Investigating the role of health care at birth on inequalities in neonatal survival: evidence from Bangladesh

Introduction: In countries such as Bangladesh many women may only seek skilled care at birth when complications become evident. This often results in higher neonatal mortality for women delivering in institutions. However, we hypothesise that the apparent increase in mortality is concentrated in less advantaged women. The aim of this paper is to examine the association between place of delivery and neonatal mortality in Bangladesh, and how this varies by socio-economic status. Methodology: The study is based on data from three pooled Bangladesh Demographic and Household Surveys, and uses bivariate analysis and binomial multivariate logistic regression. It creates composite variable combining place of delivery with indicators of socio-economic status to examine the relationship between these two factors on neonatal mortality.Results: Women from poorer socio-economic groups who give birth in institutions have worse outcomes than those who give birth at home. This difference is much less marked for more wealthy women. There is a much stronger socio-economic gradient for neonatal mortality for women who give birth in institutions than those who delivery at home.Conclusion: In Bangladesh babies from lower socio-economic groups have very poor outcomes if born in a facility, suggesting that services are particularly failing to meet the needs of poorer and less educated women