Pregnancy is a complex and long-term biological transition in a woman’s life with many associated health complications. Most natural vaginal births have minor complications, such as nausea and vomiting, headache, blurred vision, puffy face or shortness of breath, however, with healthy outcomes for both the mother and baby. On the other hand, major health problems during pregnancy include high blood pressure, convulsion, gestational diabetes, or pregnancy infections. When women have an aggregated chance of these complications, it is termed as high-risk pregnancy, which contributed to poor outcomes for mother or baby or for both, requiring special medical attention. However, the concept of high-risk pregnancy has not received the same level of attention in the literature as childbearing in general. The present study therefore aims to examine high-risk pregnancies of women in Bangladesh from a socio-demographic viewpoint.
The results of this study indicate that a significant proportion of women in Bangladesh have experienced pregnancy health complications, both minor and major. Also, a large number of women experienced two or more complications that were life-threatening. This phenomenon indicates an entrenched pattern of high-risk pregnancies in Bangladesh, making women vulnerable to adverse maternal and birth outcomes. The findings of this study further illustrate that of the three dimensions of women’s autonomy, both decision-making autonomy and autonomy in physical mobility had significant influences on high-risk pregnancies. Earlier studies identified some indirect influences of autonomy indicators on pregnancy health status. It is found that freedom to go outside the home for healthcare purposes have resulted in better maternal outcomes [9, 26, 28]. Independence in mobility can enable women to gather relevant information about pregnancy health, complications and remedy measures, thus contributed healthy outcomes. In addition to this, high level of decision-making power about contraception, having children at a favourable time, spacing and number of children, as well as decision about own and child’s healthcare also contributed to better pregnancy outcomes. In this context, both decision-making autonomy and women’s independent mobility to access maternal healthcare facilities reduces the prevalence of several health complications during pregnancy by ensuring higher levels of antenatal care utilization, which thus decreases the chance of high-risk pregnancy. In this way, a maternal autonomy in respect of decision-making and physical mobility could be associated with sound pregnancy health.
In this study, childbearing practices and the use of antenatal care services appeared to have strong effects on the severity of childbearing complications that are followed by high-risk pregnancies. Adolescent pregnancy is a common phenomenon worldwide, but is more prevalent in developing countries, including Bangladesh. This study found that teenage pregnancies are more likely to result in several life-threatening complications. The reason for this might be that as teenage mothers they are more likely than older mothers to be less educated as well as less autonomous, and lacking in awareness and experience regarding the danger signs of pregnancy complications, so they are less likely to receive early prenatal and antenatal care. At the same time, they are more likely to experience several health complications during pregnancy because of the biological effects of early childbearing. A large number of earlier studies have also focused on this phenomenon [14–16, 29–32]. Previous research also showed that the grand multiparous (more than four children) women were more likely to have caesarean deliveries, preterm births and stillbirths (19, 33). However, in this study the adverse effects of high birth order appeared to have lower risks compared to high-risk birth interval and adolescent or delayed childbearing.
The present study found that short birth intervals of less than 18 months had significant enhancing effects on high-risk pregnancies, which is similar to the previous studies that investigated the adverse effects of short birth intervals on maternal health complications (20, 28, 35). Women with very short birth intervals are more likely to have anaemia, gestational diabetics and high-blood pressure, as well as an increased risk premature and low birthweight babies. In addition to this, maternal health complications could occur due to the adverse biological effects of high parity and short birth intervals. Generally, in high order births (more than three) women experience multiple and life-threatening complications. Grand multiparous women are older and less likely to have accessed antenatal care, which results in an increased risk of maternal complications and poor neonatal outcomes (16, 18, 34). The results also showed that A significant relationship between high-risk pregnancies and maternal healthcare utilisation is also evident. About 24.6% of women reported just one complication during pregnancy and about 37.7% of women reported multiple health complications. However, only 55% of women had sufficient antenatal visits and only about 23% sought skilled care for different pregnancy complications (BDHS 2011). Women who had sufficient antenatal care visits and who received treatment for health complications were more likely to enjoy sound pregnancy health and reduced chance of high-risk pregnancies.
The main focus of this research is to investigate the associations between women’s autonomy and high-risk pregnancy. Among the three indicators of autonomy, both decision-making autonomy and autonomy in physical mobility appeared to have significant effects on high-risk pregnancy (Model–1). However, after adding the indicators of childbearing practices and antenatal care, this study identified maternal age as the strongest determinant of high-risk pregnancy. Also birth intervals and use of antenatal care services remained to have strong effects on high-risk pregnancies (Model–2); and the effects of decision-making autonomy became insignificant. This phenomenon indicates that women’s decision-making autonomy influences high-risk pregnancies through maternal age, birth interval as well as uptake of antenatal care. Additionally, the effects of autonomy in physical mobility on high-risk pregnancies have mediated by maternal childbearing practices and uptake of antenatal care. Thus, both childbearing practices and antenatal care uptake of women mediates the associations between maternal autonomy and high-risk pregnancies. To reduce the prevalence of high-risk pregnancies in Bangladesh, attention needs to be given to increase the level of autonomy of women. Also it is important to reduce the high-risk childbearing practices which require an increase in the age at first birth, a limit on the number of children and an extension of the intervals between births. which will also helps to improve their reproductive health status. At the same time it is necessary to ensure potential mothers’ access to antenatal care services for a sound pregnancy heath, as well as healthy birth outcomes.