Determinants of adolescent maternal healthcare utilization in Bangladesh.

Objectives: To identify the factors associated with adolescent maternal healthcare utilization in Bangladesh.
Study Design: A secondary analysis was undertaken using the latest data set from the Bangladesh Demographic and Health Survey (2014). Data were collected from the cross-sectional survey carried out from June to mid November 2014. In total, 17,863 ever-married women aged 15-49 years were interviewed. According to the definition of the World Health Organization, 2029 of these women were adolescents and therefore eligible for inclusion in this study.
Methods: Both bivariate and multivariate logistic regression models were used to determine the factors influencing adolescent pregnancy, use of contraception, use of antenatal care services, facility-based delivery and presence of a skilled birth attendant at the last birth. The results are presented in terms of adjusted odds ratio (OR) with 95% confidence interval (CI), at a significance level of 5%.
Results: Maternal age, education, knowledge of menstrual regulations i.e. any procedure which disrupts the intra uterine environment, awareness of community clinic, household size, socio-economic status and administrative division were found to have a significant effect on adolescent pregnancy in Bangladesh. Sexual knowledge has a significant positive role in the use of modern contraceptives. Adolescents of low socio-economic status are significantly more likely to deliver at home compared with adolescents in the richest quintile (OR 0.26, 95% CI 0.15-0.47; P < 0.001). The likelihood of delivering at a health facility was higher among adolescents who had knowledge about sexually transmitted infections (OR 1.84, 95% CI 1.28-2.65; P < 0.001) and menstrual regulations (OR 1.41, 95% CI 1.04-1.91; P < 0.05).
Conclusions: Adolescent maternal healthcare utilization was associated with a number of factors including low socio-economic status, limited reproductive knowledge (e.g. menstrual regulations, sexually transmitted infections) and geographical region. The study findings will serve to inform policy and would be beneficial for introducing need-based adolescent maternal health programmes by targeting a range of maternal health services and opportunities that contribute to better health and development for adolescent mothers in Bangladesh.
(Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)