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Exploring the influencing factors for non-utilisation of healthcare facilities during childbirth: a special mixed-method study of Bangladesh and 13 other low- and middle-income countries based on Demographic and Health Survey data
  1. Tanjim Siddiquee,
  2. Henry Ratul Halder and
  3. Md Akhtarul Islam
  1. Statistics Discipline, Khulna University, Khulna, Bangladesh
  1. Correspondence to Md Akhtarul Islam; akhtarulstat{at}


Objective To identify the associated factors affecting the decision regarding institutional delivery for pregnant women in 14 low- and middle-income countries (LMICs).

Design A special mixed-method design was used to combine cross-sectional studies for harmonising data from Bangladesh and 13 other countries to obtain extended viewpoints on non-utilisation of institutional healthcare facilities during childbirth.

Setting Demographic and Health Survey (DHS) data for 14 LMICs were used for the study.

Participants There are several kinds of datasets in the DHS. Among them IndividualWomen’s Records’ was used as this study is based on all ever-married women.

Results In the binary logistic and meta-analysis models for Bangladesh, ORs for birth order were 0.57 and 0.51 and for respondents’ age were 1.50 and 1.07, respectively. In all 14 LMICs, the most significant factors for not using institutional facilities during childbirth were respondents’ age (OR 0.903, 95% CI 0.790 to 1.032) and birth order (OR 0.371, 95% CI 0.327 to 0.421).

Conclusion Birth order and respondents’ age were the two most significant factors for non-utilisation of healthcare facilities during childbirth in 14 LMICs.

  • global health
  • health care
  • health care facilities, manpower, and services
  • maternal-child health services
  • public health

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  • Contributors MAI came up with the idea and concept and supervised the study. TS and HRRH were responsible for the methodology, formal analysis, interpretation, validation, investigation, data curation, draft preparation, review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The DHS survey was approved by the ICF International Institutional Review Board. The corresponding author has permission to use DHS data, which were accessible in the public domain in an unidentifiable form. Therefore, no additional approval was necessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.