|Year : 2022 | Volume
| Issue : 1 | Page : 10-17
Socioeconomic and demographic factors for mothers' delivery at home: A comparative study among BDHS 2007, 2011 and 2014
Ashis Talukder1, Bayezid Hasan Anik1, Md Ismail Hossain2, Iqramul Haq3, Md Jakaria Habib2
1 Statistics Discipline, Khulna University, Khulna, Bangladesh
2 Department of Statistics, Jagannath University, Dhaka, Bangladesh
3 Department of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
|Date of Submission||03-Nov-2021|
|Date of Decision||12-Jan-2022|
|Date of Acceptance||18-Jan-2022|
|Date of Web Publication||25-Feb-2022|
Statistics Discipline, Khulna University, Khulna-9208
Source of Support: None, Conflict of Interest: None
Introduction: Although Bangladesh has made some significant progress in the health sector, home delivery of pregnancy is still a widespread tradition in Bangladesh. The objective of this study was to find the effects of sociodemographic factors associated with mothers' delivery at home utilizing the data extracted from the three Bangladesh Demographic and Health Survey (BDHSs) conducted in 2007, 2011, and 2014. Methods: The present study was based mainly on the three BDHSs conducted in 2007, 2011, and 2014, which used a two-stage stratified sampling design for data collection purposes. For the analysis purpose, frequency distribution and multivariate logistic regression were considered. Results: The prevalence of home delivery among Bangladeshi mothers had dropped from 82.60% in 2007 BDHS to 64.17% in 2014 BDHS. In general, older mothers at their first birth, highly educated mother and father, women from the richest household, women who take 4 + ANC (Antenatal Care Service), and women who accessed media were a lower chance of home delivery than their counterparts. The study also showed moderate advancement in the use of institutional conveyance care among mothers in Bangladesh during 2007, 2011, 2014 BDHSs. Large variations in outcome measures were observed between rural and urban areas. Conclusion: Our research convincingly confirms that Bangladesh's delivery system implementation level is improving day by day, but the Sustainable Development Goals goals are still far from being achieved. Therefore, to overcome this problem, policymakers must take effective measures to improve maternal education level, wealth status, and maternal health-care service, including family planning.
Keywords: Bangladesh, delivery place, logit model, trend
|How to cite this article:|
Talukder A, Anik BH, Hossain MI, Haq I, Habib MJ. Socioeconomic and demographic factors for mothers' delivery at home: A comparative study among BDHS 2007, 2011 and 2014. Asian J Soc Health Behav 2022;5:10-7
|How to cite this URL:|
Talukder A, Anik BH, Hossain MI, Haq I, Habib MJ. Socioeconomic and demographic factors for mothers' delivery at home: A comparative study among BDHS 2007, 2011 and 2014. Asian J Soc Health Behav [serial online] 2022 [cited 2022 May 19];5:10-7. Available from: http://www.healthandbehavior.com/text.asp?2022/5/1/10/338377
| Introduction|| |
Worldwide, 303,000 women die each year (approximately 830 women/day) in childbirth or from pregnancy-related complications. The weight is most noteworthy in Africa, trailed by the South Asian area. The uniqueness between maternal mortality in underdeveloped and well-developed nations is striking, practically all maternal deaths (approximately 99%) occur in low-wage nations, such as Nigerian India, Ethiopia, Pakistan, Bangladesh, and so on.,, The World Health Organization (WHO) has recognized the significant reasons for maternal mortality; these are extreme discharge (25%), contamination (15%), eclampsia (12%), discouragement work (8%), and risky premature birth (13%). In any case, the majority of these deaths could be avoided by looking for ideal considerations during pregnancy and the presence of a skilled birth attendant during the delivery of the baby.,,
Over the past two decades, Bangladesh has made significant gains in health, education, and other aspects of socioeconomic development. The government of Bangladesh has gained surprising ground in achieving Millennium Development Goals 4 and 5 and has reduced the maternal mortality proportion (MMR) from 322 to 194 per 100,000 live births. The average rate of decline, in this case, was 3.3% per year. The Government of Bangladesh focused on achieving MMR 143 deaths per 100,000 live births by increasing health-care facilities during pregnancy and delivery, especially trained birth attendant, ensure at least four ANC visits, and so on. Most of the conveyances happen at home (62%), and over 56% of conveyances are helped by conventional birth orderlies traditional birth attendant or relatives while restoratively prepared faculty direct just 42% of all births, both at home and in offices at the public level.
The improvement in the maternal and child health situation in Bangladesh is not uniform across the country. For example, approximately 36% of pregnant women received no antenatal care from skilled providers and this rate was higher in rural residences (41%) than in urban residences (21%) in Bangladesh. A recent report from the Bangladesh Demographic and Health Survey (BDHSs) 2014 showed that only 64% of pregnant women receive antenatal care from suppliers prepared therapeutically and women who did not look for ANC believed that registration was not required. These poor health facilities, low coverage of antenatal care are obstacles to reducing maternal mortality in Bangladesh. Hence, it is important to focus on the maternal health sector and important to determine the effects of risk factors.
The main objective of this study was to identify the factors that influence the delivery process in Bangladesh using secondary data adopted from the BDHSs. This study is a comparative study that can be performed to assess risk factors that have significant effects on mother's delivery at home in Bangladesh. Therefore, the main aim of our study was to find out the effects of sociodemographic factors associated with mothers' delivery at home using the data extracted from the three BDHSs conducted in 2007, 2011, and 2014.
| Methods|| |
The study used nationally representative secondary data from the fifth, sixth, and seventh programs of the BDHS, 2007, 2011, and 2014. The data are publicly available for research. BDHS is based on two stage-stratified cluster sampling of households. In the first stage of the survey, predetermined numbers of enumeration area (EA) were selected with probability proportional to EA size, and then in the second stage of the survey, a systematic sampling procedure was used to select an average number of households per EA to collect the information.
Sample size and sampling method
The data come from seven divisions: Barisal, Chattogram, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. The size of the division varies from 5.6% (Sylhet, the smallest) to 33.7% (Dhaka, the largest). In Bangladesh, 23.3%of the households are in urban areas; 8.2% are in city corporations, and 15.1% are in other than city corporations.,,
The survey used the list of the enumerated area (EA) of the Bangladesh population and housing census in 2011 provided by the Bangladesh Statistics Office (BBS). In the first stage, the Enumerated Areas (EAs) were selected with probability proportional to the size of the EA and with independent selection in each sampling stratum with the allocation of the sample. In the second stage, households were selected from each EA.
The BDHSs covered 10,819, 17,964, and 17,989 residential households from 2007, 2011 to 2014, respectively. Among them, 10,996 women between the ages of 15 and 49 (for BDHS, 2007); 17,842 women between the ages of 15 and 49 (for BDHS, 2011); and 17,863 women between the ages of 15 and 49 (for BDHS, 2014) were successfully interviewed. The yield response rate for 2011 and 2014 BDHS had the same (98%), while in 2007 BDHS had 98.2%.
We have used the Kids Recode data set, as it contains information on the place of delivery of the mother at the time of the interview from ever-married women aged 15–49 years. After weighted the original data set, we got a data set with a total of 4598 observations in BDHS-2007, 6335 observations in BDHS-2011, and 8092 observations in BDHS-2014. The data weighted for this research purpose were provided with the BDHS and the final sample size for this study is from several BDHSs were 4598 observations in BDHS-2007, 6335 observations in BDHS-2011, and 8092 observations in BDHS-2014.
One of the main purposes of our study is to determine the factors associated with the place of delivery of mothers. Therefore, our main variable of interest is the delivery of mothers at home. Hence, we classified our response variable as “Yes” or “No.”
In our study, a set of sociodemographic risk factors associated with mothers' delivery at home were considered covariates. As for our study, Mother's age at first birth (15–24 years, 25–34 years, 35–49 years), Region (Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Sylhet, Rangpur), Place of residence (Urban, Rural), Mother's education (No education, Primary, Secondary, and Higher education), Father's education (No education, Primary, Secondary, and Higher education), Wealth index (Poorest, Poorer, Middle, Richer, Richest) (Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, and housing characteristics such as the source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual [de jure] household member, ranking each person in the household population by her or his score, and then dividing the distribution into five equal categories, each comprising 20% of the population). The number of living children (0, 1–2, 3+), Family size (Small (1–4), Medium (5–6), Large (7+)), ANC visit (0, 1–3, 4+), Religion (Islam, Hinduism, and others), Media access (No, Yes) were selected as potential risk factors for mother delivery at home in this analysis.
Simple descriptive analysis, bivariate and multivariate statistical analyses were performed to achieve different objectives in this analysis. The distribution of frequencies and percentages was calculated using descriptive statistics. In terms of the bivariate section, we applied the Chi-squared test to examine to assess the association between mother delivery at home with selected covariates. For multivariate analysis, we have fitted the binomial logit model, which is a model for multi-categories nominal response. An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. The result was presented as OR and 95% confidence interval (CI).
The data were complied with, tabulated and analyzed under the objectives of the study. An elaborate and constructive analysis was made using the following recognized software are Stata (version 13.1; Stata Corp., College Station, Texas, USA). MS Excel (Microsoft Corporation, Redmond, Washington, United States).
This study depends on secondary dataset collected by NIPORT (Bangladesh) and MEASURE DHS. Every legitimate strategy was performed including human participants as per the moral norms of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The information records are unreservedly accessible from the website: www.dhsprogram.com. We got approval from the DHS program for utilizing the applicable datasets for this investigation. Ethical clearance for the BDHS 2007, 2011, and 2014 data collection was taken from the ICF International's Institutional Review Board (IRB).,, This survey confirmed international ethical standards of anonymity, confidentiality, and informed con-sent 28. A letter of data authorization was taken from the Demographic and Health Surveys (DHS) Program, ICF International. Furthermore, we have the approval of the IRB Findings Form ICF IRB FWA00000846 (Approval date: “March 11, 2015, Approval number: 132989.0.000).
| Results|| |
[Table 1] shows the percentage distribution of women in each category of the selected variables in three BDHS surveys of Bangladesh. It was observed that the percentage of mother's delivery places at home were 82.60% in the year 2007, 77.54% in the year 2011, and 64.17% in the year 2014. Home delivery thus decreased over time in Bangladesh. Most of the mothers were in the age group of 15–24 years with a percentage of 39.93%, 37.77%, and 35.51% in the years 2007, 2011, and 2014, respectively. In terms of region, 17.18% of mothers were from Dhaka in 2007 while in 2011 and 2014, 15.36% and 12.84% of mothers were from Chittagong, respectively. On the other hand, the percentages of the mother were low in all three surveys in the Khulna region (9.20%, 7.56%, and 5.34%, respectively). Percentages of women from rural areas were higher among different BDHS surveys from 2007 to 2014. Regarding mother's education, the highest percentage (29.25%) of mothers had completed their primary education in 2007, 30.78%, and 29.34% of mothers had completed their secondary and higher education in 2011 and 2014, respectively. 23.31%, 24.01%, 20.51% of the father were completed secondary or higher education in 2007, 2011, and 2014 respectively. In our study, the lowest percentage of respondents were from the richest families (11.46%, 7.88%, and 5.02% from 2007, 2011, to 2014, respectively). Most of the women had 1–2 living children and were from Muslim families. From the 2011 to 2014 surveys, we found that 28.81% and 23.57% of mothers were from medium-size family respectively. In 2007 and 2011, 37.71% and 34.16% of mothers did not visit for any ANC, but in 2014, the percentage decreased to 21.09. The percentage of mothers who did not have access to the media was higher among the different BDHS surveys from 2007 to 2014.
|Table 1: Distribution of women in each category of the selected variables in three Bangladesh demographic and health survey surveys of Bangladesh|
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[Table 1]. Distribution frequency of women SDH characteristics of studied participants.
To assess the adjusted effects of the selected risk factors on mother delivery at home in each survey point, we considered separate three binary logistic regression models and the results are demonstrated in [Table 2]. It is observed from [Table 2] that mothers who were aged between 25 and 34 years at their first birth had 0.638 times lower odds and mother's aged 35–49 years have 0.354 times lower odds of home delivery compared to the mother's aged 15–24 years based on 2007. In 2011, mothers aged 25–34 years had 0.695 times lower odds and mothers aged 35–49 years had 0.468 times lower odds of home delivery compared to mothers aged 15–24 years. According to BDHS 2014, mothers aged 35–49 years had a 0.452 times lower chance of home delivery compared to mothers aged 15–24 years. Evidence from the three surveys showed that Khulna and Rajshahi women had significantly lower odds of home delivery compared to those from the Barisal division. For residence in all three surveys, rural women had higher odds of home delivery than urban women. For example, the result indicates that in 2011 BDHS (OR = 1.596) had significantly highest odd home delivery among women living in rural areas followed by 2014 BDHS (OR = 1.457) and 2007 BDHS (OR = 1.45) compared to urban women in Bangladesh.
|Table 2: Multivariable logistic regression for mothers' delivery at home|
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With regard to mother education, women who attained secondary and above education had more chance of getting home delivery than women having no education. For example, the 2007 BDHS result showed that secondary and higher educated mothers had lower odds of home delivery (OR = 0.235) compared to mothers without education. In addition to husband education in all three surveys period, the odds of home delivery were lower among the secondary and higher educated husbands than among women whose husbands had no formal education. In 2014, women whose husbands having secondary and higher education were a 43.3% lower chance of getting home delivery compared to husbands having no formal education.
Mothers who belonged to the richest families were 60.2%, 75.9%, and 82.8% less likely (P < 0.001) to have home deliveries in 2007, 2011, and 2014, respectively, than respondents from the poorest families. Furthermore, for the last two surveys (BDHSs 2011 and 2014), the chance of home delivery increases with the higher number of living children. The women with more than 3 children were more prone (OR = 3.967, CI: 2.043–7.703, P < 0.001) to home delivery as compared to those with 0 living children. Among the ANC visits, the result suggested that women who received a higher number of antenatal care visits from private facilities had a lower chance of home delivery in all three surveys periods. Furthermore, for the first two surveys (2007 and 2011 BDHS), Hinduism and other religious mothers had fewer odds of home delivery done than Muslim women. In our study, we find that respondents who have media access at least once a week have 0.825 times lower chances of home delivery compared to respondents who have not media access at least once a week based on 2011.
Multivariable logistic regression for mothers' delivery at home [Table 2].
| Discussion|| |
In this study, data from three consecutive national surveys (2007, 2011, and 2014 BDHSs) were used to identify risk factors for home delivery for Bangladeshi women. Factors included in this study were mother's age at first birth, region, residence, mother's education, father's education, wealth index, number of living children, family size, ANC visit, religion, media access, and the outcome variable of interest was a place of delivery in the last birth. In 2018, the research found that some factors like having more than two children, mothers with no education, living in rural areas, and poor families were significant effects on mothers' home delivery.
The study found that in 2007, about 82.60% of mothers gave birth at home, and in 2014, about 64.17% of mothers gave birth at home. This result shows that the number of deliveries in hospitals is on the rise. This improvement may be due to the Bangladesh government's greater emphasis on reducing maternal mortality due to pregnancy complications. The study of rural areas of Bangladesh observed that the cesarean section increased almost 21.3%, from 2.7% in 2000 to 24% in 2014.
This analysis found that older mothers aged 25–34 years and 35–49 years had a lower chance of delivery at home than adolescent mothers aged 15–19 years. The findings of this study are well aligned with those of a previous study conducted in Bangladesh and showed that cesarean section delivery was more often in older mothers than in adolescent mothers aged 15–19 years.
Place of residence is an important factor for home delivery in all three surveys. Rural women were more likely to give birth at home than urban women. Some previous studies have also shown the same explanation for rural residential areas.,,, According to these studies, women living in urban areas have a better childbirth experience than women in rural areas.
In this analysis, a negative association was found between mother home delivery and the level of education of both mother and her partners in all three surveys. Earlier studies investigating factors associated with place of delivery reported that the education status of both mothers and fathers was as significant risk factor associated with mothers' home delivery. The education level of mothers and their partners is largely related to home delivery. This result is consistent with various studies conducted in Ethiopia., A well-educated mother is unlikely to give birth at home. Since they are more aware of the dangers of pregnancy and the benefits of institutionalized childbirth services. This result is consistent with another study.,, A study conducted in Nepal showed that education for women acts as a crucial factor in decision-making about delivery. Education can promote gender equality, increase earning potential, and contribute to changing societal norms around delivery locations. Due to a lack of knowledge, people in the community do not want to go to a facility for delivery. They do not have the right information about the appropriate place for delivery as well as the demerits of home deliveries. Husband's educational status was another factor significantly associated with the delivery place.
The current study revealed that a negative association was between the delivery of the mother at home and the wealth status of the mother in the three survey periods in Bangladesh. Concerning the family wealth status, it has been noted that women from the richest households are less prone to be home delivered than women of poor quantile in Bangladesh. This finding was supported by the study in Nepal. There may be a reason for this finding. Health institutional cost may be an important factor that women in the richest families can afford. This result is consistent with research conducted in Ethiopia.
The present study demonstrated that there was a positive association between mothers' home delivery and the number of living children. One study conducted in rural coastal areas of Kenya found a similar result and they observed that those women who had 2 or more children had more chance of getting home delivery done than the women who had only one child.
ANC is the best place to contact mothers to understand the risks and challenges they may face during childbirth. The WHO recommends that women without complications have at least four antenatal visits, the first of which should take place during the first trimester. Our research found a strong correlation between prenatal check-ups and home delivery. Consistent results were found in research conducted in Ethiopia. Women who receive four or more prenatal benefits are less likely to give birth at home. This finding is consistent with many other studies. Another Ethiopian study found that women who regularly attend pregnancy week are more likely to give birth in medical institutions.
Compared to nonmuslim families, Muslim families have a higher home delivery rate, and these results are directly consistent with previous results. The largest number of people believe in religious restrictions, conservatism, and believe that it would be a major sin for male doctors to treat women in society.
Our analysis found that there was a significant association between women who gave birth at home and women exposed to the media, and indicated that women exposed to the media were less likely to give birth at home. A similar study in Pakistan also described exposure to mass media as an important driver of institutional delivery. The media can inform women about pregnancy and its complications. This finding is consistent with other studies in Ethiopia, Ghana, Indonesia, and India and others.,,
We use data from BDHS, 2007, 2011, and 2014. In these data, there were some missing values and we cleaned these missing values. Furthermore, we could not include all the factors (such as respondent's workplace, body mass index, etc.) related to the birthplace of the mother due to these missing values. Hence, our analysis would be better if there were no missing values. Furthermore, some influencing factors were not available in BDHS, 2007, 2011, and 2014. The DHS data for Bangladesh were based on the participant's self-report with no scope of validation by the interviewers and could suffer from the report or recall bias. Finally, we have faced several problems; such as limited time, lack of manpower and shortage of money.
| Conclusion|| |
The study showed that even after 10 years (2004–2014) there was no such improved situation of deliveries at home. In this study, we tried to identify and determine the covariates of the mother's delivery place. Binary logit model, which is a model for multicategories nominal response was incorporated to assess the different factors. To identify the significant determinant bivariate analysis of Chi-square was applied to check the association between mother's delivery place and various socioeconomic and demographic factors. The potential covariates which influence mother's delivery place are found and they are: mother's age at first delivery, region, place of residence, mother's education, father's education, wealth index, no. of living children, family size, ANC visit, religion, media access at least once a week. These are vital factors for the fluctuation from the mother's delivery place.
In our study, we have used BDHS 2007, 2011, 2014 data. We find out that some socio-economic factors like mother's age at first birth, place of residence, religion, mother's and father's education level are key factors. From the binary logit model, it was found that mothers having 3 + children have 3.967 times and 3.387 times high chances on home delivery based on 2011 and 2014, respectively, compared to mothers who have not had any children before. ANC visiting is also significant factor for the choice of delivery place.
In a nutshell, we need to grow awareness among people. Mothers from rural places need to be more aware about their pregnancy period. Most importantly, mother's education level and access to the media, the visit to the ANC are the key reason for our concern. Since many mothers and babies died during delivery. For this reason, the delivery place is very much important issue a developing nation like us. Finally, according to our study, we can say that mothers from the urban region, less educated mothers need to be more careful for their delivery. Otherwise, the whole nation will suffer in the long run.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]