Household head- an unspoken crucial dimension to improve maternal healthcare services utilization in Bangladesh: evidence from nationally representative surveys
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International Centre for Diarrhoeal Disease Research, Bangladesh Bangladesh
University of Dhaka Bangladesh
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1112
Background and Objective:
Bangladesh, a lower-middle income country is enormously struggling to reduce the high maternal mortality ratio (196 per 100,000 live births) which got stagnant at the level of 2010. Poor maternal healthcare (MH) services utilization could be attributed to this stagnation. MH programs mostly overlook the household head (HH)- the most influential person in household decision-making in Bangladesh. This study aims to examine the role of HH and their relationship dynamics with women in MH services utilization during pregnancy and childbirth. Additionally, this study explores the possibilities of short and long-term policy actions.

This study used data from the latest nationally representative cross-sectional Bangladesh Multiple Indicator Cluster Survey 2019, Bangladesh Maternal Mortality Survey 2016, and Bangladesh Adolescent Health and Wellbeing Survey 2019-20. Antenatal care (ANC), facility birth (FB), skilled birth attendance (SBA) for home births, and care-seeking for maternal complications were assessed as MH services. The role of HHs’ education and relationship dynamics were examined through multivariate regressions and marginal effects. Spatial hotspot analyses were performed to generate policy suggestions.

After controlling for pregnancy complications and all other confounders, the adjusted odds of at least four ANC visits, FB, SBA in home births, and facility-based care seeking for pregnancy complication monotonically decreased by lower levels of HH education. Marginal effects of HHs’ education across different level of ANC visits indicates that less educated HHs diminish the maximum benefits of ANC in facilitating FB. Hotspot analyses revealed low-level of education among HHs and male adolescents of the eastern region, while the coverage of mobile phone ownership among HH was high there.

This study warrants integrating household heads into MH programs. Mobile phone-based awareness programs targeting household heads can be the immediate call for action, while averting school dropout among male adolescents can be the long-term strategy.

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