Inequalities in adequate maternal healthcare opportunities: evidence from Bangladesh Demographic and Health Survey 2017-2018

Md Injamul Haq Methun; Bright Opoku Ahinkorah; Sutopa Roy; Joshua Okyere; Md Ismail Hossain; Iqramul Haq; Shatabdi Shamrita Ume; Md Kamrul Hasan

doi:10.1136/bmjopen-2022-070111

Inequalities in adequate maternal healthcare opportunities: evidence from Bangladesh Demographic and Health Survey 2017-2018

BMJ Open. 2023 Oct 10;13(10):e070111. doi: 10.1136/bmjopen-2022-070111.

Authors

Md Injamul Haq Methun¹, Bright Opoku Ahinkorah², Sutopa Roy³, Joshua Okyere⁴, Md Ismail Hossain³, Iqramul Haq⁵, Shatabdi Shamrita Ume³, Md Kamrul Hasan⁶

Affiliations

¹ Department of Statistics, Tejgaon College, National University Bangladesh, Dhaka, Bangladesh.
² Faculty of Health, The Australian Centre for Public and Population Health Research, University of Technology Sydney, Liverpool, New South Wales, Australia.
³ Department of Statistics, Jagannath University, Dhaka, Bangladesh.
⁴ Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
⁵ Department of Agricultural Statistics, Faculty of Agribusiness Management, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh.
⁶ Department of Public Health, North South University, Dhaka, Bangladesh kamrul.hasan11@northsouth.edu.

Abstract

Objectives: This study investigated the inequalities in access to maternal healthcare services in Bangladesh.

Design and setting: This study used cross-sectional data from the nationally representative Bangladesh Demographic and Health Survey conducted in 2017-2018. The survey encompassed diverse regions and households across Bangladesh. The study used the Human Opportunity Index (HOI) and Shapley's decomposition technique to measure the inequality in access to maternal healthcare opportunities.

Participants: This study included 20 127 women aged 15-49 years. Among them, 5012 women had live births in the preceding 3 years of the survey, forming the study sample.

Primary and secondary outcome measures: This study has no secondary outcome variable. The primary dependent variable is 'adequate maternal healthcare', a dichotomous variable.

Results: Household wealth status contributed the highest to inequality in accessing adequate maternal healthcare services (41.4%) such as receiving at least four antenatal care (ANC) visits (39.7%), access to proper ANC (50.7% and 44.0%) and health facility birth (43.4%). Maternal educational status contributes the second highest inequality among all factors in accessing adequate maternal healthcare (29.5%). Adequate maternal healthcare presented the lowest coverage rate and opportunity index among all (approximately 24% with HOI=17.2).

Conclusions: We found that attained adequate maternal healthcare had the lowest coverage and widest dissimilarity, while wealth index, education and place of residence are the major factors that contribute to inequalities in accessibility to maternal healthcare services in Bangladesh. These findings underscore a need for pro-poor interventions to narrow the economic inequalities between the poor and rich in terms of accessibility to maternal healthcare services. The results indicate the need for the Bangladeshi government and its health department to strengthen their commitment to improving female education. Investments should be made in initiatives that facilitate the proximity of maternal healthcare services to women in rural areas.

Keywords: Health Equity; Health policy; OBSTETRICS; PUBLIC HEALTH.

MeSH terms

Bangladesh
Cross-Sectional Studies
Demography
Female
Health Services Accessibility
Healthcare Disparities
Humans
Maternal Health Services*
Pregnancy
Prenatal Care
Socioeconomic Factors