Factors Associated with Delivery Assistance: Does Differentials Exist between Rural and Urban Areas in Bangladesh?

摘要

This paper investigates rural-urban differentials of the utilization of delivery assistance in Bangladesh using data from the BDHS 2004. Findings reveal that there exist strong urban-rural differentials of receiving delivery assistance. About 75%and 93% of deliveries still occur at home in the urban and rural area respectively. Non-medically trained providers play a major role in the delivery assistance. Educated husbands in the urban area are more careful about delivery assistance of their wives than their rural counterparts. Urban mothers who receive ANC from medically trained providers out of them 41% mothers are assisted during delivery by medically trained providers and the corresponding figure for rural mothers is only 17.8%. Logistic regression analysis shows that mother’s education, children ever born, wealth index, telling about pregnancy complications, permission to go to hospital/health center, religion, type of toilet facility and type of antenatal care providers are the significant determinants of receiving delivery assistance. Introduction An important component of efforts to reduce the health risks for mothers and children is to increase the proportion of babies who are delivered by skilled providers with adequate medical supervision1. Proper medical attention and hygienic conditions during delivery can reduce the risk of infection and increase the timeless of effective intervention in the event of obstetric emergencies, both of which can lead to serious illness or death to the mother or the newborn. One of the underlying factors leading to poor maternal situation in Bangladesh is that a very low percentage of women actually seek professional medical assistance for pregnancy related care, deliveries and complications. Only 7.9 percent deliveries take place in the health facilities and only 5 percent of the expected complications seek services of static health facilities2. Bangladesh is a developing country and maternity hospitals are quite inadequate. Most of our pregnant mothers are mainly accustomed to deliver births traditionally taking help from traditional qualified or unqualified birth attendant (TBA) or their relatives or neighbors. Bangladesh Maternal Health Services and Maternal Mortality Survey-2001 have reported that only 12 percent of births are associated by trained medical professional and overall three-fourths of births are associated by TBA. The high perinatal mortality and maternal mortality in Bangladesh may be attributed to the low prevalence of delivery care and assistance. Again there are significant rural urban differences, as professionally trained personnel attend 33 percent of births in urban areas, compared to only 8 percent in rural areas3. The Bangladesh Maternal Health Strategy encourages women to deliver under the care of medically trained birth attendants.It is therefore, widely agreed that one of the most important health interventions useful in reducing maternal mortality is to have mother’s delivery with a skilled birth attendant4. In this paper a limited attempt has been made to investigate the characteristics of delivery care and to identify the factors that have influence on receiving delivery assistance. Materials and Methods This study utilizes the data extracted from 2004 Bangladesh Demographic and Health Survey (BDHS), which were conducted under the authority of the National Institute of Population Research and Training (NIPORT) of the Ministry of Health and Family Welfare. The BDHS 2004 is a nationally representative survey from 11,440 ever married women of age 10-49 and 4297 men age 15-54 from 10,500 households covering 361 sample points (clusters) throughout Bangladesh, 122 urban areas and 239 in the rural areas. Out of 11,440 ever-married samples, 2586 women and 8854 women are taken from urban and rural areas respectively. The data has collected from six administrative divisions of the country- Barisal, Chittagong, Dhaka, Khulna, Rajshahi and Sylhet. Data collection t