https://orcid.org/0000-0001-9554-4825
Figures
Abstract
Background
High-quality antenatal care (ANC) reduces maternal and infant mortality and improves health outcomes, particularly in low-income countries. To assess the quality of ANC, three criteria are used: the number of visits, the timing of care initiation, and the inclusion of all recommended care components. The goal of this study was to identify and compare the factors associated with attending 4+ and 8 + ANC visits as well as obtaining high-quality ANC.
Methods
Data from the Bangladesh Demographic and Health Survey (BDHS) 2017--2018 and 2022 were used to evaluate the prevalence of ANC, and a binary logistic regression model was used. High quality ANC included the following components: blood pressure measurement, urine tests for detecting bacteriuria and proteinuria, blood tests for syphilis and anemia, iron supplementation, vitamin A administration, a child’s health check before discharge, and health education.
Results
In 2017--2018, 48% of women attended four or more visits, which decreased to 41% in 2022. ANC attendance for eight or more visits declined from 12% to 5%, and approximately 8% of women received no ANC in both periods. Higher levels of education among mothers and their spouses, urban residency and higher household wealth were positively correlated with ANC attendance and quality. Notably, essential components such as blood pressure monitoring and iron supplementation were more common among women with higher socioeconomic status, but their prevalence declined between 2017–2018 and 2022.
Citation: Barna SD, Quayyum A, Hossain G, Islam A, Rahman F (2025) Trends and determinants of antenatal care use and quality in Bangladesh: Insights from demographic and health survey data. PLoS One 20(11): e0337449. https://doi.org/10.1371/journal.pone.0337449
Editor: Muhammad Haroon Stanikzai, Kandahar University, Faculty of Medicine, AFGHANISTAN
Received: March 23, 2025; Accepted: November 6, 2025; Published: November 24, 2025
Copyright: © 2025 Barna et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: “Third party data was obtained for this study from The DHS Program ( https://dhsprogram.com/). Data may be requested from The DHS Program after creating an account and submitting a concept note. More access information can be found on The DHS Program website (https://dhsprogram.com/data/Access-Instructions.cfm). The data set is openly available upon permission from the MEASURE DHS website (https://www.dhsprogram.com/data/available-datasets.cfm). The authors confirm that interested researchers would be able to access these data in the same manner as the authors. The authors also confirm that they had no special access privileges that others would not have”.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Since pregnancy is a crucial time in a woman’s life, the provision of high-quality ANC is essential to ensure maternal and fetal health while also providing an opportunity to identify high-risk women for screening, prevention, and treatment of cardiovascular disease, the leading cause of morbidity and mortality [1]. In 2021, global maternal deaths reached 267,000, a 40% decline in MMR from 328 per 100,000 live births in 2000–197, yet progress stalled post-2020 due to pandemic disruptions and inequities. Disproportionately affecting low- and lower-middle-income countries (94% of cases), where one woman dies every two minutes from preventable causes, this underscores the urgent need for accelerated investments in equitable maternal health services to achieve SDG targets by 2030 [2]. It has been hard to lower the number of mothers who die. For instance, the number of maternal fatalities around the world only went down by 2.3% each year from 1990 to 2015. This shows that development was consistent but not enough to fulfill global goals [3]. Bangladesh, as a developing country, faces significant challenges in maternal healthcare. The maternal mortality ratio in Bangladesh remains high, contributing to the country’s overall health burden. In 2017, the maternal mortality rate in Bangladesh was 173, a decrease of 6.99% from 2016 [4]. In the examined sub-Saharan African countries, the prevalence of at least eight ANC visits ranged from a high of 98.7% in Zambia to a low of 73.4% in Libya [5].
The World Health Organization (WHO) recommends initiating ANC within the first trimester and attending at least eight visits during an uncomplicated pregnancy to optimize maternal and neonatal outcomes [5,6]. In addition to the frequency of visits, the quality of ANC is determined by the timing of the first visit and the inclusion of essential components such as blood pressure measurement, urine and blood tests, iron-folic acid supplementation, tetanus toxoid immunization, and health education [7–9]. Despite these guidelines, access to comprehensive ANC remains limited in Bangladesh, particularly among women from rural and low-income backgrounds [10]. IFA supplementation and TT immunization during pregnancy decreased the risk of infant mortality in Bangladesh. Baseline proteinuria was substantially associated with increased rates of preeclampsia, preterm birth, and growth restriction in expectant women with treated chronic hypertension, even at proteinuria values previously considered to be within the normal range (less than 300 mg/d) [11]. The effect of the WHO’s recommended number of prenatal care visits for developing countries on birth outcomes is highly robust to changes in birth outcome measures but is significant only in urban areas [12]. This may be due to the inferior quality of prenatal care services received in rural areas. A lack of access to health providers and facilities has contributed to nearly three-quarters (73%) of mothers in Bangladesh not receiving four or more ANC visits from trained health professionals, let alone the eight visits that the WHO recently recommended [13]. In comparison, only 49% of women living in rural areas receive ANC from a skilled practitioner, whereas 74% of women living in urban areas do [14]. Joshi et al. (2014) reported that only 50% of Nepalese women attended the recommended minimum of four prenatal appointments during their previous pregnancy, indicating possible gaps in ANC usage [15].
Persistent pro-rich inequities and a pronounced rural-urban divide continue to hinder equitable access to high-quality ANC services in Bangladesh [16]. Although national surveys such as the BDHS report gradual improvements in ANC coverage, significant gaps remain in both utilization and service quality, particularly among women from rural and disadvantaged communities. Understanding the determinants of ANC utilization and quality is essential for designing targeted policy interventions aimed at achieving Sustainable Development Goal (SDG) 3, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 [17].
The primary objective of this population-based study, therefore, is to investigate the factors associated with the use and quality of ANC in Bangladesh and analyze high-risk factors and complications linked to maternal mortality. This study, which utilizes data from BDHS 2018 and 2022, explores the factors associated with ANC usage and quality in Bangladesh, with a focus on identifying barriers to reaching the WHO-recommended eight ANC visits. The findings of this trend analysis will be useful in health policy to respond to deficiencies in ANC service delivery, especially in rural unidentified and less served mother and newborn communities. The purpose of this research is to provide some recommendations for understanding the trend of ANC usage and potential predictors of ANC usage and service quality in Bangladesh.
Method
Data sources
This study used survey data from the BDHS, 2018 and 2022, which was conducted by the National Institute of Population Research and Training (NIPORT), which is a government national research institute researching family planning in Bangladesh and training government officers involved in family planning in Bangladesh, which is situated in Dhaka, Bangladesh. The BDHS is a nationally representative survey that aims to collect demographic and health data and includes a set of indicators of maternal and child health, fertility, family planning, and service utilization that can support the development of related policies. In the data collection process, the person or institution delivering ANC (if any), the number of ANC visits, the date of the first ANC visit, and the components contained in the ANC presented were all recorded. These included blood pressure checks, urine tests for bacteriuria and proteinuria, blood tests for syphilis and anemia, iron supplements, tetanus injections, and antenatal health information. Inquiries regarding health education centered on the spread of knowledge about pregnancy risk indicators, where to address such difficulties, and recommendations to use a qualified birth attendant for delivery. For this analysis, 10,076 (5,012 in 2018 and 5,064 in 2022) women of reproductive age from both the 2018 and 2022 surveys were used to establish the trends in and factors influencing ANC and its quality.
Outcome variable
The primary outcome variables in this study were attendance at four or more ANC visits and attendance at eight or more ANC visits during pregnancy, as recommended by WHO and adopted in recent Bangladesh health guidelines. For each outcome, a binary variable was created: women who attended at least 4 (or 8) ANC visits were coded as “1” (Yes), and those who attended fewer than 4 (or 8) visits were coded as “0” (No). These two binary outcomes were analyzed separately to assess their associated factors.
First, we computed descriptive statistics and 95% confidence intervals. Then, via logistic regression models, we calculated unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the associations between study characteristics and 1) four or more ANC visits, 2) eight or more ANC visits and 3) high-quality ANC.
Study variables
Seven variables were considered for their potential association with attendance at four or more ANC visits and eight or more ANC visits. These were place of birth (urban, rural), women’s education (no education, primary, secondary, or higher education), women’s work status in the previous 12 months (no, in the previous year, currently working, have a job but have been absent for the last 7 days), the wealth index combined (the DHS wealth quintile is a composite indicator that divides the households into five categories: poorest, poorer, middle, richer and richest; and were derived via principal component analysis on the basis of information from housing characteristics and ownership of household durable goods), religion (Islam, Hinduism, Buddhism, Christianity), unwanted pregnancy when becoming pregnant (then, later, no more), and the husband’s education (no education, primary, secondary and higher education).
A variety of factors influence how well prenatal care services are delivered in Bangladesh. In this arrangement, women can receive antenatal care at four locations. They are made up of the public, private, nonprofit, and other sectors. The public or governmental sector included medical college hospitals, district hospitals, upazila hospitals, and community clinics. The private sector included private hospitals, private medical college hospitals, private clinics, and certified doctor chambers. In addition, some nongovernmental organizations (NGOs) provide antenatal care. A doctor, nurse, NGO, family member, and traditional birth attendant were also among the health professionals who offered antenatal care to the women.
Analytical strategy
We initially retained all variables that were significant at P = 0.25 in the univariable models. Next, we used a backward elimination approach to remove the model’s least essential variable. This step was performed until every variable in the model had a P value of 0.05. We retained the mother’s education variable in the final model for the ANC quality model since its significance was somewhat greater than 0.05. We evaluated whether a quadratic component for mothers’ ages was still required in both models, and the model with simply a linear term was sufficient in both circumstances. The analyses were carried out via the Statistical Package for Social Sciences (SPSS 26.0).
Results
A total of 10,076 women were included in the analysis, with 5,012 participants from the 2017--2018 period and 5,064 from the 2022 period.
In Table 1, the analysis of 2017–2018 data revealed significant sociodemographic disparities in ANC attendance, with women’s education (71% attendance for higher-educated vs 20% for uneducated; aOR=3.37, p < 0.001), wealth quintile (richest women having 2.6 times higher odds than poorest), and urban residence (59% vs 42% rural) being the strongest predictors of ≥4 ANC visits. Husband’s education (aOR=2.17 for higher-educated) and pregnancy intention (50% attendance for planned pregnancies) were also significant determinants, while religion showed limited association. The same factors influenced ≥8 visits but with more pronounced disparities (22% attendance for higher-educated vs 3% for uneducated), highlighting persistent inequities in maternal healthcare utilization.
In Table 2, the analysis revealed distinct patterns for 4+ versus 8 + visit adherence across sectors. For 4 + visits, private medical colleges showed exceptional performance (aOR=4.45), followed by NGO static clinics (aOR=2.10) and government medical colleges (aOR=2.46), while district hospitals (aOR=1.92) and upazila complexes (aOR=1.36) demonstrated progressively weaker effects. Private clinics (aOR=1.46) and doctor chambers (aOR=1.39) maintained consistent quality advantages. For 8 + visits, these associations attenuated but remained significant, with medical colleges (aOR=2.74) and NGOs (aOR=1.69) retaining leadership. Provider-type analysis showed doctors (4 + aOR=2.21; 8 + aOR=2.22) and nurses (4 + aOR=2.27; 8 + aOR=2.26) delivering equally strong outcomes, while NGO workers showed particularly strong 4 + visit performance (aOR=4.09). Traditional birth attendants had modest 4 + visit effects (aOR=1.66) that became insignificant for 8 + visits, and family-provided care showed no significant benefit at either threshold (4 + aOR=0.95, p = 0.629; 8 + aOR=1.06, p = 0.767). These patterns persisted after controlling for socioeconomic factors, suggesting structural advantages of formal healthcare settings are most pronounced for basic (4+) visit adherence.
In Table 3, of the 5,064 women, only 2,065 (41%) attended four or more ANC visits, whereas 403 (8%) of the participants did not attend any ANC visits in 2022. The analysis revealed significant sociodemographic disparities in ANC attendance, with urban women showing higher rates of both 4+ (54.2% vs 34.2% rural; aOR=0.636, p < 0.001) and 8 + visits (7.9% vs 3.6%; aOR=0.838, p = 0.224). Education demonstrated a strong dose-response relationship, where higher-educated women had 2.84 times greater odds of 4 + visits (64.5% vs 20.6% no education; aOR=2.842, p < 0.001) and 2.30 times greater odds of 8 + visits (13.3% vs 1.5%; aOR=2.296, p = 0.140). Wealth disparities were most pronounced, with the richest women having 3.00 times higher odds of 4 + visits (66.9% vs 22.7% poorest; aOR=2.999, p < 0.001) and 5.82 times higher odds of 8 + visits (13.3% vs 1.0%; aOR=5.817, p = 0.001). Husband’s education showed similar but attenuated effects (higher education: aOR=2.169 for 4 + , aOR=1.760 for 8 + visits). Notably, while Hindu women had moderately higher 4 + visit rates (aOR=1.377, p = 0.005), religion showed no significant association with 8 + visits, and employment status showed minimal impact after adjustment. These adjusted odds ratios (controlling for all other variables) highlight how economic status and education remain the most powerful predictors of ANC utilization, particularly for intensive (8+) visit schedules, suggesting that financial and educational barriers disproportionately affect comprehensive ANC access.
In Table 4, the quality of ANC received by women is significantly influenced by both the healthcare professional delivering the care and the environment in which it is provided. Women access ANC across four distinct settings: public, private, nonprofit (NGO), and others. Notably, government medical colleges are particularly prominent among public healthcare facilities. In contrast, private hospitals, clinics, and medical colleges play important roles within the private sector. In the government sector, medical college hospitals demonstrated the highest performance for ≥4 visits (53.16% achievement, OR=1.44, p = 0.026), indicating women receiving care there were 44% more likely to meet this threshold compared to other government facilities. However, this advantage did not extend to ≥8 visits (OR=0.99, p = 0.982). District hospitals and Upazila Health Complexes showed no significant associations with ≥4 visits, but the latter exhibited notably reduced odds for ≥8 visits (OR=0.43, p = 0.002), suggesting women at these facilities were 57% less likely to achieve frequent ANC attendance. Community clinics displayed neutral effects for both outcomes. The private sector consistently outperformed government facilities. Private hospitals showed strong positive associations for both ≥4 visits (OR=1.43, p < 0.001) and ≥8 visits (OR=2.33, p < 0.001), as did private clinics (OR=1.30 and 1.74 respectively). NGO static clinics demonstrated particularly impressive results for ≥4 visits (OR=2.05, p < 0.001), while qualified doctor chambers showed robust effects for ≥8 visits (OR=2.09, p = 0.001). The “Other” category, despite small sample sizes, revealed striking ORs of 3.01 (p = 0.005) and 3.86 (p = 0.014) for ≥4 and ≥8 visits respectively, suggesting exceptional performance in unconventional settings. Provider qualifications significantly influenced ANC attendance. Doctor-led care showed the strongest positive associations, with women 2.36 times more likely to achieve ≥4 visits (p < 0.001) and 3.38 times more likely to complete ≥8 visits (p < 0.001). Nurses also positively impacted ≥4 visit rates (OR=1.43, p < 0.001), though their effect on ≥8 visits was insignificant. NGO health workers demonstrated an extraordinary OR of 8.00 for ≥4 visits (p < 0.001), though the wide CI (3.10–20.65) and small sample size warrant cautious interpretation. Conversely, care from relatives was associated with substantially worse outcomes, showing 25% reduced odds for ≥4 visits (OR=0.75, p < 0.001) and 37% reduction for ≥8 visits (OR=0.63, p = 0.048). Traditional birth attendants showed no significant effects, though their point estimates suggested potentially reduced attendance. The analysis reveals clear disparities in ANC service quality. Private sector facilities consistently outperformed government counterparts, with private hospitals and NGO clinics showing particular strength. Doctor-provided care yielded superior results, while non-professional care (relatives, traditional attendants) correlated with poorer outcomes. Notably, achieving ≥8 visits remained uncommon (≤13.33% across all groups), suggesting systemic barriers to frequent ANC utilization even in optimal settings. These findings underscore the importance of healthcare system factors, particularly facility resources and provider qualifications in shaping ANC service quality and maternal healthcare outcomes.
Table 5 presents data on the quality of ANC received by women during pregnancy in two different time periods: 2017–2018 and 2022. The table compares the percentage of women who had 4 or more visits (≥4 Visits) and 8 or more visits (≥8 Visits) for various study variables. Child’s Health Check before discharge declined from 1587 out of 2488 women (63.79%) with ≥4 visits and 430 (17.28%) with ≥8 visits (95% CI: 1.00–1.03) in 2017–2018–1482 out of 2814 (52.67%) and 200 (7.11%) in 2022 (95% CI: 90–95), a drop of 11.12% and 10.17%; Blood Sample taken decreased from 1894 out of 3060 (61.89%) and 494 (16.14%) (95% CI: 65–68) to 1858 out of 3716 (50.00%) and 241 (6.45%) (95% CI: 79–82), a 11.89% reduction; Urine Sample taken fell from 2023 out of 3369 (60.05%) and 534 (15.85%) (95% CI: 72–74) to 1890 out of 3847 (50.86%) and 241 (6.26%) (95% CI: 82–84), a 9.19% decrease; and Mother received Vitamin A saw the sharpest decline, from 1157 out of 2072 (55.84%) and 292 (14.09%) (95% CI: 44–48) to 1262 out of 3086 (40.89%) and 144 (4.67%) (95% CI: 64–68), a 14.95% drop, highlighting a consistent reduction in care frequency potentially linked to access or policy change.
Fig 1 demonstrates a notable reduction in prenatal care (ANC) coverage from 2017–2018 to 2022, with a decreased number of women completing both four or more and eight or more ANC visits in the subsequent survey period.
Discussion
This study focused on the main features of ANC service delivery and the act of seeking treatment in Bangladesh, in addition to pointing out shortcomings in adhering to ANC subcomponents and striking differences in the ANC landscape of the country. On the basis of the results from the 2017 and 2022 BDHS, only 6.24% of Bangladeshi women who had given birth obtained the required minimum of four ANC visits. Research conducted by Ahinkorah et al. (2022) using data from the 2018 Cameroon Demographic and Health Survey revealed that only 6.3% of women had obtained a minimum of eight prenatal care visits [18]. According to the data obtained from the BDHS (2017--18), 48.2% of women clearly had four or more ANC visits, and from BDHS 2022 data, 41% of women had four or more ANC visits. The report also revealed that 8.14% of women did not receive ANC, whereas 11.7% received eight or more ANC visits. On the other hand, in 2022, 8% of women did not receive ANC, whereas only 5% of women received eight or more visits. Bangladesh requires improvements in the accessibility of appropriate ANC for its female population. This study revealed that certain socioeconomic, demographic, and women’s empowerment-related variables had an impact on both the frequency and quality of ANC visits.
Women with more education have a better chance of getting the recommended number of ANC visits and following through with them. Education for women is a key factor in whether or not they use maternal health services, no matter what their socioeconomic status is, how easy it is for them to get healthcare, or what other women have been through [19,20]. In Afghanistan, analogous challenges endure. A recent study revealed that merely 12.7% of Afghan women attended eight or more antenatal care (ANC) visits, with maternal education identified as a significant predictor (AOR = 2.1, 95% CI 1.8–2.5). In Afghanistan, same challenges endure in ensuring adequate usage of prenatal care. A study utilizing data from the Afghanistan Demographic and Health Survey found that a low percentage of women had four or more antenatal care (ANC) sessions. Maternal education emerged as a major predictor of ANC service usage, with women possessing secondary education being more than twice as likely to attend adequate ANC visits compared to those lacking formal education (AOR = 2.43, 95% CI 1.25–4.70) [21]. These results are consistent with our study, which demonstrated a significant correlation between women’s education and compliance with WHO-recommended antenatal care visits. Enhancing educational attainment in women has been demonstrated to boost ANC coverage by increasing health awareness and autonomy. In Bangladesh, the completion rate of secondary education for females is quite low, and the adult literacy rate among women is also quite low. This underscores the pressing necessity to prioritize and improve female education in the country [22].
Similar obstacles are present, with the husband’s educational attainment being a crucial factor influencing ANC utilization. Women whose husbands completed secondary education were 1.8 times more likely to attend four or more ANC visits and 2.3 times more likely to reach eight visits compared to those whose husbands lacked formal schooling [23]. This pattern aligns with our findings, indicating that the education and involvement of male partners are essential for enhancing maternal healthcare engagement in patriarchal settings.
Women from wealthier families had a greater probability of attending four or more prenatal care appointments, and this correlation also applies to obtaining eight or more ANC visits. Female education and family affordability are the primary factors closely linked to ANC and skilled birth attendance (SBA) in Bangladesh [24]. Female education and family affordability are the strongest predictors of both ANC and SBA in Bangladesh, where four important criteria have been identified: domicile, wealth index, education, and ANC access [25].
Within our study, we pinpointed six noteworthy factors associated with four or more ANC visits, which impact the utilization of antenatal care. These variables included place of residence, wealth index, level of education of the wife and husband, employment status of the woman over the previous year, and intention of the pregnancy. However, in regard to achieving eight or more ANC visits, women’s work status within the last 12 months, religion, and pregnancy intentions did not yield significant results. A similar finding was reached in Nepal concerning four or more ANC visits [15].
According to the BNHSM (2017-18), the national strategy guided some principals for maternal care. Service delivery along the continuum of care, strengthening the health system, reducing equalities, community empowerment and engagement, multisector involvement, implementation and impact evaluation are the main strategies used by the Bangladesh government to improve ANC [33]. A developing country such as Bangladesh must focus on promoting awareness of ANC services. There must be at least a 3rd-level maternity hospital (1 per million residents) in every division where complicated pregnancies can be properly treated [34].
Quality
The type of health professional who provides ANC is one of the most important factors influencing the overall quality of ANC that women receive [10]. This study emphasizes the importance of having competent healthcare providers (such as doctors, nurses, or traditional birth attendants) in the process of providing ANC care. Compared with those who were generally less trained (relatives, village health workers, maternal and child health workers, and health assistants/auxiliary health workers), women who attended professional providers had a better chance of obtaining high-quality ANC. This was reflected in the increased percentage of women who received ANC. Women who completed more schooling were more likely to receive high-quality care. According to Ugandan research, women’s education is crucial for receiving all of the necessary ANC components [26]. High-quality ANC was more likely to be provided to women from higher-income households. This aligns with research from India and Nigeria, which shows a correlation between better socioeconomic position and a greater likelihood of utilizing all ANC components [27,28]. These relationships may be explained by women with greater socioeconomic status having more affordable health care and access to health information than women with lower socioeconomic status [29]. This study demonstrates how the quality of ANC is impacted by how rural the area where women live is. Compared with women in rural regions, urban women were more likely to obtain high-quality ANC. This could be because access to health care is more challenging in rural locations where there is much less or no transportation infrastructure [30].
Various ANC strategies can be utilized to increase the health of both mothers and infants. Most women in this research had blood pressure measurements, enabling the identification of hypertension, which might indicate the onset of preeclampsia [31]. Just over half of the women (67%) had urine tests to detect protein and infection, whereas a slightly larger percentage (61%) had blood samples taken to screen for anemia. These findings are consistent with those of a previous study, which linked poor utilization to health centers’ inability to perform such tests [32]. Eighty six percent of women had their blood pressure checked [25]. Iron supplements were used by 74% of the female population. Pregnant women in impoverished nations who are at greater risk of iron deficiency are advised to take iron supplements [26]. On the other hand, in 2022, the maximum number of mothers with both 4 or more visits and 8 or more visits were concerned with their children. They were concerned with their child’s health check before discharge.
This study has several advantages. The survey was a nationwide population-based study conducted with a substantial sample size that accurately represented the whole country. It was carried out meticulously with the assistance of qualified data gatherers and established protocols. The questionnaires were translated and pretested in two regional languages. The poll, however, had several limitations. The information obtained may have been impacted by recall bias due to the self-reported nature of the data and the retrospective design of the study. To mitigate the effects of remembering bias, the study focused on analyzing the most recent pregnancy that occurred during a five-year timeframe prior to the survey. Since the data were obtained from the women themselves, it is uncertain if the healthcare workers executed the procedures optimally.
Quality of ANC comparison (4+ and 8 + visits)
Blood pressure measurement remained the most consistently delivered service (over 80%) during ANC visits, yet the provision of urine and blood tests declined between 2017-18 and 2022 [6,17]. These findings align with Midhet et al. (2025) [19], who reported systemic health service gaps in ANC service delivery in rural Pakistan. Similarly, in India, Nihal and Shekhar (2024) found that underutilization of laboratory tests was largely attributed to supply chain constraints and facility-level inadequacies. [32]
Fifty-five percent of women had their blood pressure checked at 4 + visits, and 13% had their blood pressure checked at 8 + visits; in 2022, blood pressure decreased to 47% and 6%, respectively. [26]. Iron supplements were used by 57% and 14% of the female population at 4+ and 8 + visits, respectively, whereas in 2022, it was used by 46% and 6%, respectively. All expecting women in developing countries who are at high risk of iron insufficiency are encouraged to take iron supplements [25].
Strength and limitation
This study reveals several advantageous components. The survey was a nationwide, population-based study conducted with a substantial sample size that accurately represented the whole country. It was carried out meticulously with the assistance of qualified data gatherers and established protocols. The questionnaires were translated and pretested in two regional languages. The poll, however, had several limitations. The information obtained may have been impacted by recall bias due to the self-reported nature of the data and the retrospective design of the study. To mitigate the impact of remembering bias, we specifically assessed the most recent pregnancy that occurred within a five-year timeframe from the survey. Since the data were supplied by the women, it is uncertain if the healthcare workers executed the procedures optimally. One important limitation of this study is that sampling weights or account for the clustering design inherent in the DHS data. Since the DHS uses a multistage stratified cluster sampling method, failing to incorporate sampling weights and clustering may affect the representativeness of the results and could lead to underestimation of standard errors.
Conclusion
Only 48.2% of Bangladeshi women attended at least four antenatal appointments during their most recent pregnancy, and 11.7% of women attended eight or more antenatal visits in 2017, whereas in 2022, this figure decreased to 41%. However, in 2017 and 2022, only 8% of the women received no ANC during their pregnancy. The socioeconomic parameters associated with having access to high-quality ANC are investigated in this study. These findings support increasing ANC participation among women with lower levels of education and who are socioeconomically disadvantaged to improve results in the short term. However, as part of a plan to promote gender equity and women’s empowerment, there must be an emphasis on expanding the education of girls and women in Bangladesh to create long-term advances in women’s access to high-quality ANC. For further improvement, Bangladesh should update the standard to 8 or more ANC visits as a minimum requirement for better maternal health. However, as part of a plan to promote gender equity and women’s empowerment, there must be an emphasis on expanding the education of girls and women in Bangladesh to create long-term advances in women’s access to high-quality ANC. Mass media campaigns can be broadcast more frequently. This should be carried out in Bangladesh.
Acknowledgments
The authors are grateful to the Demographic and Health Surveys (DHS) Program for providing BDHS data accessibility for conducting the study.
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