Exploring the factors behind the shift in unwanted childbearing rate in Bangladesh between 2007 and 2017/2018: a cross-sectional study

OBJECTIVES: This study aimed at exploring the factors associated with the reduction in the proportion of women reporting unwanted births in Bangladesh between 2007 and 2017/2018. DESIGN AND SETTING: A cross-sectional analysis of the data collected by the 2007 and 2017/2018 Bangladesh Demographic and Health Surveys by using a two-stage stratified sampling covering the entire population in Bangladesh. PARTICIPANTS: Our analysis included 4810 (2007) and 7403 (2017/2018) weighted ever-married women aged 15–49 years reporting at least one birth in the 5 years preceding each of the surveys. RESULTS: The proportion of women reporting unwanted births declined by 26.2% between 2007 and 2017/2018. Overall changes in women’s behaviour and their proportions with distinct characteristics explained 66.2% (0.051 points decrease, 95% CI −0.071 to –0.031, p<0.001) and 45.5% (0.035 points decrease, 95% CI −0.051 to –0.019, p<0.001) of the overall reduction in the proportion reporting unwanted births, respectively. Behavioural changes among those being visited by family planning (FP) workers (0.004 points decrease, 95% CI −0.008 to –0.000, p=0.047), having complete secondary education or higher (0.009 points decrease, 95% CI −0.016 to –0.003, p=0.002), and earning in kind (0.002 points decrease, 95% CI −0.005 to –0.000, p=0.035) were associated with a reduction in unwanted childbearing. Increases in the proportions of women married at age 18 or older (0.008 points decrease, 95% CI −0.010 to –0.005, p<0.001), and having some secondary education (0.013 points decrease, 95% CI −0.019 to –0.008, p<0.001) were negatively associated with unwanted childbearing. Conversely, an increase in the proportion expressing preference for a balanced sex composition of the family was positively associated with unwanted childbearing (0.013 points increase, 95% CI 0.008 to 0.017, p<0.001). CONCLUSIONS: Women’s behavioural changes driven by the FP programmes and other external factors, and changes in their characteristics, could reduce the incidence of unwanted childbearing in Bangladesh, and thereby contribute to improvements in maternal health.