Antenatal Care and Skilled Birth Attendance in Bangladesh are influenced by female education and family affordability: BDHS 2014


Antenatal care (ANC) during pregnancy and skilled birth attendance (SBA) during delivery are important policy concerns to reduce maternal deaths. Bangladesh is one of the developing countries which has made remarkable progress in both services during the last couple of decades by improving the SBA service rate from 16% in 2004 to 43% in 2014. However, this rate remains below the targeted level (50%) of the Health Population and Nutrition Sector Development Program set by the Ministry of the Health and Family Welfare of Bangladesh. This paper explored the sociodemographic factors associated with the ANC and SBA service attainment. Furthermore, the possible implication of using ANC on SBA was also investigated. The study followed a cross-sectional design using Bangladesh demographic and health survey (BDHS) 2014, with a sample of size 4603 women with at least one live-birth three years preceding the survey. Following a bivariate analysis, linear mixed effect models were used to assess the relationship between sociodemographic factors and the outcome indicators (ANC and SBA). Finally, association between SBA and ANC were evaluated through another mixed effect model. Wealth index, participation in household decisions, partner’s and respondent’s education were significant predictors of ANC; whereas, residence, age at first birth, wealth index, working status, participation in household decisions, partner and respondent’s education were significant for skilled birth attendance. Female education and household affordability were the strongest predictors for both ANC and SBA. ANC showed significant association with SBA as women accessing essential ANC during delivery seemed to be 4 times more likely (95% CI: 3.05 - 5.93) to avail SBA services. Overall, four factors were significant: residence, wealth index, education and ANC access. Women residing in urban areas, having higher financial solvency, completing higher education, and accessing ANC by skilled personnel were more likely to receive SBA at delivery than their counterparts. Accessibility to skilled care during pregnancy leads to increased professional care during delivery. Thus, policies to encourage women and heads of families to seek skilled care during pregnancy would be beneficial to reach the maternal health care targets of Bangladesh

Public Health