Factors influencing use of institutional delivery services in rural Bangladesh

Background Institutional delivery is very important in reducing maternal and neonatal mortality； however, several women deliver outside of health facilities in Bangladesh. Therefore, objective of this study was to determine the prevalence of institutional deliveries and identify factors influencing institutional deliveries among women in rural Bangladesh. Methods A community-based cross-sectional study from August to September 2015 was conducted with women who gave birth in the last two years prior to the study in Kurigram District, Rangpur division, Bangladesh. Using a stratified sampling method, a total of 348 participants were enrolled in the study. Data were collected via pretested standardized questionnaire. Using SPSS version 21, chi-square and binary logistic regression analyses were carried out to determine factors influencing use of institutional delivery services. Results Among 348 participating women (mean age: 24.36 ± 4.18), it was found that only 83 (23.9%) went for institutional delivery and the remaining 76.1% delivered in home. Reasons for home delivery included: feeling embarrassed in hospital (92.8%), more comfortable at home (83.8%), long distance to health facility (46.4%) and high costs in hospital (38.1%). The factors significantly influencing institutional delivery included women’ s education (OR: 9.859; p=0.036), knowledge of institutional delivery services (OR: 8.064； p=0.007), women，s knowledge about danger signs of pregnancy (OR: 47.35; p〈0.000), pregnancy related complications (OR: 5.182； p〈0.000), and four or more antenatal care (ANG) visits (OR: 4.627; p=0.049). Conclusions This study found very low prevalence of skilled institutional delivery in rural Bangladesh. Findings of the study suggest that number of ANG visits, women’ s education and knowledge on pregnancy and delivery services can play very crucial role to increase the uptake of institutional delivery services. Health policies, health promotion and education programs should focus on these factors in order to reduce the number of preventable maternal and neonatal deaths. Efforts from different sections of the society using multisectoral approach can help in improving the maternal, newborn and child health.