**Background:** Antenatal care (ANC) is a key strategy for reducing maternal and neonatal mortality, yet utilization remains suboptimal in Sub-Saharan Africa (SSA). While previous studies examined ANC prevalence and timing, limited evidence exists on the mean number of ANC visits and associated factors using count models that avoid information loss from categorizing visit numbers. This study aimed to investigate the mean number of ANC visits and associated factors among reproductive-age women in SSA using recent DHS data.
**Methods:** Secondary data analysis was conducted on DHS datasets from 35 SSA countries collected between 2008 and 2019. The study included 257,924 women (weighted sample: 256,425) who gave birth within five years before each survey. DHS uses a two-stage stratified cluster sampling design. The outcome variable was the number of ANC visits (non-negative integer). Individual-level factors included maternal age, education, wealth status, media exposure, parity, and pregnancy planning. Community-level factors included residence (urban/rural), SSA region, country income level, survey year, community-level media exposure, and community-level women's education. A multilevel negative binomial regression model was fitted to account for the hierarchical data structure and overdispersion (variance 6.6 vs. mean 3.83). Adjusted Incident Rate Ratios (AIRR) with 95% CI were reported; statistical significance was set at p < 0.05.
**Key Results:** The mean number of ANC visits across SSA was 3.83 (95% CI: 3.82–3.84), ranging from 2.29 in Chad to 6.44 in Ghana. By region, means were: Central 3.55, Eastern 3.66, Western 4.02, and Southern 4.99. The final model (Model 4) explained 63.6% of total variability (PCV). Individual-level factors significantly associated with more ANC visits included: age 20–35 years (AIRR = 1.08, 95% CI: 1.07–1.10), age 36–49 years (AIRR = 1.18, 95% CI: 1.16–1.20), primary education (AIRR = 1.26, 95% CI: 1.25–1.27), secondary education and above (AIRR = 1.44, 95% CI: 1.42–1.45), middle wealth (AIRR = 1.05, 95% CI: 1.04–1.06), rich wealth (AIRR = 1.08, 95% CI: 1.07–1.09), and media exposure (AIRR = 1.10, 95% CI: 1.09–1.11). Factors associated with fewer visits included multiparity (AIRR = 0.98, 95% CI: 0.97–0.99), grand multiparity (AIRR = 0.90, 95% CI: 0.89–0.91), and unplanned pregnancy (AIRR = 0.97, 95% CI: 0.96–0.98). Community-level factors associated with more visits included: Western SSA region (AIRR = 1.17, 95% CI: 1.16–1.18), Southern SSA region (AIRR = 1.11, 95% CI: 1.09–1.13), Eastern SSA region (AIRR = 1.03, 95% CI: 1.02–1.04), middle-income country (AIRR = 1.10, 95% CI: 1.08–1.11), high community media exposure (AIRR = 1.03, 95% CI: 1.02–1.04), high community women's education (AIRR = 1.02, 95% CI: 1.01–1.03), and later survey years (2016–2019: AIRR = 1.07, 95% CI: 1.06–1.08). Rural residence was associated with fewer visits (AIRR = 0.90, 95% CI: 0.89–0.91).
**Clinical Implications:** The mean number of ANC visits in SSA (3.83) approximates the WHO minimum recommendation of four visits, but significant disparities exist across regions and socioeconomic groups. Interventions should target younger women (15–19 years), women with lower education, those in poor households, women with high parity, and those with unplanned pregnancies. Addressing rural-urban disparities, improving women's education and media access, and strengthening health systems in low-income and Central African countries are essential strategies. The increasing number of visits over survey periods (2008–2019) suggests progress, but accelerated efforts are needed to meet SDG 3 targets for maternal and child mortality reduction.