Women's involvement in understanding and establishing their rights (here it is resembling if the mothers can say no to domestic violence and if they discourage an early marriage) in Bangladesh may not at all times be prioritized. In many societies, women are often restricted from understanding their worth regarding their own well-being and health, with their rights being dictated by their husbands. Consequently, this can result in inadequate or inappropriate care for women during pregnancy, negatively impacting their health and the well-being of their babies. Anyway, it remains uncertain whether women's view about their own rights directly relates to improved antenatal care in Bangladesh. This topic holds noticeable importance as antenatal care plays a critical role in ensuring a healthy pregnancy and reducing maternal and infant mortality rates. According to a report in 2015, approximately 300,000 women worldwide died annually due to birth giving related complications, with a majority of these deaths being preventable [17]. In 2020, the number of global maternal mortalities came to 2,80,000 [16].
Antenatal care encompasses various aspects such as regular check-ups, tests, and counseling, all aimed at promoting a healthy pregnancy and delivery. Factors such as the timing of the first antenatal care visit, the frequency of visits, and seeking care from professionals greatly influence the effectiveness of maternal health interventions during the antenatal period. According to “the WHO FANC model”, it is required that the mother’s 1st ANC visit must be within the first 12 weeks of gestation [18]. It is also mandatory that under usual circumstances, a prospective mother should have a minimum of four ANC visits [19]. Not receiving a proper ANC at least four times might diminish the likelihood of receiving a worthwhile maternal health intervention during the antenatal period [20, 21]. Despite an increase in antenatal care coverage in Bangladesh, the country still ranked among the top ten contributors to global maternal mortality rates in 2015. Although there has been some improvement in recent years, it remains insufficient compared to other developed countries [22]. Therefore, it is crucial to identify the impact of women's upholding their rights related to marriage on antenatal care utilization.
Previous studies have shown that receiving antenatal care from skilled providers reduces the risk of complications and adverse pregnancy outcomes; such as- intrauterine growth retardation, stillbirths, preterm births, fetal abnormalities, etc [7–15]. However, in Bangladesh, only a small percentage of women received their first antenatal care within the recommended timeframe, highlighting the need for improved access to quality care. In 2016, it is manifested that just about one-fifth (21%) of Bangladeshi women received their first ANC within 3 months of gestation from any health service provider; more agitatedly only 14% of those women received ANC from a skilled service provider [23].
Women's attitude to their rights can significantly influence the standard of care they receive during pregnancy and childbirth. When women have the mentality or attitude to say no to violence and early marriage, they might be more likely to seek care early in their pregnancy, attend all recommended appointments, and follow healthcare providers' advice; which was investigated through this analysis. This, in turn, can lead to better health outcomes for both mothers and babies, as well as a more positive childbirth experience and improved health for women. In Rwanda, there was a significant negative relationship between physical intimate partner violence and both early ANC and sufficient ANC [24]. In India, the results of a study revealed that women who married at < 18 years were significantly less likely to use maternal health care services than those married at ≥ 18 years even after accounting for socio-economic and demographic characteristics of women [25]. Once more, a research about child marriage in south Asian countries showed that the common factors resulting from child marriage were reproductive and maternal factors such as reduced utilization of ANC services, fewer institutional deliveries, and the absence of a skilled birth attendant during delivery [26]. Again, in Bangladesh, domestic violence was significantly associated with the lower utilization of four or more ANC and health-center-based delivery care [27]. But no research showed the urgency of the overall ANC coverage that includes the required times to visit for ANC, the first ANC visit time, and going to qualified centers or doctors; with the effect of women’s attitude to violence and their preferred age for marriage.
The primary goal of raising awareness among women about their marriage rights and improving access to quality antenatal care (ANC) is to ensure their overall well-being during the crucial stages of pregnancy. The importance of women's rights and equitable healthcare provision during pregnancy cannot be overstated for this country, as it directly influences maternal and child health outcomes. Educating women about their rights within the institution of marriage, such as the right to consent, equips women to make informed choices regarding their reproductive health, including seeking timely and appropriate ANC. Simultaneously, enhancing access to better ANC services is essential for promoting positive maternal and child health outcomes. By providing comprehensive and evidence-based care during pregnancy, ANC plays a vital role in detecting and managing potential risks, ensuring healthy pregnancies, and reducing maternal and antenatal mortality rates.
However, there is a lack of research specifically examining the impact of women's view to say no to the violation of their rights on receiving quality antenatal care in Bangladesh. Further investigation is obligatory to understand the important relationship between women's view about their rights and antenatal care utilization in this country. It is essential to recognize the significance of enlightening women and ensuring the good for their own health and the health of their families. By promoting women's attitude toward their rights and saying no, Bangladesh can endeavor toward providing adequate antenatal care and improving maternal and antenatal health outcomes in Bangladesh.
Data and Variables
The data from the Bangladesh Demographic and Health Survey (BDHS) of the 2017-18 year has been used in this analysis. It contains the data of Bangladeshi married women who ever had a child. Finally, the analysis was done using the data of 10582 respondents. The process of ending up to 10582 respondents after data cleaning is discussed in the Methodology section.
The independent variables that were used to predict the dependent variable “ANC Coverage” were “Woman’s justification of being beaten by husband” and “Preferred age for marriage”. The covariates were: Highest educational level, Religion, Type of place of residence, and Exposure to media. It is to mention that covariates were selected seeing the highest Cox and Snell R square doing backward elimination.
Dependent Variable:
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ANC Coverage: ANC coverage is calculated based on three factors. If the woman goes for her first ANC visit within the first three months of conceiving, had at least four ANC visits during her whole pregnancy period, and went to qualified centers/doctors for ANC visits were assumed to be under ANC coverage. Here the qualified centers or doctors were all the govt. medical centers and hospitals, private medical centers and hospitals, and qualified doctors. The clinics in local area or community or ANC at home were not assumed as quality ANC. Specific factors behind being under ANC coverage are analyzed in this research.
Independent Variables:
Women’s view to their rights
In this analysis, women’s view to their rights resembles if the mothers can say no to domestic violence and if they discourage early marriage. So this attitude is manifested into two independent variables.
1. Women’s justification of being beaten by husband: In this analysis, the factors that might affect being under ANC coverage were related to women’s view to their rights. That means how married women in Bangladesh who ever had a child behave or think about their own good and self-respect. The women who think being beaten by husbands for any reason is okay and justified are not carrying the same attitude that the other women do, who think beating is not justified for any reason. The reasons were if women go out without telling their husbands, neglect their children, argue with husband, refuse to have sex with their partners, and burn the food. Women who think being beaten for any of these reasons is okay justify beating.
2. Preferred age for marriage: In the logistic regression and further calculation, the quantitative variable “Preferred age for marriage” was used. In percentage analysis (Table 1), the preferred age for marriage is grouped into 3 classes for representing the percentage easily as it is impossible without grouping the quantitative variable like age. But the quantitative raw variable was used in the probit model. In Bangladesh, the minimum age of marriage for girls is 18 years [1]. In the following dataset, it is seen that many women prefer marrying at the minimum age which is 18, and even before 18. The preferred age of marriage according to the individuals also indicates their view to their marriage rights and planning for their future and own selves.
Covariates:
- Highest educational level: Four educational levels are labeled in the highest education variable to check if there are any significant changes in ANC coverage with different educational levels. It is used to adjust the model.
- Type of place of residence: This demographic variable is also used as a covariate and is used to adjust the model in logistic regression. It can show whether rural or urban people are more likely to be under ANC coverage.
- Religion: The religion variable from BDHS data was again divided into two categories- Muslims and Non-Muslims. This variable also shows the likelihood of being under ANC coverage among two categories of religion and is mainly employed to adjust the model.
- Exposure to Media: Respondents who are connected to any single news media at least once a week are assumed to be exposed to media; and those who don’t watch or listen to any type of news media even once a week are not exposed to media. This created variable is also used to adjust the model.
It is seen that these socio-demographic variables put an impact in adjusting the model where the dependent variable is ANC coverage [2]. Though it might vary regarding the data, social changes at different times in a country, and the goal of a study.