Disparities, distribution, and determinants in appropriate timely initiation, number, and quality of antenatal care in Bangladesh: Evidence from Demographic and Health Survey 2017-18

Abstract

Like many other low- and middle-income countries, Bangladesh experiences a disproportionately higher number of maternal and neonatal deaths compared to high-income countries. Despite this, a majority of pregnant women in Bangladesh do not receive appropriate antenatal care (ANC). We investigated the disparities, distribution, and determinants of the timing, number, and quality of ANC in this country. This cross-sectional study analyzed Bangladesh Demographic and Health Survey (BDHS) 2017-18 data on ever-married reproductive-age (i.e., 15-49-year-olds) women. After describing the study sample and proportions, multilevel logistic regression was applied to study determinants. The prevalence and odds of the studied outcomes were higher among women with higher parity, a higher education level, more highly educated husbands, urban residence, and residence in some administrative divisions (p<0.05). For instance, among women in the poorest, poorer, middle, richer, and richest wealth quintiles, the proportions of those who initiated ANC during the first trimester were 22.2% (95% confidence interval (CI): 19.6-25.0), 30.1% (95% CI: 27.1-33.2), 35.1% (95% CI: 31.7-38.6), 38.5% (95% CI: 35.2-42.0), and 61.0% (95% CI: 57.5-64.3). Then, compared to women in the poorest wealth quintile, the adjusted odds ratio (AOR) for ANC initiation was higher among those in the poorer (AOR: 1.3, 95% CI: 1.1-1.7), middle (AOR: 1.5, 95% CI: 1.2-1.9), richer (AOR: 1.4, 95% CI: 1.1-1.8), and richest (AOR: 2.7, 95% CI: 2.1-3.5) household wealth quintiles. Given the importance of appropriate ANC, it is crucial to increase awareness and coverage among women with low socioeconomic status and rural residence, among other factors studied.

Fig 1. Distribution of Antenatal Care’s (a) Timing of Initiation, (b) Number of Visits, and (c) Components of Quality.