Effects of health facility level factors on accessing normal delivery services in hospitals in Bangladesh: evidence from linked population and health facility survey data

Abstract Background:Home delivery without assistance from medically trained providers is common in Low- and Middle-Income Countries (LMICs), including Bangladesh, and is associated with adverse maternal and child health outcomes, including mortality. The government of Bangladesh is focusing on increasing hospitalized deliveries to improve outcomes, but the majority of hospital deliveries are caesarean sections, placing an additional burden on the healthcare system. This study aimed to assess the effects of health facility-level factors on hospitalized normal delivery in Bangladesh. Methods:This study used linked data from the 2017/18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The outcome variable was hospitalized normal delivery (yes or no), and health facility-level factors were major explanatory variables. These factors included general health facility readiness (management and infrastructure), the degree of availability of normal delivery healthcare services at the nearest healthcare facility, readiness of the nearest healthcare facility to provide normal delivery care, and average distance from mothers’ homes to the nearest healthcare facility where normal delivery care is available. Multi-level logistic regression models were used to assess the effects of health facility-level factors on hospitalized normal delivery, adjusted for potential confounders at the individual, household, and community-level. Results:The study found that the likelihood of hospitalized normal delivery increased with higher scores for management (adjusted odds ratio (aOR) 1.24; 95% CI, 1.01-1.62) and infrastructure (aOR, 1.20; 95% CI, 1.01-1.60) of the nearest healthcare facility to mothers’ homes. Furthermore, a one-unit increase in the availability and readiness of the nearest healthcare facility to provide normal delivery care was associated with 2.10 (95% CI, 1.14- 3.12) and 3.15 (95% CI, 1.16-5.11) times higher likelihoods of hospitalized normal delivery, respectively. The study also found that the likelihood of hospitalized normal delivery decreased by 20% for every kilometer increase in the distance from mothers’ homes to the nearest healthcare facility. Conclusion: The study suggests that the availability and readiness of healthcare facilities to provide normal delivery care services are significant factors in performing hospitalized normal deliveries in Bangladesh. It highlights the need for policies and programs to increase healthcare facility capacity to provide normal delivery healthcare services.