Bridging the Gaps: Uncovering the Reasons Behind Maternal Care Dropout in Bangladesh (Preprint)

BACKGROUND Utilization of the maternal continuum of care (CoC)—comprising antenatal, delivery, and postnatal services—is critical for ensuring healthy pregnancy outcomes. Despite these benefits, maternal retention along the CoC remains suboptimal in Bangladesh. OBJECTIVE This study quantifies maternal dropouts at each stage of the CoC and identifies factors associated with these discontinuities, using nationally representative data. METHODS Data were drawn from the Bangladesh Demographic and Health Surveys (BDHS) 2017–18 and 2022. Women were considered to have completed the full maternal CoC if they received at least four antenatal care (ANC) visits, delivered with a skilled birth attendant (SBA), and obtained at least one postnatal care (PNC) contact within 48 hours of delivery. Potential determinants were identified using Andersen’s behavioral model for healthcare utilization. Multivariable logistic regression was applied to assess factors associated with CoC dropout and presented as adjusted odds ratio (aOR). RESULTS Among 8,424 mothers, 27.9% failed to complete all components of the maternal CoC. Dropout was most pronounced at the ANC stage (55.7%), followed by PNC (47.2%) and SBA-assisted delivery (40.2%). Key factors significantly associated with higher odds of dropout included lower maternal education (aOR 2.70, 95% CI: 1.94–3.77), higher parity (aOR 2.73, 95% CI: 2.12–3.50), being in lower wealth quintiles (aOR 4.04, 95% CI: 3.02–5.41), and rural residence (aOR 1.40, 95% CI: 1.18–1.67). Lower odds of dropout were found for older women at delivery (aOR 0.56, 95% CI: 0.42–0.74) compared to younger women (less than 19 years at delivery) and a history of ever-terminated pregnancy (aOR 0.74, 95% CI: 0.63–0.86). Other significant predictors included media exposure, pregnancy intention, and religious affiliation. CONCLUSIONS Maternal, socioeconomic, and contextual factors are associated with discontinuity along the maternal healthcare continuum in Bangladesh. Tailored policy interventions addressing these determinants are essential to improve maternal healthcare retention and achieve better maternal and child health outcomes.