Women’s Preferences for Maternal Healthcare Services in Bangladesh: Evidence from a Discrete Choice Experiment

Abstract

Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-methods approach. Qualitative methods (expert interviews, focus group discussions) were initially employed to identify and develop the characteristics which most influence a women’s decision making when selecting a maternal health service facility. A discrete choice experiment (DCE) was then constructed to elicit women’s preferences. Women were shown choice scenarios representing hypothetical health facilities with nine attributes outlined. The women were then asked to rank the attributes they considered most important in the delivery of their future babies. A Hierarchical Bayes method was used to measure mean utility parameters. A total of 601 women completed the DCE survey. The model demonstrated significant predictive strength for actual facility choice for maternal health services. The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including the availability of a C-section delivery and lesser waiting times. Attended maternal healthcare utilisation rates are low despite the access to primary healthcare facilities. Further implementation of quality improvements in maternal healthcare facilities should be prioritised.

Barriers to accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh: A qualitative descriptive study of Indigenous women’s experiences

“…Not having comprehensive health knowledge about modern MHC interventions and led to lower rates of MHC usage among Indigenous women [53,54]. This was the case for Indigenous women in the CHT, despite basic MHC services being free at public health facilities in Bangladesh [21]. Given that word-of-mouth is an influential channel of communication, it is likely that this type of information will need to be shared and disseminated in face-to-face modes.…”

“…The CHT communities, isolated politically and socially until a Peace Accord was signed in 1997 between the Government of Bangladesh and the Indigenous communities [ 20 ], have received minimal policy recognition regarding their human rights, including health rights. While national MHC access rates have improved, the health system has not necessarily provided inclusive or equitable care for women from diverse socio-cultural backgrounds including from Indigenous communities [ 3 , 21 ]. Like many countries, Bangladesh policy has prioritised the health needs of the majority Bengali population, and health rights of other cultural minority groups, including Indigenous groups, have not been well-addressed [ 8 , 22 , 23 ].…”

Addressing the Linkages between Gender and Transport in Low- and Middle-Income Countries

“…One of the research gaps identified so far is that there is little recorded evidence in the form of research studies to highlight the constrained access of urban low-income women to health services. Most of the studies in urban areas have focused on the quality, patient-provider relationships, accountability and affordability of the health services [67]. However, referral services like assisted or non-assisted transport services have been rarely studied in the urban areas of the developing economies, except for studies such as that by Murray et al [68] that focused on Lusaka, Zambia and there is need for much more rigorous research work.…”

Does knowledge of pregnancy complications influence health facility delivery? Analysis of 2014 Bangladesh Demographic and Health Survey

“…MMR in Bangladesh as of 2015 was 176 per 100 000 live births [1]. Maternal mortality in Bangladesh is linked to imbalances in primary healthcare access with a huge gap between women in advantaged and disadvantaged socioeconomic communities [5]. This is marked by the 15% and 70% health facility deliveries among women in lowest and highest wealth quintiles respectively [6].…”