Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?

Despite a central element of the Millennium Development Goals (MDGs), the progress in making pregnancy and childbearing safer for women has been slow in many developing countries. Though Bangladesh has achieved commendable progress in reducing maternal mortality in recent decades, the country faces pervasive inequity in antennal (ANC) and delivery care services. The purpose of this study is to provide recent estimates of trend in inequity in antenatal and delivery care services in Bangladesh during 2004-2011. We employ rich-poor ratio, concentration curve and concentration index to examine the trends of inequities in ANC and delivery care services using the latest three waves of Bangladesh Demographic and Health Survey. This study uses logistic regression analysis to investigate the relationship between socioeconomic factors and six indicators of ANC and delivery care. Concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 while it remained around 0.20 for receiving ANC from medically trained provider. Findings indicate that inequity in delivery at health facility and delivery by caesarean section decreased by about 33% in between 2004 and 2011. Women from the richest households were about 3 times more likely to have 4+ ANC visits (OR=2.91, 95% CI: 2.24-3.78), delivery at health facility (OR=3.16, 95% CI: 2.40-4.17), and skilled assistance at birth (OR=3.32, 95% CI: 2.51-4.38) compared to women from the poorest households. There was an overall progress in reducing inequity in utilization of maternal health care but rural area lagged behind to achieve equity compared to urban area. The evidence of inequity in maternal health care utilization highlights that the country faces not only a persistent equity gap between rich and poor women but also substantial rural-urban inequity. It is essential to design multi-sectoral and concerted interventions from an equity perspective to accelerate safe motherhood and childbirth in Bangladesh.