Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study

Abstract

BackgroundIn communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions.MethodsUtilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor).ResultsOut of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women’s literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women’s employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers.ConclusionsWhile the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh.Trial registrationTrial Registration Number: NCT00860470.

Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study

“…Care-seeking from a trained provider was associated with both women’s and husband’s literacy for both antepartum and intrapartum complications; these findings were consistent with the findings of an earlier study in Bangladesh where women’s literacy was associated with seeking care from a qualified provider for obstetric complications [15]. Women’s literacy and household wealth status are important factors and are considered as proxies of women’s decision making ability, empowerment and affordability for maternal health care utilization [23, 24].…”

“…In our study, women who were living in a distance of less than 10 km of a health facility were more likely to seek trained care for both antepartum and intrapartum complications. This finding is consistent with findings of a number of studies conducted in Bangladesh and elsewhere [12, 15]. In a study conducted between 2007 and 2011 in Bangladesh, Sikder et al showed that living within 10 km from the health facility was associated with seeking formal care for intrapartum complications [15].…”

“…Care-seeking from a trained provider, both for antepartum (47.4%) and intrapartum (46.5%) complications, in our study was higher compared to a similar study conducted among women in rural Gaibandha and Rangpur districts in Bangladesh between 2007 and 2011, where only a quarter of the women sought trained care [15]. Also, the care-seeking rate in our study was higher compared to findings of a national survey, conducted 10 years earlier in Bangladesh, where one in three women reported receiving care from a qualified provider for their life threatening antepartum complications [11].…”

“…Many studies in Bangladesh and elsewhere have shown socio-economic disparities in care seeking [22] with some studies documenting positive association between improved wealth status and seeking trained maternity care [9, 11, 12, 15]. In our study, women in the highest two wealth quintiles were about two times more likely to seek trained care both for reported antepartum and intrapartum complications [15], which was in agreement with findings of earlier studies conducted in Bangladesh and in other countries [13, 15]. …”

“…Earlier studies that examined factors associated with care seeking found that women belonging to wealthier households were more likely to seek skilled care for antepartum complications [11, 13]. Factors associated with skilled birth attendants during intrapartum period included mothers’ occupation, higher parity, complications during antepartum period, having antenatal care [14], and closer distance to a health facility [13, 15, 16]. In addition, access to skilled attendants, availability of quality care and associated medical cost remained major barriers to seeking care [11].…”