Individual and community-level factors associated with skilled birth attendants during delivery in Bangladesh: A multilevel analysis of demographic and health surveys

Abstract

Background Skilled birth attendants (SBAs) play a crucial role in reducing infant and maternal mortality. Although the ratio of skilled assistance at birth has increased in Bangladesh, factors associated with SBA use are unknown. The main goal of our study was to reveal the individual- and community-level factors associated with SBA use during childbirth in Bangladesh. We also showed the prevalence and trend of SBA use and related independent variables in Bangladesh over the past decade. Methods This study utilized the Bangladesh Health and Demographic Survey (BDHS) 2017–2018, a cross-sectional study. We used binary logistic regression to examine the extent of variation in SBA use attributable to the individual- and community-level variables. Results Overall, 53.35% of women received assistance from SBAs during childbirth. The average annual rate of increase (AARI) in the number of SBA-assisted births over the past 10 years was 8.88%. Respondents who gave birth at or above 19 years had 1.40 times (AOR = 1.40; 95% CI: 1.21–1.62) greater odds of having skilled delivery assistance than respondents aged 18 years old or less. Women and their husband’s education levels were significantly associated with using skilled assistance during delivery, with odds of 1.60 (AOR = 1.60; 95% CI: 1.45–2.01) and 1.41 (AOR = 1.41; 95% CI: 1.21–1.66), respectively compared to those with education up to primary level. Women from rich families and those receiving better antenatal care (ANC) visits were more likely to have professional delivery assistance. Community-level factors also showed significance towards having professional assistance while giving birth. Women from urban communities and those who utilized more than four ANC visits and had completed secondary or higher education showed a greater tendency to use an SBA during childbirth than their counterparts. Conclusion The use of SBAs during delivery was significantly associated with some individual- and community-level factors. To reduce maternal and child mortality, there is a need to focus on rural and uneducated people who are less likely to access these facilities. Special programs could increase awareness and help the poor community obtain the minimum facility in maternal care.

Two level logistic regression analysis of factors influencing skilled birth attendant during delivery among Bangladeshi mothers: A nationally representative sample

“…Also medical facilities in urban area are more than rural in Bangladesh; consequently urban mothers are more likely to get SKB than rural mothers. We also observed that comparatively higher educated and rich mothers were more likely to use SKB than their counterparts; these results are supported to the findings of other studies [ 21 , 22 , 24 , 32 ]. Education is an important factor for using SBA during delivery.…”

“…Same results had been found previous study in Bangladesh [ 22 , 32 ]. We found that more number of urban mothers uses SKB during their delivery than rural mothers, same findings had been found in other studies [ 22 , 24 , 32 ]. Mothers living in urban environment are more educated and living in family having higher wealth quintile than rural are [ 8 ], and educated and rich mothers are more conscious about their health comparatively less educated and poor mothers.…”

“…However, one study used multilevel logistic regression to overcome the effect. To the best of our knowledge, no researchers did try to determine the contribution of individual associated factors of skilled birth attendants which are very important for considering factors according their importance to improve health policy for increasing skilled birth attendants of a particular population [ 24 ].…”

Prevalence and determinants of utilizing skilled birth attendance during home delivery of pregnant women in India: Evidence from the Indian Demographic and Health Survey 2015–16

“…Women in their early pregnancies are more likely to use home-based skilled birth attendance compared to later pregnancies. Similar studies also found that with later pregnancies, women are less likely to ask for skilled birth assistance [ 44 , 59 ]. During the first couple of pregnancies women may feel insecure as they don’t have prior experience of child-birth.…”

“…Literature showing relationship between BMI and skilled birth attendance is extremely scarce. A study, conducted on women in Bangladesh, found that women whose weight is not normal are more likely to use skilled birth attendance compared to normal-weighted women [ 44 ]. High BMI is associated with a number of health risks such as diabetes, cardiovascular diseases, kidney diseases, stroke etc.…”