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Does unintended pregnancy have an impact on skilled delivery care use in Bangladesh? A nationally representative cross-sectional study using Demography and Health Survey data

Published online by Cambridge University Press:  14 September 2020

Md Nuruzzaman Khan Open the ORCID record for Md Nuruzzaman Khan [Opens in a new window] ,
Melissa L. Harris  and
Deborah Loxton
Md Nuruzzaman Khan*
Affiliation:
Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
Melissa L. Harris
Affiliation:
School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
Deborah Loxton
Affiliation:
Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Australia
*
*Corresponding author. Email: [email protected]
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Abstract

Skilled delivery care has been targeted in the Sustainable Development Goals to reduce preventable maternal and newborn deaths, which mostly occur because of birthing complications. Birthing complications are more frequent in women with unintended than intended pregnancies, and around 43% of total pregnancies in low- and middle-income countries are unintended. This study quantified the impact of unintended pregnancy on skilled birth attendance and delivery in health care facilities in Bangladesh. Data from 4493 women participating in the cross-sectional 2014 Bangladesh Demographic and Health Survey were analysed. Multilevel logistic regression models were used to assess the association of unintended pregnancy with skilled birth attendance and delivery in a health care facility through skilled providers while adjusting for individual-, household- and community-level factors identified using a directed acyclic graph. Around 26% of women reported that their last pregnancy (occurring within the previous 3 years) that ended with a live birth was unintended at conception. Only 42% reported having a skilled birth attendant present at their last birth and 38% gave birth in a health care facility. Significant differences were found across pregnancy intention. Lower odds of skilled birth attendance (OR, 0.70, 95% CI, 0.52–0.93) and delivery in a health care facility through skilled providers (OR, 0.65, 95% CI, 0.48–0.89) were found among women who had an unwanted pregnancy relative to women who had a wanted pregnancy. However, a mistimed pregnancy was not found to be associated with skilled birth attendance or delivery in health care facility through skilled providers. Increased availability of health care facilities at the community level is required in Bangladesh to ensure skilled delivery care for women with an unwanted pregnancy. Policies are also required to integrate women with an unwanted pregnancy into mainstream health care services through earlier detection and increased awareness in order to reduce the adverse maternal and fetal outcomes associated with lack of quality birthing care.

Keywords

Unintended pregnancySkilled birth attendanceBangladesh
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 5 , September 2021 , pp. 773 - 789
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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