Applying a Positive Deviance Approach to Understanding Maternal Healthcare Use in Bangladesh

Abstract

Utilization of maternal healthcare services is important for improving maternal and sexual health during pregnancy. One of the Sustainable Development Goals is to reduce the maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030. However, in Bangladesh, the MMR in 2015 was 176 maternal deaths per 100,000 live births. To reduce maternal morbidity and mortality, we must gain new understandings of what facilitates maternal healthcare use in Bangladesh. Previous research recognizes community effects in maternal healthcare use; however, to capture the variation in women’s experiences, it is important to understand how deviation from community norms may be associated with maternal healthcare utilization. Data are from the 2014 Demographic and Health Survey in Bangladesh. Separate identical random-effects logistic regression models were fit to examine the relationship between deviance on socioeconomic characteristics, gender and fertility norms, health and media exposure and four maternal healthcare outcomes (antenatal care, delivery care, postpartum care, all three). Deviance variables examined women who were above or below the average for their community and were created based on differences between a woman’s individual response and the aggregate community variable.