title: Investigating the role of health care at birth on inequalities in neonatal survival: evidence from Bangladesh.
abstract: BACKGROUND
  In countries such as Bangladesh many women may only seek skilled care at birth when complications become evident. This often results in higher neonatal mortality for women who give birth in institutions than for those that give birth at home. However, we hypothesise that this apparent excess mortality is concentrated among less advantaged women. The aim of this paper is to examine the association between place of birth and neonatal mortality in Bangladesh, and how this varies by socio-economic status.
  
  
  METHODS
  The study is based on pooled data from four Bangladesh Demographic and Household Surveys, and uses descriptive analysis and binomial multivariate logistic regression. It uses regression models stratified for place of delivery to examine the impact of socio-economic status and place of residence on neonatal mortality.
  
  
  RESULTS
  Poor women from rural areas and those with no education who gave birth in institutions had much worse outcomes than those who gave birth at home. There is no difference for more wealthy women. There is a much stronger socio-economic gradient in neonatal mortality for women who gave birth in institutions than those who delivered at home.
  
  
  CONCLUSIONS
  In Bangladesh babies from lower socio-economic groups and particularly those in rural areas have very poor outcomes if born in a facility. This suggests poorer, rural and less educated women are failing to obtain the timely access to quality maternal health care services needed to improve newborn outcomes.
authors.affiliation: Centre for Global Health, Population, Poverty and Policy, Department of Social Science, University of Southampton, University Rd, Southampton, Hampshire, SO17 1BJ, United Kingdom. sn1c09@soton.ac.uk
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Neal
authors.forename: Zoë
authors.initials: Z
authors.lastname: Matthews
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D011247:Pregnancy; D012959:Socioeconomic Factors; D055815:Young Adult