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BACKGROUND: Early initiation of antenatal care visits is anessential component of services to improving maternal and newborn health. The Ethiopian Demographic and Health Surveyconducted in 2011 indicated that only 11% of pregnant womenstart antenatal care in the first trimester. However, detailed study toidentify factors associated with late initiation of care has not beenconducted in Addis Ababa where access to health services is almostuniversal. The aim of this study was to assess the level of late firstantenatal care visit and the associated factors.METHODS: Facility based cross sectional study was conducted inpublic health centers in Addis Ababa. The health centers withexperience of at least more than two years were selected randomly,one form each sub-city. The study subjects were pregnant womenvisiting the facilities for the first time during the index pregnancy.The study health centers were selected randomly from each sub-city, and the study women were recruited consecutively until therequired sample size was achieved. Data were collected using pre-tested questionnaire. Logistic regression analysis was done toidentify factors associated with late ANC initiation.RESULT: A total of 979 women participated in the study;411(42.0%; 95% CI of 38.9%, 45.1%) of them came for their firstANC visit late, after 16 weeks of gestation. Wrongly perceived ANCinitiation schedule was the strongest predictor of late initiation.After controlling for basic demographic and obstetric factors, theodds of starting the first antenatal care visit late was higher forwomen who did not know the antennal care initiation schedulecorrectly compared to women who knew the schedule correctly(AOR6.6; 95% CI 3.03, 14.03).CONCLUSION: Over 40% of pregnant women do not initiate ANCvisit in the first trimester largely due to lack of correct knowledgeof the recommended ANC schedule.