Risk deciphering pathways from women’s autonomy to perinatal deaths in Bangladesh

Background
The level of perinatal mortality in Bangladesh is one of the highest in the world. Certain childbearing practices and low use of antenatal care make Bangladeshi women vulnerable to adverse birth outcomes. Women in Bangladesh also remain considerably subordinate to men in almost all aspects of their lives, from education and paid work to healthcare utilisation. Lack of these opportunities contributes to the low status of women within family and society, and to generally poor health outcomes for women and their children.

Objective
This study investigates the risk factors of perinatal deaths in light of the low level of women’s autonomy, and the relative role of childbearing practices and antenatal care in influencing the relationship between autonomy and perinatal deaths.

Methods
The relevant data was extracted from the 2014 Bangladesh Demographic and Health Survey. Causal mediation analysis was undertaken to investigate the effects of mediators on the associations between women’s autonomy and perinatal deaths.

Results
The risk of perinatal deaths was greater by about 44% and 39% respectively for high-risk maternal age and birth interval. Those who had received sufficient antenatal care had a much lower risk of perinatal deaths compared to those who had not received sufficient care. No significant direct relationship between women’s autonomy and perinatal deaths was evident. However, the influence of women’s autonomy was mediated through maternal age, birth interval and antenatal care, and the average amount of mediation was approximately 9.7%, 25.6% and 9.9% respectively.

Conclusions
In Bangladesh, although women’s autonomy did not exert any significant direct influence on perinatal deaths, the influence was transmitted through the pathways of childbearing practices and use of antenatal care.

Significance
The inherent causes of adverse birth outcomes are largely concerned with women’s health status during pregnancy. However, many earlier studies had identified significant effects of childbearing practices, use of antenatal care services, and individual socio-demographic attributes on adverse birth outcomes. The present study extends this analysis from a socio-demographic viewpoint by identifying the risk factors of perinatal deaths. Specifically, this study examines the nature of the associations between women’s autonomy and perinatal deaths, and the relative role of maternal childbearing practices and antenatal care in influencing this relationship in Bangladesh.