Association of rural-urban place of residence with adequate antenatal care visit in Bangladesh

Abstract

Adequate antenatal care (ANC) is crucial to reduce maternal/neonatal deaths, but the proportion of mothers with appropriate ANC is lower in most low- and middle-income countries (LMICs) than in high-income countries. Furthermore, in many LMICs, including Bangladesh, there are intra-country disparities, and rural regions have substantially lower adequate ANC than urban regions. In this cross-sectional study, we performed secondary analyses on Bangladesh Demographic and Health Survey 2017-18 data to examine the rural-urban differences in adequate initiation, number, and quality of ANC. Women of reproductive age (i.e., 15-49-year-olds) with at least one birth in the three years before the survey were included. After reporting the prevalence of adequate ANC by rural-urban place, simple and multivariable logistic regression analyses were performed to examine the association. Among 4974 women, 1331 and 3643 were from urban rural regions, respectively. The proportions of mothers who initiated the visits in the first trimester, had at least four ANC visits, and had quality ANC were 47.5% (95% confidence interval (CI): 44.6-50.3), 59.0% (95% CI: 56.3-61.8), and 27.1% (95% CI: 24.6-29.6) in urban regions, and 33.4% (95% CI: 31.6-35.1), 42.8% (95% CI: 41.0-44.7), and 14.5% (95% CI: 13.1-15.8) in rural regions, respectively. These differences in ANC utilization were observed regardless of most sociodemographic and socioeconomic characteristics. After adjusting for sociodemographic and socioeconomic characteristics, compared to urban mothers, rural mothers had lower odds of at least four ANC visits (adjusted odds ratio (AOR): 0.77, 95% CI: 0.65-0.91) and quality ANC (AOR: 0.79, 95% CI: 0.65-0.97) but the odds for timely initiation (AOR: 0.85, 95% CI: 0.73-1.01) was not significant. Findings of this study showed significant disparities between rural and urban regions regarding appropriate ANC coverage, and the importance of improving ANC coverage among some sociodemographic groups to reduce these disparities, especially among mothers with low socioeconomic status.