Trends and Inequities in the Continuum of Care for Maternal Healthcare Services in Bangladesh: A National and Subnational Analysis.

Background: Ensuring a continuum of care in accessing antenatal to postnatal healthcare services is crucial for improving maternal and child health outcomes. This study aims to explore trends in the continuum of care over the years, both nationally and across regions; to provide district-level estimates; and to examine socio-economic disparities and determinants of continuum of care uptake in Bangladesh.

Methods: A total of 28,260 samples were analysed. Continuum of care was considered as the outcome variable. District, wealth index, and several socio-demographic factors were included as explanatory variables. Trends of the continuum of care estimates were illustrated over survey years using descriptive statistics. Additional exploration of inequality was conducted across wealth quintiles, educational attainment and urban-rural residence through Equiplot. Finally, a multilevel multinomial logistic regression model was used to assess the factors associated with continuum of care.

Results: The study revealed a significant increase in the highest level of continuum of care, rising from 6.0% in 2004 to 30.5% in 2017/2018, before declining to 24.8% in 2022. However, notable dropouts from the continuum of care were observed, particularly during the transitions from Antenatal Care to Skilled Birth Attendant and from Skilled Birth Attendant to postnatal Care. The analysis also identified district-level variations, urban-rural disparities and differences across wealth quintiles. Maternal socio-demographic characteristics, such as higher education and belonging to a higher wealth quintile, were associated with increased likelihoods of achieving moderate to the highest levels of continuum of care. In contrast, higher parity and rural residence were associated with lower likelihoods of attaining these levels of care.

Conclusion: The findings underscore substantial progress in maternal healthcare services uptake in Bangladesh over the years, alongside persistent challenges in ensuring continuous care throughout the maternal healthcare continuum and district-level variations. Addressing district-level disparities and socioeconomic inequalities is crucial, necessitating tailored, area-specific policies and programmes to achieve universal access to quality maternal healthcare services across the country.