Levels and Determinants of Skilled Antenatal Care Utilization and Its Practice under WHO Recommendation in Northern Part of Bangladesh

Abstract

Skilled antenatal care (ANC) is essential for maternal and newborn health. It enables timely detection and management of pregnancy complications. In 2016 WHO raised its recommendation to at least eight ANC visits and suggested some criterion per pregnancy to ensure comprehensive care. This study analyzes cross-sectional primary data from 1,195 mothers across four districts in northern Bangladesh. Bivariate associations of maternal and household factors with the practice of ANC use were tested using Kruskal–Wallis test, Mann-Whitney U test and Chi-square test of association. To model the count of Skilled ANC visits, a zero-inflated mixed Poisson regression with a random effect at the sub-district level was used. Overall, 80.8% of mothers received ANC from a skilled provider, and 47.9% received care meeting quality standards and only 18% achieved complete ANC, while awareness of WHO recommendations remained alarmingly low, just 10.1% of mothers knew of the minimum 4-visit guideline, and only 1.3% were aware of the 8-visit recommendation. In the unadjusted analysis, mothers from the poorest households were significantly less likely to receive skilled antenatal care compared to those from the richest households. Also better road access, greater maternal autonomy in decision-making, and ability to afford care were also positively associated with skilled and quality ANC uptake. Significant gaps remain in both the coverage and quality of antenatal care in northern Bangladesh. The findings of the study underscore the need for equity-focused, proper interventions to reduce disparities and improve access to high-quality ANC for underserved women.

Dhaka Univ. J. Sci. 74(2): 311–320, 2026 (July)