IDEAS home Printed from https://ideas.repec.org/a/wly/sustdv/v34y2026i2p2925-2962.html

Breaking the Regional Barriers: Identifying Determinants of Antenatal Care Access in Bangladesh for Improved Maternal Health Policy

Author

Listed:
  • Md. Salman
  • Mou Rani Sarker
  • Md. Asifur Rahman
  • Andrew M. McKenzie
  • Md Abdur Rouf Sarkar

Abstract

Inadequate utilization of antenatal care (ANC) services remains a major contributor to maternal and child morbidity globally, posing barriers to achieving Sustainable Development Goal 3.1 in developing countries such as Bangladesh. Despite notable national progress, regional disparities continue to constrain timely ANC access for pregnant women. This study identifies the region‐specific determinants of ANC access using advanced econometric modeling. A nonparametric copula control function approach is applied to correct for endogeneity in Poisson regression, with robustness validated through machine learning techniques. Using nationally representative data from the 2022 Bangladesh Demographic and Health Survey, findings show that only 41% of pregnant women achieved the recommended ≥ 4 visits, with the highest coverage in Dhaka and the lowest in Khulna. Determinants varied across divisions: higher education, household wealth, family‐planning knowledge, financial inclusion, prior caesarean delivery, decision‐making autonomy, and media exposure significantly increased ANC use, while higher birth order, more young children, large household size, agricultural employment, and rural residence reduced utilization. Unique contextual findings, such as the positive role of women's land ownership in Sylhet and the potential of ICT‐based counseling in remote regions, underscore the need for region‐specific interventions. Policy recommendations include re‐targeting health budgets to underserved regions, reforming inheritance and land‐distribution laws, expanding mobile banking and community insurance, and scaling digital health counseling platforms. The study highlights that achieving universal ANC coverage requires empowerment‐driven, evidence‐based, and cross‐sectoral strategies integrating social, financial, and infrastructural dimensions into the regional maternal health planning framework.

Suggested Citation

  • Md. Salman & Mou Rani Sarker & Md. Asifur Rahman & Andrew M. McKenzie & Md Abdur Rouf Sarkar, 2026. "Breaking the Regional Barriers: Identifying Determinants of Antenatal Care Access in Bangladesh for Improved Maternal Health Policy," Sustainable Development, John Wiley & Sons, Ltd., vol. 34(2), pages 2925-2962, April.
    • Handle: RePEc:wly:sustdv:v:34:y:2026:i:2:p:2925-2962
    DOI: 10.1002/sd.70493
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/sd.70493
    Download Restriction: no
    File URL: https://libkey.io/10.1002/sd.70493?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Ema Akter & Aniqa Tasnim Hossain & Ahmed Ehsanur Rahman & Anisuddin Ahmed & Tazeen Tahsina & Tania Sultana Tanwi & Nowrin Nusrat & Quamrun Nahar & Shams El Arifeen & Mahbub Elahi Chowdhury, 2023. "Levels and determinants of quality antenatal care in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey," PLOS ONE, Public Library of Science, vol. 18(5), pages 1-15, May.
    2. Saifuddin Ahmed & Andreea A Creanga & Duff G Gillespie & Amy O Tsui, 2010. "Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries," PLOS ONE, Public Library of Science, vol. 5(6), pages 1-6, June.
    3. Belayet Hossain & Ahmed A. Hoque, 2015. "Women empowerment and antenatal care utilization in Bangladesh," Journal of Developing Areas, Tennessee State University, College of Business, vol. 49(2), pages 109-124, April-Jun.
    4. Yi-Sheng Chao & Chao-Jung Wu, 2017. "Principal component-based weighted indices and a framework to evaluate indices: Results from the Medical Expenditure Panel Survey 1996 to 2011," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-20, September.
    5. Papadopoulos Alecos, 2022. "Accounting for Endogeneity in Regression Models Using Copulas: A Step-by-Step Guide for Empirical Studies," Journal of Econometric Methods, De Gruyter, vol. 11(1), pages 127-154, January.
    6. Sarah Fredsted Villadsen & Hodan Jama Ims & Anne-Marie Nybo Andersen, 2019. "Universal or Targeted Antenatal Care for Immigrant Women? Mapping and Qualitative Analysis of Practices in Denmark," IJERPH, MDPI, vol. 16(18), pages 1-11, September.
    7. Yuzhe Teng, 2025. "Does Wealth Decrease Victimization in Property Crime?: Evidence from Thailand," Asian Journal of Applied Economics/ Applied Economics Journal, Kasetsart University, Faculty of Economics, Center for Applied Economic Research, vol. 32(1), pages 15-29.
    8. Gulam Muhammed Al Kibria & Jannatun Nayeem, 2023. "Association of rural-urban place of residence with adequate antenatal care visit in Bangladesh," PLOS Global Public Health, Public Library of Science, vol. 3(10), pages 1-10, October.
    9. Block Joern H. & Hoogerheide Lennart & Thurik Roy, 2012. "Are Education and Entrepreneurial Income Endogenous? A Bayesian Analysis," Entrepreneurship Research Journal, De Gruyter, vol. 2(3), pages 1-29, July.
    10. Li, Baibing & Martin, Elaine B. & Morris, A. Julian, 2002. "On principal component analysis in L1," Computational Statistics & Data Analysis, Elsevier, vol. 40(3), pages 471-474, September.
    11. Max Kuhn & Kjell Johnson, 2013. "Applied Predictive Modeling," Springer Books, Springer, number 978-1-4614-6849-3, January.
    12. Bhat, Chandra R. & Koppelman, Frank S., 1993. "An endogenous switching simultaneous equation system of employment, income, and car ownership," Transportation Research Part A: Policy and Practice, Elsevier, vol. 27(6), pages 447-459, November.
    13. Teng, Yuzhe, . "Does Wealth Decrease Victimization in Property Crime?: Evidence from Thailand," Asian Journal of Applied Economics, Kasetsart University, Center for Applied Economics Research, vol. 32(1).
    14. Yousef Makhlouf & Christopher Lalley, 2023. "Education Expansion, Income Inequality and Structural Transformation: Evidence From OECD Countries," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 169(1), pages 255-281, September.
    15. David B. Wilson, 2022. "The Relative Incident Rate Ratio Effect Size for Count-Based Impact Evaluations: When an Odds Ratio is Not an Odds Ratio," Journal of Quantitative Criminology, Springer, vol. 38(2), pages 323-341, June.
    16. Fatema, Kaniz, 2020. "Mass Media Exposure and Maternal Healthcare Utilization in South Asia," SocArXiv 5dhyr, Center for Open Science.
    17. Benjamin D. Liengaard & Jan-Michael Becker & Mikkel Bennedsen & Phillip Heiler & Luke N. Taylor & Christian M. Ringle, 2025. "Dealing with regression models’ endogeneity by means of an adjusted estimator for the Gaussian copula approach," Journal of the Academy of Marketing Science, Springer, vol. 53(1), pages 279-299, January.
    18. Biplab Biswas & Nishith Kumar & Md Matiur Rahaman & Sukanta Das & Md Aminul Hoque, 2024. "Socioeconomic inequality and urban-rural disparity of antenatal care visits in Bangladesh: A trend and decomposition analysis," PLOS ONE, Public Library of Science, vol. 19(3), pages 1-22, March.
    19. Muhammad Asim & Waqas Hameed & Sarah Saleem, 2022. "Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data," PLOS ONE, Public Library of Science, vol. 17(1), pages 1-13, January.
    20. Enayetur Raheem & Jahidur Rahman Khan & Mohammad Sorowar Hossain, 2019. "Regional disparities in maternal and child health indicators: Cluster analysis of districts in Bangladesh," PLOS ONE, Public Library of Science, vol. 14(2), pages 1-12, February.
    21. repec:osf:socarx:5dhyr_v1 is not listed on IDEAS
    22. Jan-Michael Becker & Dorian Proksch & Christian M. Ringle, 2022. "Revisiting Gaussian copulas to handle endogenous regressors," Journal of the Academy of Marketing Science, Springer, vol. 50(1), pages 46-66, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Laura K. Merrell & Sarah R. Blackstone, 2020. "Women’s Empowerment as a Mitigating Factor for Improved Antenatal Care Quality despite Impact of 2014 Ebola Outbreak in Guinea," IJERPH, MDPI, vol. 17(21), pages 1-18, November.
    2. Minh-Tay Huynh, 2025. "Individual Data-Driven Mindset and Decision-Making Performance: The Mediating Roles of Effort and Persistence," Information Systems Frontiers, Springer, vol. 27(6), pages 2511-2538, December.
    3. Harald Hruschka, 2024. "Endogeneity of marketing variables in multicategory choice models," Journal of Business Economics, Springer, vol. 94(4), pages 639-657, May.
    4. Hiranya Sritart & Hiroyuki Miyazaki & Sakiko Kanbara & Somchat Taertulakarn, 2025. "Geospatial Patterns of Property Crime in Thailand: A Socioeconomic Perspective for Sustainable Cities," Sustainability, MDPI, vol. 17(14), pages 1-25, July.
    5. Ayman wael Al‐khatib, 2025. "Toward Achieving the Sustainable Development Goals: The Roles of Digital Human Capital, Circular Supply Chain Practices, Frugal Innovation, and the Moderating Effect of Relational Capital," Sustainable Development, John Wiley & Sons, Ltd., vol. 33(6), pages 7974-7991, December.
    6. Rouven E. Haschka, 2024. "“Wrong” skewness and endogenous regressors in stochastic frontier models: an instrument-free copula approach with an application to estimate firm efficiency in Vietnam," Journal of Productivity Analysis, Springer, vol. 62(1), pages 71-90, August.
    7. Mattarelli, Elisa & Schecter, Aaron & Hinds, Pamela & Contractor, Noshir, 2025. "Secondhand social capital and idea quality in open innovation communities," Research Policy, Elsevier, vol. 54(10).
    8. Plat, Richard, 2009. "Stochastic portfolio specific mortality and the quantification of mortality basis risk," Insurance: Mathematics and Economics, Elsevier, vol. 45(1), pages 123-132, August.
    9. Kondylis, Athanassios & Whittaker, Joe, 2008. "Spectral preconditioning of Krylov spaces: Combining PLS and PC regression," Computational Statistics & Data Analysis, Elsevier, vol. 52(5), pages 2588-2603, January.
    10. Ouyang, Yaofu & Li, Peng, 2018. "On the nexus of financial development, economic growth, and energy consumption in China: New perspective from a GMM panel VAR approach," Energy Economics, Elsevier, vol. 71(C), pages 238-252.
    11. Paschalis Arvanitidis & Athina Economou & Christos Kollias, 2016. "Terrorism’s effects on social capital in European countries," Public Choice, Springer, vol. 169(3), pages 231-250, December.
    12. Rizvi, Syed Kumail Abbas & Rahat, Birjees & Naqvi, Bushra & Umar, Muhammad, 2024. "Revolutionizing finance: The synergy of fintech, digital adoption, and innovation," Technological Forecasting and Social Change, Elsevier, vol. 200(C).
    13. Marcos Carchano & Inmaculada Carrasco & Angela González, 2025. "Examining environmental proactivity in the Spanish wine industry: The moderating role of size," Agribusiness, John Wiley & Sons, Ltd., vol. 41(1), pages 127-157, January.
    14. Teerachai Amnuaylojaroen & Pavinee Chanvichit, 2024. "Historical Analysis of the Effects of Drought on Rice and Maize Yields in Southeast Asia," Resources, MDPI, vol. 13(3), pages 1-18, March.
    15. Anahita Nodehi & Mousa Golalizadeh & Mehdi Maadooliat & Claudio Agostinelli, 2025. "Torus Probabilistic Principal Component Analysis," Journal of Classification, Springer;The Classification Society, vol. 42(2), pages 435-456, July.
    16. Weili Duan & Bin He & Daniel Nover & Guishan Yang & Wen Chen & Huifang Meng & Shan Zou & Chuanming Liu, 2016. "Water Quality Assessment and Pollution Source Identification of the Eastern Poyang Lake Basin Using Multivariate Statistical Methods," Sustainability, MDPI, vol. 8(2), pages 1-15, January.
    17. Adele Ravagnani & Fabrizio Lillo & Paola Deriu & Piero Mazzarisi & Francesca Medda & Antonio Russo, 2024. "Dimensionality reduction techniques to support insider trading detection," Papers 2403.00707, arXiv.org, revised May 2024.
    18. Herwansyah Herwansyah & Katarzyna Czabanowska & Stavroula Kalaitzi & Peter Schröder-Bäck, 2022. "Exploring the Influence of Sociodemographic Characteristics on the Utilization of Maternal Health Services: A Study on Community Health Centers Setting in Province of Jambi, Indonesia," IJERPH, MDPI, vol. 19(14), pages 1-13, July.
    19. Cling, Jean-Pierre & Delecourt, Clément, 2022. "Interlinkages between the Sustainable Development Goals," World Development Perspectives, Elsevier, vol. 25(C).
    20. Hino, Hideitsu & Wakayama, Keigo & Murata, Noboru, 2013. "Entropy-based sliced inverse regression," Computational Statistics & Data Analysis, Elsevier, vol. 67(C), pages 105-114.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:sustdv:v:34:y:2026:i:2:p:2925-2962. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1719 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.