An empirical analysis of socioeconomic risk factors associated with antenatal care attendance in Bangladesh

Abstract

Maternal mortality and morbidity reduction constitute policy priorities, facilitated by prenatal care and World Health Organization (WHO)-endorsed antenatal care (ANC) utilization during pregnancy. Progress in Bangladesh is hindered as only 47% of expectant women participated in a minimum of four ANC sessions according to the latest maternal mortality survey. This study, utilizing 2018 Bangladesh Demographic and Health Survey (BDHS) data, undertakes an assessment of the socioeconomic determinants influencing the utilization or non-utilization of ANC services. Additionally, the study investigates socioeconomic factors significantly impacting the attainment of the WHO-recommended four or more ANC sessions. A Hurdle Negative Binomial Model is employed to ascertain ANC risk variables and their frequency, while the utilization characteristics of WHO ANC services are discerned through the Binary Logistic Regression Model. Noteworthy among the statistically significant determinants influencing the reception of any antenatal care (ANC) in Bangladesh are the sex of the household head, place of residence, wealth index, husband/partner's education, the highest educational attainment of women, decision-making regarding the expenditure of women's earnings, ease of obtaining medical assistance permission, mobile phone ownership, and media exposure. Furthermore, this empirical inquiry reveals that income inequality, the highest educational attainment of women, decision-making regarding the expenditure of women's earnings, distance to health facilities, mobile phone ownership, utilization of phones for financial transactions, and media exposure significantly determine adherence to WHO-recommended ANC guidelines. This study identifies four crucial determinants for the initiation of ANC services and adherence to recommended prenatal care: a pregnant woman's wealth index ranking, highest educational attainment, ownership of a mobile phone, and exposure to media. The findings of this study can aid Bangladeshi healthcare programmers and policymakers in devising strategies to achieve comprehensive ANC coverage for all pregnant women.