Abstract
BackgroundIn communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions.MethodsUtilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor).ResultsOut of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women’s literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women’s employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers.ConclusionsWhile the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh.Trial registrationTrial Registration Number: NCT00860470.
Highlights
In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications
A package of evidence-based interventions known as emergency obstetric care (EmOC) is recommended by the World Health Organization (WHO) to treat obstetric complications, or acute conditions that can lead to maternal death, such as hemorrhage, eclampsia, sepsis, and obstructed labor [1,3]
Socioeconomic variables including living in a household classified in the highest wealth quartile (RRR of 1.49; 95% CI of [1.33-1.73]), women’s literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women’s employment (RRR of 1.10; 95% CI of [1.01-1.18]), along with maternal age greater than 35 years and having a wanted pregnancy, were significantly and positively associated with care seeking from formal providers
Summary
In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions. Care seeking (defined as activities undertaken to obtain treatment for health problems) is recognized as a complex behavioral process that is influenced by factors including demographic and socioeconomic characteristics, perceived need, and service availability [4,5,6]. Factors associated with facility use during delivery included maternal age greater than 18 years, antenatal care seeking, and nulliparity [7,8,9,10,11]. Research from Peru and India suggests that women with wanted pregnancies were more likely to seek skilled attendance at delivery, with studies from rural Guatemala and sub-Saharan Africa showing associations between adverse obstetric history and skilled attendance at delivery [7,21,22]
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