Spatiotemporal variations in the prevalence and determinants of maternal delivery at home in Bangladesh, 2012-2022: A population-based cross-sectional study

BackgroundDespite significant progress in reducing maternal and neonatal mortality, home delivery remains a substantial public health challenge in Bangladesh and many other low- and middle-income countries. While the proportion of home deliveries has markedly decreased in the past decade, pronounced disparities persist across geographic, socioeconomic, and demographic groups. A nuanced understanding of the prevalence and determinants of maternal home delivery is key to designing targeted interventions. This study examines national and subnational variations in maternal home delivery and associated factors in Bangladesh. MethodsWe analyzed data from the Multiple Indicator Cluster Surveys (2012-13 and 2019) and the Bangladesh Demographic and Health Survey (2022), covering 20,770 ever-married women aged 15-49 who gave birth in the preceding two years. District-level prevalence, descriptive statistics, and multivariable logistic regression were used to assess trends and determinants. ResultsHome delivery prevalence declined from 68% in 2012-13 to 35% in 2022. Disparities remain: divisions such as Barisal (48.9%), Chattogram, Sylhet, and Mymensingh showed higher rates, while Dhaka and Khulna had the lowest. At the subnational level, remote areas like Bandarban, Rangamati, and Bhola exhibited higher prevalence. The logistic regression analysis identified several significant predictors, such as women with no formal education, limited ANC visits ([≤]3), rural residence, lower wealth status, multiparity ([≥]3 children), and lack of media exposure were more likely to deliver at home. ConclusionsDespite marked improvement, persistent geographic and socioeconomic inequities highlight the need for targeted interventions. Strengthening healthcare infrastructure in underserved regions, promoting maternal health awareness, scaling up ANC utilization, and reducing financial barriers through subsidies and incentive programs can help further decrease home deliveries. Future research should explore cultural and religious factors to inform context-specific policies for equitable facility-based childbirth.