Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh: analysis of linked data

Background: Sustainable Development Goals 3.7 targets to ensure universal access to sexual and reproductive healthcare services, where antenatal care (ANC) is a core component. This study aimed at examining the influence of health facility availability and readiness on uptake of four or more ANC in Bangladesh. Methods: : The 2017/18 Bangladesh Demographic and Health Survey data were linked with the 2017 Health Facility Survey and analysed in this study. The associations of health facility level factors with recommended number of ANC uptake were determined. Multilevel mixed-effect poison regression model was used to determine the association adjusting for potential confounders. Results: : Nearly 44% of mothers reported four or more ANC uptake with significant variations across several areas in Bangladesh. The average distance of mothers' homes from the nearest health facilities was 6.12 km, which was higher in Sylhet division (7.90 km) and lower in Dhaka division (4.01 km). The overall uptake of the recommended number of ANC visits was positively associated with higher scores for the management (adjusted prevalence ratio (APR) 1.85; 95% CI, 1.16-2.82) and infrastructure (APR, 1.59; 95% CI, 1.09-1.82) of health facilities closest to mothers' homes. The APRs for mothers reporting using the recommended number of ANC were increased to 3.02 (95% CI, 2.01-4.19) and 2.36 (95% CI, 2.09-4.16) times for each unit increase in the availability and readiness scores to provide ANC services at the closest health facilities, respectively. Every kilometre increase in the average regional-level distance between mothers' homes and the nearest health facilities reduced the likelihood of receiving the recommended number of ANC visits by nearly 42%. Conclusion: The availability of healthcare facilities closes to residence as well as their improved management, infrastructure, and readiness to provide ANC play crucial role to increase ANC services uptake. Policies and programmes should prioritise to increase availability, accessibility, and readiness of health facilities to provide ANC services.