Determinants of Institutional Delivery in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey

Background: A substantial number of mothers and infants lose their lives due to complications during childbirth. Institutional delivery can lower the number of fatalities. This study aims to explore the prevalence of institutional delivery and its multifaceted associated factors in Bangladesh. Methods: The data were extracted from Bangladesh Demographic and Health Survey (BDHS), conducted during the period of 2017-18. Following data preprocessing, a total of 4974 women were included in this study. This study attempts to identify and assess the variables (at the individual and community levels) having the significant impact on the institutional delivery by using a multilevel binary logistic regression model. Results: Approximately half of the Bangladeshi women's deliveries were done at the medical center. The study found that women aged 20 or older had a 1.53 times greater likelihood of using healthcare facilities during childbirth (OR 1.53, [1.31-1.78]) than those under 20. Women with higher levels of education were more than twice as likely to choose institutional delivery as those with no education, and the women whose husbands had higher education had the same likelihood. The likelihood of using an institutional delivery service was also boosted by women's higher socioeconomic status. Women with exposure to any form of media had a 36% (OR 1.36, [1.16-1.60] higher likelihood of accessing healthcare facilities during childbirth. Rural women had a 20% lower likelihood of receiving institutional delivery. The utilization of institutional delivery was positively correlated with religion, geographical region, child ever born, and antenatal care visits (ANC). This study discovered significant variations at the community level. Conclusion: In order to increase the prevalence of institutional delivery in Bangladesh, the study findings suggest that policymakers should focus on addressing socioeconomic and demographic factors, particularly on women's education, husbands' education, age at first delivery and frequency of ANC visits.