Associations between Maternal Autonomy and High-Risk Pregnancy in Bangladesh: the Mediating Influences of Childbearing Practices and Antenatal Care Uptake
Abstract Background A high level of maternal, infant and neonatal mortality occurs in Bangladesh. Certain childbearing practices as well as low use of antenatal care services make Bangladeshi women more vulnerable to experience poor health during pregnancy which contributes adverse birth outcomes. Also, women in Bangladesh remain considerably subordinate to men in almost all aspects of their lives, from education and work opportunities to healthcare utilisation. This lack of opportunities contributes to the low status of women within their family and society, and generally poor health outcomes for both mother and children. This study thus aims to investigate the factors associated with severity of health complications during pregnancy in relation to the low status of women, and the relative role of childbearing practices and antenatal care uptake to influence this relationship. Methods The relevant data from the last Bangladesh Demographic and Health Survey (BDHS) is used in this study. Multinomial logistic regression models (MLRM) of categorical response variables are applied as statistical tools to analyse the relevant data for the outcome variable: high-risk pregnancy. Results In Bangladesh, about 38.7% of women experienced high-risk pregnancies with multiple health complications. Findings of the study firstly found women’s decision-making autonomy and freedom of movement significantly associated with high-risk pregnancies. However, the results further reveal that maternal childbearing practices and antenatal care uptake had strong significant effects on high-risk pregnancies. Maternal age, particularly early childbearing of women had about 52% increased risk, and use of antenatal care had about 0.58 times less risk in having high-risk pregnancies. Conclusion Although the maternal decision-making autonomy and freedom of movement had significant effects on high-risk pregnancies, however, their relationships were strongly mediated by both maternal childbearing practices and uses of antenatal care.