Prevalence of pregnancy complications
Table-1 presents information about the most recent live births for which mothers experienced any pregnancy complication. This table shows that over one in ten women (11.5%) had pregnancy-related diabetics. About 9.1% and 6.1% women (i.e. about one in seven women) had experienced two major complications (high blood pressure and convulsion, respectively) that were life-threatening for both the mother and newborn. A significant proportion of women experienced some minor health complications during their pregnancy such as blurred vision (30.3%), severe headache (36.7%), shortness of breath (21.2%) and puffy face (17%). About 28.8% of women had experienced labour lasting more than 12 hours, whereas about 19% women experienced excessive bleeding during labour. When all the complications were combined, it is clear that the vast majority (80%) had experienced at least one complication during pregnancy and childbirth. While about 38.6% of women had experienced one or two complications during pregnancy (low risk), a similar percentage (41.5%) of women were reported to have experienced at least three health complications during pregnancy (high risk).
Table 1: Distribution of health complications during pregnancy among Bangladesh women, BDHS 2011 (n=327)
Pregnancy complications
|
Percentage of women
|
High blood pressure
|
9.1
|
Gestational diabetes
|
11.5
|
Heart disease
|
4.6
|
Convulsion
|
6.1
|
Vaginal discharge
|
4.5
|
Puffy face
|
17.0
|
Blurred vision
|
30.3
|
Severe headache
|
36.7
|
High fever
|
37.1
|
Long labour
|
28.8
|
Excessive bleeding
|
19.3
|
Shortness of breath
|
21.2
|
Pregnancy risk
|
|
No risk: No complication
|
19.9
|
Low risk: One to Two complications
|
38.6
|
High risk: More than two complications
|
41.5
|
All
|
100.0
|
Table 2 provides information on the three components of autonomy and the four factors, namely maternal age, parity, birth interval and use of antenatal care, that were hypothesised to mediate the relationship between women’s autonomy and the experience of high-risk pregnancy. It is interesting that most Bangladeshi women tended to enjoy at least some degree of autonomy in decision making (61.5%) and freedom of mobility (54.5%). But they seem to enjoy very little economic autonomy: about 86% of women included in the study did not report any degree of autonomy in economic matters. In terms of the mediating factors, the vast majority had their recent birth at the appropriate age (neither early, nor late), have had fewer than four births, and the average interval between births was at least 18 months. Table 2 further shows that one half of the women did not receive sufficient antenatal care.
Table 2: Women’s autonomy, maternal childbearing practices and antenatal care among Bangladeshi women, BDHS 2011 (n=327)
Autonomy and mediating factors
|
Percentage of women
|
Autonomy of women
Decision-making autonomy
No autonomy
Autonomous
|
38.5
61.5
|
Autonomy in physical mobility
No autonomy
Autonomous
|
45.6
54.4
|
Economic autonomy
No autonomy
Autonomous
|
86.2
13.8
|
Maternal childbearing practices
Maternal age
Low-risk (20 to 34 years)
High-risk (<20 years and/or >34 years)
|
65.5
34.5
|
Parity
Low-risk (1-3 births)
High-risk (> 3 births)
|
75.8
24.2
|
Birth interval
Low-risk (> 18 months)
High-risk (< 18 months)
|
57.5
42.5
|
Antenatal care visits
No sufficient (< 3 ANC visits)
Sufficient (≥3 ANC visits)
|
49.8
50.2
|
High-risk pregnancy and associated factors
We first examine the relationship between women’s autonomy, mediating factors and high-risk pregnancy through conventional cross-tabulations. We then present the results from the regression analysis. Percentage distribution in Table 3 shows that, of the three dimensions of autonomy, only economic autonomy (ability to spend money when necessary) had a clear association with pregnancy risk although it was not statistically significant (p=0.11). Among those who had the ability to decide on using the available economic resources (e.g. for health care), only 33% reported having experienced multiple complications during their last pregnancy compared to 50% among those who reported that they did not enjoy any autonomy in economic matters. The association was weak (chi-square=4.36, p=0.11) which may be related to the fact that there was only a relatively small number of respondents who had reported some level of economic autonomy (13.8%).
In contrast to autonomy variables, all the mediating variables had a strong and statistically significant relationship with pregnancy risks. Early or late childbearing, higher parity and shorter birth intervals increased the risk of experiencing multiple complications (high risk) during pregnancy (Table 3). On the other hand, as would be expected, sufficient utilisation of antenatal health services, decreased the risk of multiple complications.
Table 3: Percentage distribution of women by pregnancy risk, and women’s autonomy, maternal childbearing practices and antenatal care of Bangladesh women (n=327)
|
Pregnancy risk (%)
|
Characteristics of respondents
|
No risk
|
Low risk
|
High risk
|
Chi square
(p-value)
|
Autonomy of women
Decision-making autonomy
|
|
|
|
2.874
(0.238)
|
No autonomy
|
20.6
|
29.4
|
50.0
|
Autonomous
|
19.4
|
34.3
|
46.3
|
Autonomy in physical mobility
|
|
|
|
4.920
(0.085)
|
No autonomy
|
24.8
|
28.2
|
47.0
|
Autonomous
|
15.7
|
36.0
|
48.3
|
Economic autonomy
|
|
|
|
4.355
(0.113)
|
No autonomy
|
19.1
|
30.9
|
50.0
|
Autonomous
|
24.4
|
42.2
|
33.4
|
Maternal childbearing practices Maternal age
Low-risk (20-34 years)
High-risk (< 20 years and/or > 34 years)
|
20.9
17.6
|
32.0
33.7
|
47.1
49.0
|
12.463
(0.002)
|
Parity
Low-risk (1-3 births)
High-risk (> 3 births)
|
21.8
14.0
|
32.7
31.6
|
45.5
54.4
|
8.864
(0.011)
|
Birth interval
Low-risk (> 18 months)
High-risk (< 18 months)
|
18.5
21.6
|
30.5
36.2
|
51.0
42.2
|
9.034
(0.012)
|
Antenatal care
No sufficient (< 3 ANC visits)
Sufficient (≥ 3 ANC visits)
|
18.4
21.3
|
23.9
40.9
|
57.7
37.8
|
14.342
(0.001)
|
Low risk: One-Two pregnancy complications
High-risk: More than two pregnancy complications
The estimated odds ratios (OR) from two regression models are presented in Table 4. Model 1 included only the autonomy variables and Model 2 includes both autonomy and mediating variables. In model 1, all three autonomy variables had a strong (OR=0.63 for economic autonomy) to moderately strong (OR=0.79 for decision making) association with high risk (multiple complications) pregnancy. When the mediating variables were added in Model 2, women’s autonomy in physical mobility was no more important. This shows that the influence of only one of the three autonomy variables seems to be mediated by factors related to childbearing and the use of antenatal care. However, all mediating variable were still important. Early and late age at childbirth increased the odds of high risk pregnancies by 30%, shorter birth interval and higher parity increased it by 31% and 23% respectively, and sufficient uptake of antenatal care services decreased the odds by almost 46%. The results confirmed that all but one autonomy variable had an independent effect on pregnancy risks, and that pregnancy risks are an outcome of the combined influences of respondents’ childbearing practices, use of antenatal care and women’s autonomy in decision making and economic autonomy. The role of women’s autonomy in pregnancy complications was mediated only in a limited way by childbearing factors and use of antenatal care.
Table 4: Estimated odds ratios (multinomial logistic regression models) of the effects of women’s autonomy, maternal childbearing practices, and antenatal care on pregnancy risk of Bangladesh women
|
Model 1
|
Model 2
|
Variables
|
Low-risk
vs
No risk
|
High-risk
vs
No risk
|
Low-risk
vs
No risk
|
High-risk
vs
No risk
|
Autonomy of women
Decision-making autonomy
No autonomy@
|
-
|
-
|
-
|
-
|
Autonomous
|
0.82
|
0.79*
|
0.85
|
0.81*
|
Autonomy in physical mobility
|
|
|
|
|
No autonomy@
|
-
|
-
|
-
|
-
|
Autonomous
|
0.86*
|
0.78*
|
0.71
|
1.08
|
Economic autonomy
|
|
-
|
|
|
No autonomy@
|
-
|
-
|
-
|
-
|
Autonomous
|
0.55
|
0.63*
|
0.53
|
0.49*
|
Maternal childbearing practices
Maternal age
Low-risk (20-34 years)@
High-risk (<20 and/or >34 years)
|
|
|
-
1.21*
|
-
1.30*
|
Parity
Low-risk (1-3 births)@
High-risk (> 3 births)
|
|
|
-
1.24*
|
-
1.23*
|
Birth interval
Low-risk (> 18 months)@
High-risk (< 18 months)
|
|
|
-
1.23*
|
-
1.31*
|
Antenatal care
|
|
|
|
|
Insufficient (< 3 ANC visits)@
Sufficient (≥ 3 ANC visits)
|
|
|
-
0.68*
|
-
0.54*
|
Note: * - p<.05; @ - reference category