A Deviance Approach to Understanding Use of Maternal Health Care Services in Bangladesh.

Context: Use of maternal health care can reduce maternal morbidity and mortality in countries like Bangladesh, where rates of these outcomes are high. Community characteristics are associated with use of maternal care services, but it is unclear whether deviation from community norms is associated with service use.

Methods: Data from the 2014 Bangladesh Demographic and Health Survey on 4,106 ever-married women aged 15-49 were used to examine relationships between women's deviation from their communities on socioeconomic, fertility and other characteristics and use of maternal health care (antenatal care, delivery care, postpartum care and a composite measure). Characteristics were examined at the individual and community levels and as deviance variables that indicated whether respondents differed from local norms in a positive way (e.g., being employed when others were not) or a negative way (being unemployed when others had jobs). Associations were identified using logistic regression.

Results: Sixty-three percent of women had had postpartum care; smaller proportions had had delivery care (40%), antenatal care (27%) or all three types (17%). Several deviance variables were associated with service use. Negative deviance on women's employment was associated with antenatal care (odds ratio, 1.3); positive deviance on violence justification, exposure to family planning messages and husband's employment was associated with delivery care (1.3-4.8); positive deviance on husband's employment was associated with not receiving postpartum care (0.7); and negative deviance on women's employment and positive deviance on age at marriage were associated with receipt of all three services (1.4-1.7).

Conclusion: Understanding associations between deviation from community norms and receipt of maternal health care may provide deeper understanding of variation within communities regarding whether women use services.