Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-26T06:03:22.260Z Has data issue: false hasContentIssue false
  • English
  • Français

Does unintended pregnancy have an impact on skilled delivery care use in Bangladesh? A nationally representative cross-sectional study using Demography and Health Survey data

Published online by Cambridge University Press:  14 September 2020

Md Nuruzzaman Khan Open the ORCID record for Md Nuruzzaman Khan [Opens in a new window] ,
Melissa L. Harris  and
Deborah Loxton
Md Nuruzzaman Khan*
Affiliation:
Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
Melissa L. Harris
Affiliation:
School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
Deborah Loxton
Affiliation:
Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Australia
*
*Corresponding author. Email: mdnuruzzaman.khan@uon.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Skilled delivery care has been targeted in the Sustainable Development Goals to reduce preventable maternal and newborn deaths, which mostly occur because of birthing complications. Birthing complications are more frequent in women with unintended than intended pregnancies, and around 43% of total pregnancies in low- and middle-income countries are unintended. This study quantified the impact of unintended pregnancy on skilled birth attendance and delivery in health care facilities in Bangladesh. Data from 4493 women participating in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Multilevel logistic regression models were used to assess the association of unintended pregnancy with skilled birth attendance and delivery in a health care facility through skilled providers while adjusting for individual-, household- and community-level factors identified using a directed acyclic graph. Around 26% of women reported that their last pregnancy (occurring within the previous 3 years) that ended with a live birth was unintended at conception. Only 42% reported having a skilled birth attendant present at their last birth and 38% gave birth in a health care facility. Significant differences were found across pregnancy intention. Lower odds of skilled birth attendance (OR, 0.70, 95% CI, 0.52–0.93) and delivery in a health care facility through skilled providers (OR, 0.65, 95% CI, 0.48–0.89) were found among women who had an unwanted pregnancy relative to women who had a wanted pregnancy. However, a mistimed pregnancy was not found to be associated with skilled birth attendance or delivery in health care facility through skilled providers. Increased availability of health care facilities at the community level is required in Bangladesh to ensure skilled delivery care for women with an unwanted pregnancy. Policies are also required to integrate women with an unwanted pregnancy into mainstream health care services through earlier detection and increased awareness in order to reduce the adverse maternal and fetal outcomes associated with lack of quality birthing care.

Keywords

Unintended pregnancySkilled birth attendanceBangladesh
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 5 , September 2021 , pp. 773 - 789
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abebe, F, Berhane, Y and Girma, B (2012) Factors associated with home delivery in Bahirdar, Ethiopia: a case control study. BMC Research Notes 5(1), 653.CrossRefGoogle ScholarPubMed
Ahmed, SM, Hossain, MA, Rajachowdhury, AM and Bhuiya, AU (2011) The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Human Resources for Health 9(1), 3.CrossRefGoogle ScholarPubMed
Al-Kibria, GM, Burrowes, V, Choudhury, A, Sharmeen, A, Ghosh, S and Kalbarczyk, A (2018) A comparison of practices, distributions and determinants of birth attendance in two divisions with highest and lowest skilled delivery attendance in Bangladesh. BMC Pregnancy and Childbirth 18(1), 122.CrossRefGoogle Scholar
Alkema, L, Chou, D, Hogan, D, Zhang, S, Moller, AB, Gemmill, A et al. (2016) Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet 387(10017), 462–474.CrossRefGoogle ScholarPubMed
Bearak, J, Popinchalk, A, Alkema, L and Sedgh, G (2018) Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health 6(4), e380–e389.CrossRefGoogle ScholarPubMed
Bitew, T, Hanlon, C, Kebede, E, Honikman, S, Onah, MN and Fekadu, A (2017) Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia. BMC Pregnancy and Childbirth 17(1), 206.CrossRefGoogle ScholarPubMed
Blencowe, H, Cousens, S, Jassir, FB, Say, L, Chou, D, Mathers, C et al. (2016) National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health 4(2), e98–e108.CrossRefGoogle ScholarPubMed
Bowen, L (2007) Applied Multilevel Analysis: A Practical Guide. Oxford University Press.Google Scholar
Dahiru, T and Oche, OM (2015) Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria. Pan African Medical Journal 21(1), 321.CrossRefGoogle ScholarPubMed
Dutamo, Z, Assefa, N and Egata, G (2015) Maternal health care use among married women in Hossaina, Ethiopia. BMC Health Services Research 15(1), 365.CrossRefGoogle ScholarPubMed
Fagbamigbe, AF, Hurricane-Ike, EO, Yusuf, OB and Idemudia, ES (2017) Trends and drivers of skilled birth attendant use in Nigeria (1990–2013): policy implications for child and maternal health. International Journal of Women’s Health 9, 843.CrossRefGoogle ScholarPubMed
Fotso, JC, Ezeh, AC and Essendi, H (2009) Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services? Reproductive Health 6(1), 9.CrossRefGoogle ScholarPubMed
Gipson, JD, Koenig, MA and Hindin, MJ (2008) The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Studies in Family Planning 39(1), 18–38.CrossRefGoogle ScholarPubMed
Goldenberg, RL, McClure, EM and Saleem, S (2018) Improving pregnancy outcomes in low-and middle-income countries. Reproductive Health 15(1), 88.CrossRefGoogle ScholarPubMed
Hall, JA, Barrett, G, Phiri, T, Copas, A and Stephenson, J (2016) Prevalence and determinants of unintended pregnancy in Mchinji District, Malawi; using a conceptual hierarchy to inform analysis. PLoS One 11(10), e0165621.CrossRefGoogle ScholarPubMed
Huda, TM., Chowdhury, M, El Arifeen, S and Dibley, MJ (2019) Individual and community level factors associated with health facility delivery: a cross sectional multilevel analysis in Bangladesh. PLoS One 14(2), e0211113.CrossRefGoogle ScholarPubMed
Islam, N, Islam, MT and Yoshimura, Y (2014) Practices and determinants of delivery by skilled birth attendants in Bangladesh. Reproductive Health 11(1), 86.CrossRefGoogle ScholarPubMed
JICA (2014) Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB) – Community Clinic Project (CCP). International Cooperation Agency (JICA), Japan, and Dhaka, Bangladesh. URL: https://www.jica.go.jp/project/english/bangladesh/002/materials/c8h0vm00004eggs3-att/newsletter_06.pdf (accessed 15th April 2019).Google Scholar
Joseph, G, Da Silva, ICM, Wehrmeister, FC, Barros, AJ and Victora, CG (2016) Inequalities in the coverage of place of delivery and skilled birth attendance: analyses of cross-sectional surveys in 80 low and middle-income countries. Reproductive Health 13(1), 77.CrossRefGoogle ScholarPubMed
Khan, MN, Harris, ML and Loxton, D (2019a) Use of modern contraception following a birth that was unintended in Bangladesh: analysis of nationwide population-based survey data. International Perspectives on Sexual and Reproductive Health 46, 77–87.CrossRefGoogle Scholar
Khan, MN, Harris, ML, Shifti, DM, Laar, AS and Loxton, D (2019b) Effects of unintended pregnancy on maternal healthcare services utilization in low-and lower-middle-income countries: systematic review and meta-analysis. International Journal of Public Health 64, 743–754.CrossRefGoogle ScholarPubMed
Kibria, G, Ghosh, S, Hossen, S, Barsha, RAA, Sharmeen, A and Uddin, SI (2017) Factors affecting deliveries attended by skilled birth attendants in Bangladesh. Maternal Health, Neonatology and Perinatology 3, 7.CrossRefGoogle ScholarPubMed
Kidanu, S, Degu, G and Tiruye, TY (2017) Factors influencing institutional delivery service utilization in Dembecha district, Northwest Ethiopia: a community based cross sectional study. Reproductive Health 14(1), 98.CrossRefGoogle ScholarPubMed
MoHFW (2014) HRH Data Sheet 2014. Ministry of Helath and Family Welfare, Government of the People’s Republic of Bangladesh. URL: http://www.mohfw.gov.bd/index.php?option=com_contentandview=articleandid=112%3Aperformance-report-2009-2010-and-hrd-data-sheet-2011-of-mohfwandcatid=72%3Aperformance-report-2009-2010-of-mohafwandlang=en (accessed 27th April 2019).Google Scholar
Muchabaiwa, L, Mazambani, D, Chigusiwa, L, Bindu, S and Mudavanhu, V (2012) Determinants of maternal healthcare utilization in Zimbabwe. International Journal of Economic Sciences and Applied Research 5(2), 145–162.Google Scholar
NIPORT, MA and ORC Macro (2013) Bangladesh Demographic and Health Survey 2011. National Institute of Population Research and Training, Mitra and Associates and ORC Macro, Dhaka, Bangladesh.Google Scholar
NIPORT, MA and ICF International (2016) Bangladesh Demographic and Health Survey 2014. National Institute of Population Research and Training, Mitra and Associates and ICF International, Dhaka, Bangladesh.Google Scholar
Nyongesa, C, Xu, X, Hall, JJ, Macharia, WM, Yego, F and Hall, B (2018) Factors influencing choice of skilled birth attendance at ANC: evidence from the Kenya Demographic Health Survey. BMC Pregnancy and Childbirth 18(1), 88.CrossRefGoogle ScholarPubMed
Rahman, MM, Rahman, MM, Tareque, MI, Ferdos, J and Jesmin, SS (2016) Maternal pregnancy intention and professional antenatal care utilization in Bangladesh: a nationwide population-based survey. PLoS One 11(6), e0157760.CrossRefGoogle ScholarPubMed
Roy, TK and Singh, BP (2016) Correlates of unwanted births in Bangladesh: a study through Path Analysis. PLoS One 11(10), e0164007.CrossRefGoogle ScholarPubMed
Saha, MOE (2017) Access to a skilled birth attendant in Bangladesh: what we know and what health system framework can teach us. Health System and Policy Research 4(4), 66.CrossRefGoogle Scholar
Sarker, BK, Rahman, M, Rahman, T, Hossain, J, Reichenbach, L and Mitra, DK (2016) Reasons for preference of home delivery with traditional birth attendants (TBAs) in rural Bangladesh: a qualitative exploration. PLoS One 11(1), e0146161.CrossRefGoogle ScholarPubMed
Shibanuma, A, Yeji, F, Okawa, S, Mahama, E, Kikuchi, K, Narh, C et al. (2018) The coverage of continuum of care in maternal, newborn and child health: a cross-sectional study of woman–child pairs in Ghana. BMJ Global Health 3(4), e000786.CrossRefGoogle ScholarPubMed
Tarekegn, SM, Lieberman, LS and Giedraitis, V (2014) Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey. BMC Pregnancy and Childbirth 14(1), 161.CrossRefGoogle ScholarPubMed
UNICEF (2013) Socio-Ecological Model of Health. URL: https://www.unicef.org/cbsc/files/Module_1_SEM-C4D.docx (accessed 1st May 2019).Google Scholar
UNIGME, WHO and World Bank (2016) Levels and Trends in Child Mortality. Report 2015. Inter-agency Group for Child Mortality Estimation, UNICEF, WHO, World Bank, United Nations Population Division, New York. URL: https://childmortality.org/files_v20/download/IGME%20Report%202015_9_3%20LR%20Web.pdf (accessed 1st May 2019).Google Scholar
United Nations (2015a) The Millennium Development Goals Report 2015. United Nations, New York. URL: https://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20(July%201).pdf (accessed 2nd May 2019).Google Scholar
United Nations (2015b) Sustainable Development Goal. URL: https://www.un.org/sustainabledevelopment/health/ (accessed 3rd May 2019).Google Scholar
World Bank (2017a) Current Health Expenditure (% of GDP). World Bank, Washington, DC. URL: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=BD (accessed 1st May 2019).Google Scholar
World Bank (2017b) Out-Of-Pocket Expenditure (% of Current Health Expenditure). World Bank, Washington, DC. URL: https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=BD (accessed 4th May 2019).Google Scholar
WHO (2018a) Definition of Skilled Health Personnel Providing Care During Childbirth: The 2018 Joint Statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA. World Health Organization, Geneva.Google Scholar
WHO (2018b) Maternal Mortality. World Health Organization, Geneva. URL: http://www.who.int/news-room/fact-sheets/detail/maternal-mortality (accessed 15th April 2019).Google Scholar
WHO (2018c) Under-Five Mortality. World Health Organization, Geneva. URL: https://www.who.int/gho/child_health/mortality/mortality_under_five_text/en/ (accessed 1st May 2019).Google Scholar
Yaya, S, Bishwajit, G and Ekholuenetale, M (2017) Factors associated with the utilization of institutional delivery services in Bangladesh. PLoS One 12(2), e0171573.CrossRefGoogle ScholarPubMed
Yeji, F, Shibanuma, A, Oduro, A, Debpuur, C, Kikuchi, K, Owusu-Agei, S et al. (2015) Continuum of care in a maternal, newborn and child health program in Ghana: low completion rate and multiple obstacle factors. PLoS One 10(12), e0142849.CrossRefGoogle Scholar
Zegeye, K, Gebeyehu, A and Melese, T (2014) The role of geographical access in the utilization of institutional delivery service in rural Jimma Horro District, Southwest Ethiopia. Primary Health Care 4(1), 2167-1079.1000150.Google Scholar