Determinants of Increased Maternal Healthcare Utilization in Bangladesh, 1993-2007

Rifat Hasan, World Bank Group
Kenneth Hill, Harvard University
Michael Reich, Harvard University
Guenther Fink, Harvard School of Public Health

DHS data are analyzed to assess the determinants of skilled attendance at birth, delivery in a health facility and antenatal care coverage in Bangladesh. Multilevel random effects logistic regression analysis is used to identify the factors that influence use of services, and decomposition analysis is used to quantify the relative importance of each in explaining the increases in utilization between 1993 and 2007. A strong socioeconomic gradient is evident with more educated and better-off women using services more over time than less educated and poor women. The findings also suggest that if facilities and medical professionals are available and accessible, then there is a higher likelihood of services being used. However, the model is limited in its ability to adequately quantify a health system effect. The decomposition analysis indicates that increases in maternal healthcare service utilization between 1993 and 2007 are explained primarily by improvements in education and household wealth.