The Trend of Out‐of‐Pocket Costs for Child Delivery Care in Bangladesh During 2014–2022: A Cross‐Sectional Study
Sabrin Sultana, Mohammad Nayeem Hasan, Bodrunnahar Barna, Isratul Jannat Mim, Sohagi Akhter, Mst Fahima Khatun, Muhammad Abdul Baker Chowdhury, Md Jamal UddinABSTRACT
Background and Aims
In Bangladesh, out‐of‐pocket payments are the primary means of covering childbirth‐related expenses, often placing a substantial financial burden on households and disrupting family livelihoods. This study examines trends in out‐of‐pocket (OOP) expenditures and identifies the factors influencing childbirth costs between 2014 and 2022, highlighting differences across delivery types and socio‐demographic groups.
Methods
This study analyzed 12,752 ever‐married women aged 15–49 who reported out‐of‐pocket costs for childbirth within 2 years before each survey, we pooled data from the 2014, 2017–2018, and 2022 Bangladesh Demographic and Health Surveys (BDHS). Out‐of‐pocket costs for home delivery, institutional normal delivery, and cesarean section (C‐section) delivery expenses were the main outcome variables. Maternal age, employment status, antenatal care (ANC) visits, household wealth, body mass index (BMI), husband's education, birth order, geographic division, and place of residence were important independent variables. Descriptive statistics, ANOVA, t ‐tests, and log‐linear regression were used to investigate associations.
Results
The mean OOP of C‐section delivery was the highest ($369.84), followed by institutional normal delivery ($102.78) and home delivery ($27.38). The mean cost of C‐section delivery decreased from $501.46 in 2014 to $285.14 in 2022, while the cost of institutional normal delivery decreased from $116.23 to $93.03. The difference in costs between survey years was statistically significant ( p < 0.001). Pooled regression analysis showed that higher household wealth was associated with higher costs in the selected delivery‐type models. Other associated factors varied by delivery type and included maternal age, employment status, ANC visits, BMI, husband's age and education, birth order, geographic region, and place of residence.
Conclusion
There were significant differences in the amount of OOP costs of childbirth by type of delivery and year of survey. Despite a decline in average costs between 2014 and 2022, costs for C‐section deliveries remained consistently the highest. Socioeconomic and geographic disparities highlight the unequal financial burden of childbirth in Bangladesh and support the need for policies to improve financial protection and equitable access to maternal health care.