Factors Associated with the Non-Utilization of Maternal Health Services in Bangladesh: A Multilevel Analysis

Background: Although maternal mortality is considered preventable, it takes
thousands of mothers’ lives each year. Maternal mortality can be reduced by
minimizing the non-utilization of maternal health care services (MHCS).
Objective: This study’s primary goal was to identify the factors associated
with MHCS (i.e., Antenatal Care (ANC), Skilled Birth Attendance (SBA), and
Postnatal Care (PNC)) non-utilization in Bangladesh using multi-level analysis.
Methods: This study performed univariate, bivariate, and multivariate analyses
with Bangladesh Demographic and Health Survey 2014 data. Under multivariate
analysis, two-level binary logistic regression and the random slope were tested.
Results: A total of 4473 women who had at least one birth history were
included in this study. Among the individual characteristics, women’s
education, wealth status, media exposure, total children, body mass index, and
household head sex showed significant association with all forms of MHCS (i.e.,
ANC, SBA, and PNC) non-utilization. Place of residence, poverty, and media
concentration are significant community characteristics for different phases of
MHCS non-utilization. Media exposure is the only individual-level factor whose
effect randomly varies across communities for all three phases of MHCS
non-utilization.
Conclusion: Policymakers should focus on women’s individual-level and
community-level characteristics to ensure the least MHCS non-utilization,
resulting in reduced maternal mortality

• Supervision