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Access to maternal healthcare services among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study
  1. Shahinoor Akter1,2,3,4,
  2. Jane Louise Rich1,5,
  3. Kate Davies6,
  4. Kerry Jill Inder2,3,7
  1. 1 School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  2. 2 Priority Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia
  3. 3 Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
  4. 4 Department of Anthropology, Jagannath University, Dhaka, Bangladesh
  5. 5 Centre for Resources Health and Safety, Newcastle Institute of Energy and Resources, Shortland, New South Wales, Australia
  6. 6 School of Humanities and Social Science, University of Newcastle, Newcastle, New South Wales, Australia
  7. 7 School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Ms Shahinoor Akter; Shahinoor.Akter{at}


Objectives This study aimed to estimate the prevalence of, and factors associated with, accessing maternal healthcare services (MHC) by Indigenous women in the Chittagong Hill Tracts (CHT), Bangladesh.

Design This was a cross-sectional survey among Indigenous women of reproductive age.

Setting Two upazillas (subdistricts) of Khagrachhari hill district of the CHT.

Participants Indigenous women (15–49 years) within 36 months of delivery were surveyed about accessing MHC services (antenatal care, delivery and postnatal care) for their last pregnancy and delivery.

Primary outcome measures The primary outcome for this analysis is the prevalence of accessing any MHC service and secondary outcome is factors associated with access to MHC services for Indigenous women during their last pregnancy and childbirth.

Results Of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) who participated, 75% were aged 16–30 years. With an 89% response rate, a total of 258 (59%) women reported accessing at least one MHC service (Chakma 51.6%, Marma 28%, Tripura 20.5%; p=<0.001). Independent factors associated with accessing MHC after adjusting for clustering were attending secondary school and above (OR 2.4; 95% CI 1.2 to 4.9); knowledge about nearest health facilities (OR 3.8, 95% CI 1.8 to 7.8) and knowledge of pregnancy-related complications (OR 3.0, 95% CI 1.5 to 5.8).

Conclusion Findings suggest that the prevalence of accessing MHC services is lower among Indigenous women in the CHT compared with national average. MHC access may be improved through better education and awareness raising of local services.

  • Indigenous women
  • access
  • maternal health care services
  • maternal health
  • Bangladesh

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  • Contributors SA conceived and designed the study and undertook data collection under the guidance of KJI, KD and JLR. SA and KJI analysed and interpreted the data. SA wrote the draft of the manuscript. KJI, KD and JLR critically edited the manuscript and supervised the study. All authors read and approved the final manuscript.

  • Funding This research was supported by an Australian Government Research Training Program Scholarship and an International Postgraduate Research Scholarship from the University of Newcastle.

  • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approvals were obtained from the Human Research Ethics Committee of the University of Newcastle, Australia (H-2017-0204) and Department of Anthropology at Jagannath University, Bangladesh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Non-identifiable data may be shared with other parties to encourage scientific scrutiny and to contribute to further research and public knowledge. Data are available by contacting the first author and with permission from all co-authors; re-use of de-identifiable data may be permitted on agreement of a statistical analysis plan.