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.