The Relationship of Socioeconomic Status, Antenatal Care Visits, and Hospital Delivery in Bangladesh: Analysis of Demographic and Health Survey 2022

Bangladesh and many other low- and middle-income countries experience a high number of maternal and neonatal deaths; antenatal care (ANC) and hospital delivery are crucial to reducing these deaths. In this cross-sectional study, we investigated the relationship of socioeconomic status with at least 4 ANC visits and hospital delivery in Bangladesh. We also tested whether antenatal care mediated the association of socioeconomic variables and facility delivery. We used data from the Bangladesh Demographic and Health Survey 2022. After descriptive analysis, generalized structural equation modeling was used to investigate the associations. A total of 4,950 women were included in the analysis (mean age: 25.7 years, 73.2% rural). The proportion of women with at least 4 ANC visits and hospital delivery was 39.8% and 64.4%, respectively. In adjusted analyses, all socioeconomic variables had significant associations with at least 4 ANC visits and hospital delivery. For instance, compared to women with the poorest wealth quintile, those with poorer (adjusted odds ratio (AOR): 1.26, 95% confidence interval (CI):1.02-1.55), middle (AOR: 1.43, 95% CI: 1.16-1.77), richer (AOR: 1.98, 95% CI: 1.59-2.45), and richest (AOR: 3.12, 95% CI: 2.45-3.99) wealth quintiles higher odds of at least 4 ANC visits. Similarly, for hospital delivery, compared to women with the poorest wealth quintile, those with poorer (AOR: 1.44, 95% CI: 1.19-1.75), middle (AOR: 1.82, 95% CI: 1.48-2.24), richer (AOR: 2.48, 95% CI: 1.98-3.10), and richest (AOR: 3.90, 95% CI: 2.94-5.18) wealth quintiles higher odds. Women with at least 4 ANC visits, had more than two times higher odds of hospital delivery (AOR: 2.56, 95% CI: 2.20-2.97). When we looked into the mediation, at least 4 ANC visits mediated 60.5%, 34.6%, and 41.1% of the relationships of womens education, husbands education, and household wealth with hospital delivery, respectively. Considering the lower utilization of at least 4 ANC visits and its mediating impact on the relationship between socioeconomic status and facility delivery, more community-based programs are required to increase awareness about at least 4 ANC visits and hospital births.