Impact of COVID-19 on the Utilisation of Maternal Health Services in Bangladesh: A Division-level Analysis

Overview

Journal J Glob Health

Specialties Health Services
Public Health

Date 2024 Nov 22

PMID 39575613

Authors

Aniqa Tasnim Hossain

Ema Akter

Ridwana Maher Manna

Tasnu Ara

Md Alamgir Hossain

K M Tanvir

Md Hafizur Rahman

Abu Sayeed

Abu Bakkar Siddique

Bibek Ahamed

M Sabbir Haider

Sabrina Jabeen

Shafiqul Ameen

Mohammad Sohel Shomik

Anisuddin Ahmed

Luis Huicho

Alicia Matijasevich

Abdoulaye Maiga

Ahmed Ehsanur Rahman

Nadia Akseer

Shams El Arifeen

Agbessi Amouzou

Affiliations

Soon will be listed here.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic had substantially disrupted maternal health care provision and utilisation in Bangladesh. However, the extent of geographical disparities in service utilisation and how the health system withstood these challenges have not been studied. This study explores the divisional disparities in trends and disruptions in maternal health service utilisation caused by the COVID-19 pandemic.

Methods: Data was extracted from the District Health Information Software of Bangladesh from January 2017 to December 2021. We assessed the trend of first antenatal care visit, institutional delivery and number of caesarean sections over these years. We explored both the yearly and monthly trends to see the variations in the number of utilisations. Segmented regression with Poisson distribution was used to assess changes in service utilisation during the COVID-19 period. We reported incidence rate ratio (IRR) of service utilisation with a 95% confidence interval (CI) in different divisions during COVID-19 (2020-2021) compared to the reference period (2017-2019).

Results: Initially, a notable decline in maternal health care utilisation was observed in 2020 compared to the pre-pandemic period of 2017-2019. Divisional disparities were observed in this trend. Overall, compared to the pre-pandemic period, we observed around 30% decline in all three selected indicators of maternal health care. The lowest value was observed in Chattogram in 2020 (IRR = 0.66; 95% CI = 0.55-0.79) and Rajshahi in 2021 (IRR = 0.71; 95% CI = 0.60-0.82). For institutional delivery, Barishal division had the lowest IRR (0.64; 95% CI = 0.60-0.68) in 2020 and, in 2021 Rajshahi had the lowest IRR (0.71; 95% CI = 0.60-0.82). For caesarean section, the lowest value was observed in Barishal division (IRR = 0.48; 95% CI = 0.44-0.53) in 2020 and in Mymensingh (IRR = 0.37; 95% CI = 0.32-0.43) in 2021. By 2021, the three maternal health care utilisation indicators demonstrated recovery.

Conclusions: The effect of the pandemic, including lockdown, on the selected maternal service utilisation was observed in Bangladesh though there were substantial geographic disparities. These disruptions slightly recovered after the initial shock. These results will support the government in preparing the national and regional health systems for future epidemics in Bangladesh.

Citing Articles

Excess mortality during COVID-19 and prediction of mortality in Bangladesh: an analysis based on death records in urban graveyards.

Akter E, Hossain A, Ahamed B, Rahman M, Akm T, Barua U J Glob Health. 2025; 15:04050.

PMID: 40019156 PMC: 11869516. DOI: 10.7189/jogh.15.04050.

Rural-urban disparity in uptaking skilled antenatal care visits by pregnant women in Bangladesh: Zero and One Inflated Poisson regression model.

Tanvia L, Haque M, Bari W PLoS One. 2025; 20(1):e0318341.

PMID: 39879162 PMC: 11778761. DOI: 10.1371/journal.pone.0318341.

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