Attendance and Utilization of Antenatal Care (ANC) in Bangladesh: Examining individual-and division-level factors using a Multilevel Analysis

Abstract

The present study examines the individual and division-level factors associated with the utilization of antenatal care, following the adoption of the antenatal care visits in Bangladesh. In this study, two mixed effect models (Poisson regression model with random effect and negative binomial regression model with random effect) are applied to a real data set to obtain the potential determinants of number of antenatal care (ANC) visits of women during pregnancy in Bangladesh, where data are extracted from Bangladesh Demographic and Health Survey (BDHS), 2014. These mixed effect models are termed as the multilevel model with two level variations. The individual or within variation in each division is lower level (level-1) and between variation among the division is higher level (level-2). Multilevel model with two levels, where individual nested under division are fitted to address the hierarchical effect and also to find out the true estimate of the model parameter. Among the significant covariates, the place of residence, respondent's education, wealth index, respondent's husband's education, decision maker on respondent's health care and access to mass media are notable factors that are found highly associated with the number of antenatal care visits of women during their pregnancy period in Bangladesh. It is found that the educated women who live in urban area, whose husband is higher educated, socio-economic status is standard as well as who have access to mass media and to take decision about own health care, visit more for antenatal care. Although both individual-and division-level characteristics have an influence on the inadequate and non-use of ANC, division-level factors have a stronger influence in the rural areas. The results suggest that much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization. Furthermore, health promotion programs need to increase consciousness about the importance of ANC visits during pregnancy in rural area to ensure the ANC visits among the rural women, and consequently, maternal and child mortality and morbidity can be reduced to great extent and disparities of number of ANC visits between urban and rural areas will decrease.