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Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data.

ABSTRACT: Background:Around 48% of all pregnancies in low- and middle-income countries are unintended. Unintended pregnancy may contribute to lower use of antenatal care (ANC); however, current research in the area is largely inconclusive due to the methodological approaches applied. Methods:Responses from 4493 women extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) were used to assess the association between unintended pregnancy and subsequent uptake of at least one and at least four skilled ANC visits. For this, Bayesian multilevel logistic regression models with informative priors (representing a range of values within which the researcher is certain the true effect of the parameters included lies) were used, adjusting for other factors that affect ANC uptake. Informative priors were selected from the BDHS data collected in 2004, 2007, and 2011. Results:Around 64% of women in Bangladesh who had at least one pregnancy within 3 years prior to the survey (that ended in a live birth) received ANC at least once, and of these around 32% used ANC at least four times. Mistimed (aOR, 0.73, 95% Cred I, 0.66-0.81) and unwanted (aOR, 0.69, 95% Cred I, 0.64-0.75) pregnancy were associated with reduced odds of attending the recommended minimum of four skilled ANC visits compared with wanted pregnancy. These likelihoods were even lower for at least one skilled ANC visit among women with a mistimed (aOR, 0.59, 95% Cred I, 0.53-0.65) or an unwanted pregnancy (aOR, 0.67, 95% Cred I, 0.61-0.74) than women with a wanted pregnancy. Conclusions:In Bangladesh, more than one-quarter of women who report an unintended pregnancy at conception and do not terminate the pregnancy are at high risk of not using ANC. It is important for policies to include women with unintended pregnancy in mainstream healthcare services. This will increase the use of ANC and reduce associated adverse consequences.

SUBMITTER: Khan MN

PROVIDER: S-EPMC7493902 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data.

Khan Md Nuruzzaman MN Harris Melissa L ML Oldmeadow Christopher C Loxton Deborah D

Archives of public health = Archives belges de sante publique 20200916

<h4>Background</h4>Around 48% of all pregnancies in low- and middle-income countries are unintended. Unintended pregnancy may contribute to lower use of antenatal care (ANC); however, current research in the area is largely inconclusive due to the methodological approaches applied.<h4>Methods</h4>Responses from 4493 women extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) were used to assess the association between unintended pregnancy and subsequent uptake of at least one a ...[more]

PMID: 32974015

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Project description:BackgroundAntenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop-off in use between ANC1+ and ANC4+, and explores inequalities in women's use of ANC services. It also identifies determinants of utilization and describes countries' ANC-related policies, and programs.MethodsWe performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women's education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country-based informants.ResultsEach country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence-based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women's education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman's education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify.ConclusionSecondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub-groups, all countries can benefit from specific in-country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women's perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or implemented properly to ensure that women receive the recommended number of ANC visits with appropriate content, especially, poor and less educated women residing in rural areas.

Project description:Antenatal care (ANC) contacts have long been considered a critical component of the continuum of care for a pregnant mother along with the newborn baby. The latest maternal mortality survey in Bangladesh suggests that progress in reducing maternal mortality has stalled as only 37% of pregnant women have attended at least four ANC contacts. This paper aims to determine what factors are associated with ANC contacts for women in Bangladesh. We analysed the data, provided by Bangladesh demographic and health survey 2014, covering a nationally representative sample of 17,863 ever married women aged 15-49 years. A two-stage stratified cluster sampling was used to collect the data. Data derived from 4,475 mothers who gave birth in the three years preceding the survey. Descriptive, inferential, and multivariate statistical techniques were used to analyse the data. An overall 78.4% of women had ANC contacts, but the WHO recommended ?8 ANC contacts and ANC contacts by qualified doctors were only 8% for each. The logistic regression analysis revealed that division, maternal age, women's education, husband's education, wealth index and media exposure were associated with the ANC contacts. Likewise, place of residence, women's education, religion, and wealth index were also found to be associated with the WHO recommended ANC contacts. Furthermore, the husband's education, division, religion and husband's employment showed significant associations with ANC contacts by qualified doctors. However, Bangladeshi women in general revealed an unsatisfactory level of ANC contacts, the WHO recommended as well as ANC contacts by qualified doctors. In order to improve the situation, it is necessary to follow the most recent ANC contacts recommended by the WHO and to contact the qualified doctors. Moreover, an improvement in education as well as access to information along with an increase of transports, care centres and reduction of service costs would see an improvement of ANC contacts in Bangladesh.

Project description:Background:A pregnancy is described unintended if it is either unwanted or mistimed. The former occurs when no child or no more children are desired, and the latter is when the conception occurs earlier than the desired time, but wanted later. Unwanted pregnancy causes a serious health, economic, and social problem to the woman and her family. In the study area, there is limited data on unintended pregnancy. Therefore, this study fills this gap by studying the magnitude of unintended pregnancy and its associated factors among pregnant women attending antenatal care in the study area. Methods:A facility-based cross-sectional study was done from 1 March to 1 April 2019, among 612 randomly selected pregnant women attending antenatal care at Bako Tibe district public health facility. The data were collected via interview using a structured and pretested questionnaire. They were entered into EpiData Version 3.1 and SPSS Version 23 for cleaning and analyses. The variables, which were significant at P ? 0.2 in the bivariate logistic regression, were included in the multivariable analysis. The direction and strength of statistical association were measured by an odds ratio with 95% CI. A variable with a P value < 0.05 was considered a significantly associated factor with the outcome one. Results:In this study, the prevalence of unintended pregnancy was 33.3%, at 95% CI (29.8, 37.3). The factors that had significant association with unintended pregnancy were family?size ? 6 (AOR = 8.0, 95% CI: 1.38-46.66), women who did not communicate about family planning with their husbands (AOR = 2.8, 95% CI: 1.50-5.20), and parity ? 5 (AOR = 3.0, 95% CI: 1.34-6.8). Conclusion:About one-third of the pregnant women reported that their pregnancy was unintended. Parity, family size, and lack of spousal communication showed a significant association with the problem. To decrease the current level of unintended pregnancy in the area, the Bako Tibe District Health Bureau and the health workers should work harder to scale up spousal communication on family planning.

Project description:BackgroundComplications during pregnancy, childbirth and the postpartum period present a significant and complex public health problem in low income countries such as Ethiopia. One strategy endorsed by the World Health Organisation (WHO) to improve maternal and child health outcomes is to encourage male partner involvement in pregnancy care. This research aimed to explore the relationships between 1) male attendance at antenatal care and 2) socio-economic and women's empowerment factors and adherence to focused antenatal care guidelines among women receiving care in Ethiopia.MethodsSecondary analysis of 2011 Ethiopian Demographic and Health Survey (DHS) data. A sub-sample of couples with a child aged 0-2 years old, for whom women attended at least one antenatal care (ANC) appointment was selected. Predictor variables on socio-economic position, demographic and women's empowerment factors, and male attendance at antenatal care were identified. Six outcome variables were constructed to indicate whether or not women: commenced ANC in the first trimester, attended at least four ANC appointments, received a urine test, received a blood test, were counselled on potential complications during pregnancy and met these focused antenatal care guidelines. Binary logistic regression was performed to estimate the relationship between the predictor and outcome variables.ResultsAfter controlling for other factors, women whose partners attended ANC were significantly more likely to receive urine and blood tests and be counselled about pregnancy complications compared to women who attended alone. Male attendance was not associated with women commencing care in the first trimester or attending at least four appointments. Although more women whose male partners had attended appointments received all recommended components of ANC than those who attended alone, this association was not significant.ConclusionsThe results revealed some benefits and did not detect harms from including male partners in focused antenatal care. Including men may require changes to maternal healthcare systems and training of healthcare workers, to adopt 'father inclusive' practices. Given the limited research in this area, large population studies including the DHS routinely carried out in Ethiopia could enhance knowledge by including more detailed indicators of male involvement in pregnancy, maternal and child healthcare and early child development.

Dataset Information

Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data.

Publications

Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data.

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