Quality of antenatal care experience in rural Bangladesh: social support, respect, dignity, communication and counselling

Abstract

Background Quality antenatal care (ANC) can contribute to reducing maternal and neonatal morbidity and mortality. Very little information is available on the experience of care during ANC contacts in Bangladesh. This study aims to understand social support received by women, their experience of respect and dignity, and quality of communication and counselling during ANC contacts in rural Bangladesh for improving the quality of ANC services. Methods A cross-sectional household survey was administered in three upazillas (sub-districts) of Bangladesh in 2018. We defined the experience of care as reported by women using three indicators: social support received, respect and dignity experienced, quality of communication and counselling. Associations between explanatory and outcome variables were explored through binary and multiple logistic regression models controlling for background characteristics and health system contacts. Findings: Most women (79%) reported having any social support during their ANC contacts, i.e. someone was present during the ANC contact. More than half the women desired their husbands’ presence during their ANC contact while only one-fourth of the husbands were present. Experiences regarding different aspects of respect and dignity were mixed. Almost all women reported that their visual (94%) and auditory privacy (94%) were maintained. However, only in 58% of the ANC contacts the health service providers sought permission before carrying physical examination. Less than half of the women reported that the health services listened to their problems, assessed the overall situation and encouraged women to take part in the discussion during ANC counselling. After adjusting for background characteristics and other covariates, the odds of experiencing respect and dignity and the odds of receiving quality communication and counselling were significantly higher (AOR 1.9 and 16 respectively at p < 0.5) when the women were accompanied by someone during ANC contact. Conclusion Ensuring quality ANC in Bangladesh required focusing on addressing the existing gaps in the experience of care for a positive pregnancy experience. This study presents the importance of social support in improving the experience of care and suggests further research to identify effective interventions for the integration of quality of care components in this context.

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