Impact of Limited-Service Availability and Preparedness on Facility-Based Delivery in Bangladesh

  • Author / Creator
    Al Amin, Saad Ullah
  • Background: Globally, about 300,000 women die from childbirth per year with 94% of these deaths occurring in low- and middle-income countries, particularly in South Asia. The majority of these deaths are preventable if women receive proper treatment on time. In Bangladesh, there are several government initiatives to promote facility births as a safer alternative to homebirths. Despite these efforts, only 50% of births in the country take place in a health facility. Although
    there are a variety of factors that impact women’s decisions to utilize childbirth services such as educational attainment, religious beliefs, financial status, and more. We focused on the issue of access to facilities and the preparedness of these facilities to provide childbirth services. This study investigate whether having access to facilities with childbirth services will increase women’s uptake of these services in Bangladesh.

    Methods: To do this we first linked, 2017 Bangladesh Health Facility Survey (BHFS) to 2017- 18 Bangladesh Demographic and Health Survey (BDHS) dataset. Approximately 20,250 women from 675 clusters (enumeration areas) were selected in the BDHS. Of these, 5,012 women had a childbirth within the last 36 months of the survey and were considered in this study. In the BHFS, 818 facilities provided childbirth services and were considered in this study. By using geographical linkage, we linked facilities providing childbirth services that were accessible to a women cluster. The relationship between service availability, preparedness and facility birth was examined accounting for women characteristics using logistic regression analysis.

    Results: The mean age of the women participants was 24.86 years (standard deviation: 5.56) and the majority of the women were Muslims (73.2%), resided in the rural areas (73.2%) and had secondary or higher education (66.1%). Of the 5,012 participants, 50.28% delivered at a heath facility. The mean age of women who delivered at a healthcare facility was significantly lower that observed for women who delivered elsewhere (24.67 vs. 25.05 years, p=0.001). The majority of the women (63.5%) who lived in the urban areas had the childbirth in a health facility whereas only 44.9% of rural women opted for childbirth in a health facility with the differences being statistically significant (p < 0.001). Of the 818 facilities considered in this study, (83.37%) are government-managed, with a higher proportion of rural facilities falling into this category (94.56%) compared to urban facilities (66.15%). A greater proportion of facilities offered some interventions (75.43%) compared to Comprehensive Emergency Obstetric Care (CEmOC) services (13.45%) and Basic Emergency Obstetric Care (BemOC) services (11.12%). The distribution of services provided was significantly different between urban and rural areas, with facilities in urban areas providing a higher percentage of CemOC services (32.30%) and BemOC services (17.08%). In the multivariable logistic regression, after adjusting other factors, there was a 3% significant increase in the odds of facility childbirth for a unit increase in age adjusted odds ratio (AOR): 1.03, 95% CI: 1.002 – 1.05). Rural women were significantly less likely to utilize the facility service for childbirth in comparison to urban women (AOR: 0.62, 95% CI: 0.49 – 0.79). Women who completed their secondary school education were 62% more likely to utilize facility childbirth services in comparison to women with no formal education (AOR: 1.62, 95% CI: 1.02 – 2.59). In comparison to the women from poorer households, women from affluent ad middle income households were significantly more likely to utilize facility childbirth services. Childbirth cost was significantly associated with childbirth at a health facility. After adjusting for women characteristics, only the increased number of facilities in the service environment was significantly associated with facility birth. None of the other service environment variables including the management body of a facility, BEmOC preparedness, or distance to facility was statistically significant.

    Conclusions: After adjusting for all other individual-level factors, this study found that rural women had 38% lower likelihood of giving birth at a health facility compared to urban women. Women who live in a high service environment (6 or more facilities) exhibited a significant association with facility childbirth compared to women who live in a low service environment (0-2 facilities). The study's findings could contribute to policymakers’ effort to impose stricter regulations and improve preparedness of both private and public healthcare facilities. We recommend that efforts should be made to address barriers that prevent women, particularly
    those in rural areas, from accessing facility-based childbirth services. Targeted counseling, education campaigns, and making services affordable can improve maternal and neonatal health outcomes.

  • Subjects / Keywords
  • Graduation date
    Fall 2023
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.