Exploring the factors contributing to increase in facility child births in Bangladesh between 2004 and 2017–2018

BACKGROUND: Although Bangladesh has gained rapid improvement in births at health facilities, yet far behind to achieve the SDG target. Assessing the contribution of factors in increased use of delivery at facilities are important to demonstrate. OBJECTIVE: To explore the determinants and their contribution in explaining increased use of facility child births in Bangladesh. PARTICIPANTS: Reproductive-aged women (15–49 years) of Bangladesh. METHODS AND MATERIALS: We used the latest five rounds (2004, 2007, 2011, 2014, 2017–2018) of Bangladesh Demographic and Health Surveys (BDHSs). The regression based classical decomposition approach has been used to explore the determinants and their contribution in explaining the increased use of facility child birth. RESULTS: A sample of 26,686 reproductive-aged women were included in the analysis, 32.90% (8780) from the urban and 67.10% (17,906) from the rural area. We observed a 2.4-fold increase in delivery at facilities from 2004 to 2017–2018, in rural areas it is more than three times higher than the urban areas. The change in mean delivery at facilities is about 1.8 whereas, the predicted change is 1.4. In our full sample model antenatal care visits contribute the largest predicted change of 22.3%, wealth and education contributes 17.3% and 15.3% respectively. For the rural area health indicator (prenatal doctor visit) is the largest drivers contributing 42.7% of the predicted change, hereafter education, demography and wealth. However, in urban area education and health contributed equally 32.0% of the change followed by demography (26.3%) and wealth (9.7%). Demographic variables (maternal BMI, birth order, age at marriage) contributing more than two-thirds (41.2%) of the predicted change in the model without the health variables. All models showed more than 60.0% predictive power. CONCLUSION: Health sector interventions should focus both coverage and quality of maternal health care services to sustain steady improvements in child birth facilities.