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Determinants and trends in health facility-based deliveries and caesarean sections among married adolescent girls in Bangladesh
  1. A S M Shahabuddin1,2,3,
  2. Thérèse Delvaux1,
  3. Bettina Utz1,
  4. Azucena Bardají2,
  5. Vincent De Brouwere1
  1. 1Woman and Child Health Research Centre, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  2. 2ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
  3. 3Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to A S M Shahabuddin; shahab{at}


Objective To identify the determinants and measure the trends in health facility-based deliveries and caesarean sections among married adolescent girls in Bangladesh.

Methods In order to measure the trends in health facility-based deliveries and caesarean sections, Bangladesh Demographic Health Survey (BDHS) data sets were analysed (BDHS; 1993–1994, 1996–1997, 1999–2000, 2004, 2007, 2011). The BDHS 2011 data sets were analysed to identify the determinants of health facility-based deliveries and caesarean sections. A total of 2813 adolescent girls (aged 10–19 years) were included for analysis. Bivariate and multivariate analyses were performed.

Results Health facility-based deliveries have continuously increased among adolescents in Bangladesh over the past two decades from 3% in 1993–1994 to 24.5% in 2011. Rates of population-based and facility-based caesarean sections have increased linearly among all age groups of women including adolescents. Although the country's overall (population-based) caesarean section rate among adolescents was within acceptable range (11.6%), a rate of nearly 50% health facility level caesarean sections among adolescent girls is alarming. Among adolescent girls, use of antenatal care (ANC) appeared to be the most important predictor of health facility-based delivery (OR: 4.04; 95% CI 2.73 to 5.99), whereas the wealth index appeared as the most important predictor of caesarean sections (OR: 5.7; 95% CI 2.74 to 12.1).

Conclusions Maternal health-related interventions should be more targeted towards adolescent girls in order to encourage them to access ANC and promote health facility-based delivery. Rising trends of caesarean sections require further investigation on indication and provider–client-related determinants of these interventions among adolescent girls in Bangladesh.

  • Health facility-based delivery
  • Caesarean section
  • Adolescent girl
  • Bangladesh

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