Investigating the role of women's education status and empowerment on accessing skilled birth attendance in Bangladesh: A structural equation modelling approach

Background

The objective of this study was to investigate the associations between women's education and access to skilled birth attendant (SBA) services mediated by factors of women's empowerment and sociodemographic characteristics using a path analysis through a structural equation (SEM) modelling approach.

Methods

A sample of 4946 mothers from the most recent Bangladesh Demographic and Health Survey of 2017–18 was used in the SEM analysis. Accessing SBA service at childbirth was operationalized as utilizing SBA during last childbirth. After extracting the relevant variables and cleaning the original survey data, a subsample of 4,946 women were eligible for analysis in the current study.

Results

The SEM model revealed strong evidence of direct, indirect, and mediating effects of both education and empowerment of women in accessing SBA services. Educated women have more autonomy in decision making and are less susceptible to family violence and consequently are more likely to access SBA services during childbirth ($\beta$ = 0.094, p < 0.001). In addition, age at first marriage, media exposure, husband's education, healthcare accessibility, decision marking, and household wealth index mediated the relationship between education and SBA service use.

Conclusion

Bangladesh, a country that needs to improve several societal and health indices to achieve the Sustainable Development Goals, need to prioritize women's education to increase accessibility to maternal healthcare services. Health education and mass-media-driven awareness may be potential interventions for LMICs to increase SBA coverage.