Abstract

not-yet-known not-yet-known not-yet-known unknown Institutional delivery, defined as giving birth in a health facility with skilled delivery assistants, is essential for reducing maternal mortality in low- and middle-income countries. This study aimed to assess wealth-related disparities in the use of institutional delivery services in Bangladesh using data from the Multiple Indicator Cluster Survey (MICS) 2019. Multiple logistic regression was used to identify factors associated with institutional delivery, and a concentration index (CIX) measured wealth-related disparities. Decomposition analysis helped identify key contributors to these disparities. Results showed that 52% of deliveries were institutional. Women from rich and middle-income households had a 94% (AOR=1.94; 95% CI: 1.62-2.34) and 32% (AOR=1.32; 95% CI: 1.12-1.56) higher likelihood, respectively, of delivering in a health institution compared to poor women. The CIX value of 0.170 indicated institutional delivery was more common among wealthier women. Decomposition analysis revealed that prenatal care visits (33.11%), parity (11.79%), and wealth index (11.07%) were significant contributors to wealth-related disparities. In conclusion, this study highlights the urgent need for pro-poor strategies, particularly in rural and underserved areas like Mymensingh, to reduce socio-economic disparities in access to institutional delivery services, with a focus on improving education and healthcare access for women.