Can programmatic inputs improve adolescent mothers’ access to care in rural Bangladesh? Nine-years of evidence from a cohort study

Can programmatic inputs improve adolescent mothers’ access to care in rural Bangladesh? Nine-years of evidence from a cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Can programmatic inputs improve adolescent mothers’ access to care in rural Bangladesh? Nine-years of evidence from a cohort study Aminur Rahman, Tahmina Begum, Anne Austin, Md. Hasan, Nurul Alam, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.21953/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Adolescent mothers (Girls aged 15-19) constitute 8% of annual global births, but account for 10% of annual maternal deaths. WHO recommended 4-8 Antenatal Care (ANC) visits, in addition to quality care and facility-based deliveries, are well-documented interventions to reduce maternal and child morbidity and mortality. Determinants of maternal and child health care in Bangladesh have received considerable attention, but less attention has been focused on adolescent mothers. This study explores the factors associated with 4 or more (4+) ANC visits and facility-based delivery among adolescent mothers in one rural area of Bangladesh, Methods This study uses Health and Demographic Surveillance System (HDSS) data. We conducted a comparative study on trends in 4+ ANC visits and facility-based deliveries among adolescent mothers (10-19 years) residing in an intervention area (icddr,b service area, ISA) against a comparison area (government service areas, GSA) of HDSS between 2007 and 2015. 4,996 adolescent mothers were included in the final analysis. Binary logistic regression was used to document the statistical difference on outcome indicators in the two study areas. Results Trends in 4+ANC visits and facility-based deliveries were higher in the ISA relative to the GSA. The adjusted odds of an adolescent mother accessing 4+ ANC visits in the GSA, relative to ISA was 0.57 (95% CI: 0.49 – 0.66, p-value <0.05); the adjusted odds of an adolescent mother accessing facility-based delivery in the ISA, relative to GSA was 6.63 (95% CI: 5.85 – 7.52, p-value <0.05). Increasing numbers of ANC visits were associated with increases in facility-based births in both the ISA and GSA. Conclusion This study documented that both 4+ ANC visits and facility delivery rates among adolescent mothers are much higher in the ISA than GSA. Increasing 4+ ANC visits and facility deliveries over the years, particularly in the ISA, coincide with programmatic efforts to improve the quality and availability of maternal and newborn health services. Learning from existing interventions in ISA and applying them to other areas will strengthen Bangladesh’s efforts to improve maternal and newborn health outcomes and achieve the sustainable development goal 3 (SDG 3). Nutrition & Dietetics Adolescent pregnancy Antenatal Care Facility Delivery Maternal Health Bangladesh Figures Figure 1 Figure 2 Figure 3 Full-text Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the manuscript can be downloaded and accessed as a PDF. Cite Share Download PDF Status: Under Review Version 1 posted Reviewer # 2 agreed at journal 24 Oct, 2021 Review # 1 received at journal 16 Jun, 2021 Reviews received at journal 28 May, 2021 Reviewers invited by journal 27 May, 2021 Reviewer # 1 agreed at journal 27 May, 2021 Editor assigned by journal 24 Jan, 2020 Submission checks completed at journal 23 Jan, 2020 Editor invited by journal 23 Jan, 2020 First submitted to journal 21 Jan, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-12534","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":314328,"identity":"e9894faf-b453-4542-84b2-a0482d3d6912","order_by":1,"name":"Aminur Rahman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYDCCA0CcAMT8zAwMEjxgLrFaJJtJ0gICBgeI1cJ3+/DTDQ93HM43Ps788MbbPXcY+KWPX8CrRfJcmtmNxDOHLbcdZjO2nPPsGYNkX04BXi0GZxiAWtoOG5gd5mGT5jlwGCjCk0BAC/s3sBbjZuK18EBsMWCGa2E/gN8vZ3jKgFrSDSTAfjnwjEeyhwevDga+M+zbbv5sszbg7z/88MabA3fk+HnYH+DXgw6AVvAYkKYFCEi1ZRSMglEwCoY7AADzC0spOOkXrQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-1434-3883","institution":"International Centre for Diarrhoeal Disease Research","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Aminur","middleName":"","lastName":"Rahman","suffix":""},{"id":314329,"identity":"47411c64-5a27-4ee0-8e2b-ca06ba8751a1","order_by":2,"name":"Tahmina Begum","email":"","orcid":"","institution":"International Centre for Diarrhoeal Disease Research Bangladesh","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tahmina","middleName":"","lastName":"Begum","suffix":""},{"id":314330,"identity":"6d20595e-2b33-4c69-a5af-5d3114f2ebce","order_by":3,"name":"Anne Austin","email":"","orcid":"","institution":"JSI Research and Training Institute Inc","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"Austin","suffix":""},{"id":314331,"identity":"f2f413fe-7ab2-4e5a-a6b5-37c8e485b0be","order_by":4,"name":"Md. 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Nine-years of evidence from a cohort study","fulltext":[{"header":"Full-text","content":" \u003cp\u003eDue to technical limitations, full-text HTML conversion of this manuscript could not be completed.\u0026nbsp; However, the manuscript can be downloaded and accessed as a PDF.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-health-population-and-nutrition","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"johp","sideBox":"Learn more about [Journal of Health, Population and Nutrition](http://jhpn.biomedcentral.com/)","snPcode":"41043","submissionUrl":"https://submission.nature.com/new-submission/41043/3","title":"Journal of Health, Population and Nutrition","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adolescent pregnancy, Antenatal Care, Facility Delivery, Maternal Health, Bangladesh","lastPublishedDoi":"10.21203/rs.2.21953/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.21953/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground Adolescent mothers (Girls aged 15-19) constitute 8% of annual global births, but account for 10% of annual maternal deaths. WHO recommended 4-8 Antenatal Care (ANC) visits, in addition to quality care and facility-based deliveries, are well-documented interventions to reduce maternal and child morbidity and mortality. Determinants of maternal and child health care in Bangladesh have received considerable attention, but less attention has been focused on adolescent mothers. This study explores the factors associated with 4 or more (4+) ANC visits and facility-based delivery among adolescent mothers in one rural area of Bangladesh, \u003c/p\u003e\u003cp\u003eMethods This study uses Health and Demographic Surveillance System (HDSS) data. We conducted a comparative study on trends in 4+ ANC visits and facility-based deliveries among adolescent mothers (10-19 years) residing in an intervention area (icddr,b service area, ISA) against a comparison\u0026nbsp;area\u0026nbsp;(government service areas, GSA) of HDSS between 2007 and 2015. 4,996 adolescent mothers were included in the final analysis.\u0026nbsp;Binary logistic regression was used to document the statistical difference on outcome indicators in the two study areas. \u003c/p\u003e\u003cp\u003eResults Trends in 4+ANC visits and facility-based deliveries were higher in the ISA relative to the GSA. The adjusted odds of an adolescent mother accessing 4+ ANC visits in the GSA, relative to ISA was 0.57 (95% CI: 0.49 – 0.66, p-value \u0026lt;0.05); the adjusted odds of an adolescent mother accessing facility-based delivery in the ISA, relative to GSA was 6.63 (95% CI: 5.85 – 7.52, p-value \u0026lt;0.05). Increasing numbers of ANC visits were associated with increases in facility-based births in both the ISA and GSA. \u003c/p\u003e\u003cp\u003eConclusion This study documented that both 4+ ANC visits and facility delivery rates among adolescent mothers are much higher in the ISA than GSA.\u0026nbsp;Increasing 4+ ANC visits and facility deliveries over the years, particularly in the ISA, coincide with programmatic efforts to improve the quality and availability of maternal and newborn health services. Learning from existing interventions in ISA and applying them to other areas will strengthen Bangladesh’s efforts to improve maternal and newborn health outcomes and achieve the sustainable development goal 3 (SDG 3).\u003c/p\u003e","manuscriptTitle":"Can programmatic inputs improve adolescent mothers’ access to care in rural Bangladesh? 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