contributing to evidence-based nursing practice and strengthening healthcare systems through research-driven insights. Through her doctoral work, she aims to address critical challenges in women’s health by developing practical, context-sensitive solutions that enhance the quality of care and support better health outcomes for women and families.