A multilevel assessment of the influence of education on women's uptake of institutional delivery services during childbirth in Bangladesh

Jahidur Rahman Khan; Tasnim Ara; Md Mahabubur Rahman; Md Belal Hossain; Olav Muurlink

doi:10.1016/j.midw.2022.103425

A multilevel assessment of the influence of education on women's uptake of institutional delivery services during childbirth in Bangladesh

Midwifery. 2022 Oct:113:103425. doi: 10.1016/j.midw.2022.103425. Epub 2022 Jul 6.

Authors

Jahidur Rahman Khan¹, Tasnim Ara², Md Mahabubur Rahman³, Md Belal Hossain⁴, Olav Muurlink⁵

Affiliations

¹ Discipline of Paediatrics, School of Clinical Medicine, University of New South Wales, Sydney, Australia; Biomedical Research Foundation, Dhaka 1230, Bangladesh. Electronic address: jkhan@isrt.ac.bd.
² Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh. Electronic address: tara@isrt.ac.bd.
³ Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh.
⁴ BRAC James P Grant School of Public Health, BRAC University, Dhaka 1212, Bangladesh; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
⁵ School of Business and Law, Central Queensland University, Brisbane, Australia.

PMID: 35849912
DOI: 10.1016/j.midw.2022.103425

Abstract

Objectives: Despite a significant decline over time, maternal mortality remains high in Bangladesh. Institutional delivery during childbirth is crucial to reducing maternal mortality, but uptake of institutional delivery services (IDS) remains suboptimal in Bangladesh. Though women's education plays a crucial role in the use of IDS, the educational status of the household head and area-level literacy rate also appear to act as predictors of IDS uptake. This study aims to assess the effect of the educational status of women and household heads as well as district-level adult literacy rates on the use of IDS during childbirth among women in Bangladesh.

Design: This study analyzed nationally representative cross-sectional survey data from the 2019 Bangladesh Multiple Indicator Cluster Survey.

Setting: Bangladesh.

Participants: 9,207 currently married women aged 15-49 years who had at least one live birth in the two years preceding the survey were included in the study. The outcome measure was women's use of IDS during their last childbirth. A multilevel logistic regression model was used to explore the association between education status of women and household heads, and district (i.e., area unit) adult literacy rates and uptake of IDS among women in Bangladesh by controlling for other sociodemographic covariates and clustering.

Results: About 53% of women used IDS during childbirth. Adjusting for other factors and clustering, women with higher educational status, those living in households with higher-educated heads, and those in districts with greater adult literacy rates are more likely to use IDS, after controlling for key sociodemographic variables including wealth.

Conclusions: Uptake of IDS in Bangladesh remains low, with education playing an important independent role in determining rates. The findings of the study provide empirical evidence for policymakers to design multi-modal educational programs targeted not only at literate women but also at household head (especially male) and communities where literacy (and equally importantly health literacy) may be variable or absent.

Keywords: Association; Education; Institutional delivery.

MeSH terms

Adult
Bangladesh
Cross-Sectional Studies
Educational Status
Female
Humans
Male
Maternal Mortality*
Socioeconomic Factors