title: Factors associated with the utilization of institutional delivery services in Bangladesh.
abstract: BACKGROUND
  Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh.
  
  
  METHODS
  Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression.
  
  
  RESULTS
  According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; p<0.001; 95%CI: 0.467-0.604), and participants aged between 30 and 49 years had a 23.6% higher prevalence of institutional delivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062-1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; p<0.001; 95%CI: 1.650-2.624), and similarly, husbands with higher educational attainment exhibited an approximately 71% higher service utilization of institutional delivery facilities compared to those without formal education (OR = 1.709; p<0.001; 95%CI: 1.412-2.069). Wealth status was also a significant predictor of institutional delivery service use, with participants belonging to the highest economic stratum being more likely to receive skilled care compared to the lowest economic stratum (OR = 2.507; p<0.001; 95%CI: 2.118-2.968). In addition, results indicated that households of average economic class had a 27% higher level of institutional delivery service utilization compared to those of lower economic status (OR = 1.272; p = 0.011; 95%CI: 1.057-1.531). Furthermore, institutional health service use was 18% higher among participants who were aware of community clinical services compared to those who were hardly aware of these services (OR = 0.816; p = 0.012; 95%CI: 0.696-0.957). Lastly, the odds of utilizing delivery services was 1.553 times more likely for participants who use family planning compared to those who do not (p<0.001; 95%CI: 1.374-1.754), and 3.639 times more likely for those who receive antenatal care compared to those who do not (p<0.001; 95%CI: 3.074-4.308). These were found to be significant predictors of the choice of delivery services.
  
  
  CONCLUSIONS
  Our results suggest that efforts towards reducing national maternal mortality in Bangladesh could be aided by investments into education, poverty reduction and the strengthening of reproductive healthcare services through community clinics, with particular focus on rural areas.
authors.affiliation: School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Sanni
authors.identifier: http://orcid.org/0000-0002-4876-6043
authors.initials: S
authors.lastname: Yaya
authors.affiliation: School of Medicine and Health Management, Tongji medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors.forename: Ghose
authors.initials: G
authors.lastname: Bishwajit
authors.affiliation: Women's Health and Action Research Centre, Benin City, Nigeria.
authors.forename: Michael
authors.initials: M
authors.lastname: Ekholuenetale
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D016009:Chi-Square Distribution; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult