Discipline of Paediatrics, School of Clinical Medicine, University of New South Wales, Sydney, Australia; Biomedical Research Foundation, Dhaka 1230, Bangladesh.
Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh.
Midwifery. 2022 Oct;113:103425. doi: 10.1016/j.midw.2022.103425. Epub 2022 Jul 6.
Despite a significant decline over time, maternal mortality remains high in Bangladesh. Institutional delivery during childbirth is crucial to reducing maternal mortality, but uptake of institutional delivery services (IDS) remains suboptimal in Bangladesh. Though women's education plays a crucial role in the use of IDS, the educational status of the household head and area-level literacy rate also appear to act as predictors of IDS uptake. This study aims to assess the effect of the educational status of women and household heads as well as district-level adult literacy rates on the use of IDS during childbirth among women in Bangladesh.
This study analyzed nationally representative cross-sectional survey data from the 2019 Bangladesh Multiple Indicator Cluster Survey.
Bangladesh.
9,207 currently married women aged 15-49 years who had at least one live birth in the two years preceding the survey were included in the study. The outcome measure was women's use of IDS during their last childbirth. A multilevel logistic regression model was used to explore the association between education status of women and household heads, and district (i.e., area unit) adult literacy rates and uptake of IDS among women in Bangladesh by controlling for other sociodemographic covariates and clustering.
About 53% of women used IDS during childbirth. Adjusting for other factors and clustering, women with higher educational status, those living in households with higher-educated heads, and those in districts with greater adult literacy rates are more likely to use IDS, after controlling for key sociodemographic variables including wealth.
Uptake of IDS in Bangladesh remains low, with education playing an important independent role in determining rates. The findings of the study provide empirical evidence for policymakers to design multi-modal educational programs targeted not only at literate women but also at household head (especially male) and communities where literacy (and equally importantly health literacy) may be variable or absent.
尽管孟加拉国的产妇死亡率呈显著下降趋势，但仍居高不下。分娩时的机构分娩对降低产妇死亡率至关重要，但孟加拉国的机构分娩服务（IDS）的利用率仍不理想。尽管妇女的教育在使用 IDS 方面起着至关重要的作用，但家庭户主的教育程度和地区识字率似乎也可以作为 IDS 利用率的预测因素。本研究旨在评估妇女和家庭户主的教育状况以及地区成人识字率对孟加拉国妇女分娩时使用 IDS 的影响。
本研究分析了来自 2019 年孟加拉国多指标类集调查的全国代表性横断面调查数据。
孟加拉国。
9207 名年龄在 15-49 岁之间、在调查前两年至少生育过一次活产的已婚妇女被纳入研究。因变量为妇女在最后一次分娩时使用 IDS 的情况。使用多水平逻辑回归模型，在控制其他社会人口学协变量和聚类的情况下，探讨妇女和家庭户主的教育状况、地区（即地区单位）成人识字率与孟加拉国妇女 IDS 利用率之间的关系。
约有 53%的妇女在分娩时使用 IDS。在调整其他因素和聚类后，那些教育程度较高的妇女、生活在户主受教育程度较高的家庭中的妇女以及所在地区成人识字率较高的妇女，在控制了包括财富在内的关键社会人口学变量后，更有可能使用 IDS。
孟加拉国 IDS 的利用率仍然很低，教育在决定利用率方面起着重要的独立作用。该研究的结果为政策制定者提供了经验证据，以便设计针对不仅识字妇女而且针对户主（特别是男性）和识字率（同样重要的是健康素养）可能存在差异或缺失的社区的多模式教育计划。
