A multilevel analysis to determine the factors affecting WHO recommended quantity antenatal care utilizations of pregnant women in Bangladesh

Antenatal Care utilizations have become an essential phenomenon to all pregnant women as a means of disease preclusion during pregnancy and safe live birth. To lessen maternal death and disease, proper (minimum eight) antenatal care (ANC) contacts are necessary according to World Health Organization (WHO) new guideline. The aim of this study is to assess the factors affecting proper antenatal care utilization of pregnant Bangladeshi women. The study used data from the most recent Bangladesh Demographic and Health Survey 2017-18 for conducting a two-level binary logistic regression model. A weighted sample of 4866 women and 675 clusters were considered as individual and community level respectively. The results exhibited only 11.6% women took proper antenatal care during pregnancy. The study found 23.9% variability in utilizations of Antenatal care belongs to community-level factors. At individual-level, mother's occupation, body mass index, birth-order, pregnancy intention, education, delivery place, and media access and at community-level, rural communities (AOR = 0.70, 95% C.I = 0.542-0.920), and communities having media access (AOR = 1.38, 95% C.I = 0.979-1.96) had significant relationship with proper antenatal care utilizations of pregnant women. After testing random slopes of individual-level variables, only education of women covariate was found to be varied from community to community. This study suggests that uptake of proper antenatal care depend on both individual and community level covariates and there lies extensive variation among them. Future studies on wider aspect are therefore suggested to determine obstacles in making proper Antenatal care utilizations.