Maternal autonomy and high-risk pregnancy in Bangladesh: the mediating influences of childbearing practices and antenatal care

Background Maternal, infant and neonatal mortality rates are high in Bangladesh. Certain childbearing practices and poor utilisation of antenatal care services make Bangladeshi women more vulnerable to experience poor health during pregnancy and adverse pregnancy outcomes. Also, women in Bangladesh remain considerably subordinate to men in almost all aspects of their lives, from education and work opportunities to healthcare utilisation. This study investigates the severity of health complications during pregnancy in relation to women's autonomy, and how childbearing practices and utilisation of antenatal care mediate this relationship. Methods Data from the most recent Bangladesh Demographic and Health Survey (BDHS) is used in this study. Multinomial regression models (MLRM) are employed to examine the relationship between the outcome variable - high risk pregnancy, and explanatory variables - women's autonomy, childbearing practices and use of antenatal care. Results In Bangladesh, about 41.5% of women experienced high-risk pregnancies involving multiple health complications. Findings showed that women's autonomy in decision-making, freedom of movement and economic autonomy were significantly associated with high-risk pregnancies. However, women's autonomy in physical mobility in particular did so only through the mediating factors of maternal childbearing practices and antenatal care. Specifically, both early and delayed childbearing and shorter birth interval increased the likelihood of high-risk (multiple complications) pregnancies by about 30% and 31% respectively, high parity increased the risk by 23% and use of antenatal care decreased it by 46%. Conclusions The Women's decision-making autonomy, freedom of movement and economic autonomy had significant effects on high-risk pregnancies. However, the effects were mediated by both maternal childbearing practices and use of antenatal care in a limited way. Policies and programmes aimed at improving pregnancy outcomes need to focus on all three sets of factors: women's autonomy, childbearing practices and use of antenatal care.