Couple’s reports of household decision-making, unmet need for contraception, and unintended pregnancy in Bangladesh

Introduction: Previous researches emphasize the role of wife’s sole contribution in household decision-makings as predictor of family planning and reproductive health behaviors in many developing countries. These studies tend to overlook how couple’s joint decision-making may promote better reproductive health outcomes than any partner’s sole decision-makings which lack input or agreement from other partner in a marital relationship. Using married couple’s matched responses in decision-making questions; this study examines the association between couples’ concordant and discordant decision-makings, and wife’s unmet need for contraception and unintended pregnancy in Bangladesh. Methods: This study used couple’s dataset (n= 3336) of Bangladesh Demographic and Health Survey of 2007. Multivariate logistic regression was used to examine the likelihood of unmet need for contraception, and unintended pregnancy among married women of reproductive age. Findings: Study findings reveal that there are substantial levels of both concordance and discordance in responses to household decision-making items. Results from logistic regression analyses suggest that compared to couple’s joint decision making, husband-only or wife-only decision-making is associated with higher risk for women in having both unmet need for contraception and unintended pregnancy. Regression results also indicate that unmet need for contraception and unintended pregnancy are lower among women with lower parity, women from relatively richer households, and women heard family planning messages on television. Conclusion: As couple’s joint decision-making is significantly associated with better reproductive outcomes, policy makers may promote community based outreach programs, and communication campaigns for family planning focusing on egalitarian gender role approach

Couple’s reports of household decision-making, unmet need for contraception, and unintended pregnancy in Bangladesh

Introduction: Previous researches emphasize the role of wife’s sole contribution in household decision-makings as predictor of family planning and reproductive health behaviors in many developing countries. These studies tend to overlook how couple’s joint decision-making may promote better reproductive health outcomes than any partner’s sole decision-makings which lack input or agreement from other partner in a marital relationship. Using married couple’s matched responses in decision-making questions; this study examines the association between couples’ concordant and discordant decision-makings, and wife’s unmet need for contraception and unintended pregnancy in Bangladesh. Methods: This study used couple’s dataset (n= 3336) of Bangladesh Demographic and Health Survey of 2007. Multivariate logistic regression was used to examine the likelihood of unmet need for contraception, and unintended pregnancy among married women of reproductive age. Findings: Study findings reveal that there are substantial levels of both concordance and discordance in responses to household decision-making items. Results from logistic regression analyses suggest that compared to couple’s joint decision making, husband-only or wife-only decision-making is associated with higher risk for women in having both unmet need for contraception and unintended pregnancy. Regression results also indicate that unmet need for contraception and unintended pregnancy are lower among women with lower parity, women from relatively richer households, and women heard family planning messages on television. Conclusion: As couple’s joint decision-making is significantly associated with better reproductive outcomes, policy makers may promote community based outreach programs, and communication campaigns for family planning focusing on egalitarian gender role approach

Progress in utilization of antenatal and delivery care services in Bangladesh: Where does the equity gap lie?

Despite a central element of the Millennium Development Goals (MDGs), the progress in making pregnancy and childbearing safer for women has been slow in many developing countries. Though Bangladesh has achieved commendable progress in reducing maternal mortality in recent decades, the country faces pervasive inequity in antennal (ANC) and delivery care services. The purpose of this study is to provide recent estimates of trend in inequity in antenatal and delivery care services in Bangladesh during 2004-2011. We employ rich-poor ratio, concentration curve and concentration index to examine the trends of inequities in ANC and delivery care services using the latest three waves of Bangladesh Demographic and Health Survey. This study uses logistic regression analysis to investigate the relationship between socioeconomic factors and six indicators of ANC and delivery care. Concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 while it remained around 0.20 for receiving ANC from medically trained provider. Findings indicate that inequity in delivery at health facility and delivery by caesarean section decreased by about 33% in between 2004 and 2011. Women from the richest households were about 3 times more likely to have 4+ ANC visits (OR=2.91, 95% CI: 2.24-3.78), delivery at health facility (OR=3.16, 95% CI: 2.40-4.17), and skilled assistance at birth (OR=3.32, 95% CI: 2.51-4.38) compared to women from the poorest households. There was an overall progress in reducing inequity in utilization of maternal health care but rural area lagged behind to achieve equity compared to urban area. The evidence of inequity in maternal health care utilization highlights that the country faces not only a persistent equity gap between rich and poor women but also substantial rural-urban inequity. It is essential to design multi-sectoral and concerted interventions from an equity perspective to accelerate safe motherhood and childbirth in Bangladesh