Individual and Community - Level Factors Associated with Skilled Birth Attendants during Delivery in Bangladesh: A Multilevel Analysis of Demographic and Health Surveys

Background: Skilled birth attendants (SBAs) are crucial to reducing infant and maternal mortality. Although the ratio of skilled assistance at birth increased in Bangladesh, factors associated with SBA are not known. The main goal of our study was to reveal the individual and community level factors associated with SBA during childbirth in Bangladesh. We also showed the prevalence and trend of SBAs and related independent variables in Bangladesh over the last decade.

Methods: This study utilized the cross-sectional data of the Bangladesh Health and Demographic Survey (BDHS) 2017-18. We used binary logistic regression to examine the extent of variation in the SBA attributable to the community level and individual-level variables.

Results: In Bangladesh, 53.35% of women received SBAs during childbirth. The average annual rate of increase (AARI) of SBAs over the last ten years was 8.88%. Respondents who gave birth at 19 years or greater had 1.40 (AOR = 1.40; 95% CI: 1.21 - 1.62) times more odds to have skilled delivery assistance. Women and their husband’s education showed a significance association towards skilled assistance during delivery with odds 1.60 (AOR = 1.60; 95% CI: 1.45 - 2.01) and 1.41 (AOR = 1.41; 95% CI: 1.21 - 1.66) respectively. Women from rich families and higher antenatal care (ANC) visits were more likely to have professional delivery assistance. Community-level factors also showed some significance towards having professional help while giving birth. Women from urban communities, who utilized >4 ANC visits, and completed secondary or higher education showed a greater tendency to use SDA during childbirth than their counterparts.

Conclusion: SBAs during delivery were significantly associated with some individual and community level factors. To reduce maternal and child mortality, there is a need to focus on the rural and uneducated people who are less likely to get these facilities. Special programs could be conducted to increase awareness and help the poor community get the minimum facility of maternal care.

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