The Trend of Out‐of‐Pocket Costs for Child Delivery Care in Bangladesh During 2014–2022: A Cross‐Sectional Study
7 affiliations
- 1Department of Banking and Insurance University of Chittagong Chittagong Bangladesh
- 2Department of Statistics Shahjalal University of Science & Technology Sylhet Bangladesh
- 3School of Public Health University of Memphis Memphis Tennessee USA
- 4Department of Pharmacy University of Asia Pacific Dhaka Bangladesh
- 5Department of Economics Shahjalal University of Science & Technology Sylhet Bangladesh
- 6Department of Neurosurgery University of Florida College of Medicine Gainesville Florida USA
- 7Faculty of Graduate Studies Daffodil International University Dhaka Bangladesh
Abstract
Background and Aims: In Bangladesh, out‐of‐pocket payments are the primary means of covering childbirth‐related expenses, often placing a substantial financial burden on households and disrupting family livelihoods. This study examines trends in out‐of‐pocket (OOP) expenditures and identifies the factors influencing childbirth costs between 2014 and 2022, highlighting differences across delivery types and socio‐demographic groups.
Methods: This study analyzed 12,752 ever‐married women aged 15–49 who reported out‐of‐pocket costs for childbirth within 2 years before each survey, we pooled data from the 2014, 2017–2018, and 2022 Bangladesh Demographic and Health Surveys (BDHS). Out‐of‐pocket costs for home delivery, institutional normal delivery, and cesarean section (C‐section) delivery expenses were the main outcome variables. Maternal age, employment status, antenatal care (ANC) visits, household wealth, body mass index (BMI), husband's education, birth order, geographic division, and place of residence were important independent variables. Descriptive statistics, ANOVA, t‐tests, and log‐linear regression were used to investigate associations.
Results: The mean OOP of C‐section delivery was the highest ($369.84), followed by institutional normal delivery ($102.78) and home delivery ($27.38). The mean cost of C‐section delivery decreased from $501.46 in 2014 to $285.14 in 2022, while the cost of institutional normal delivery decreased from $116.23 to $93.03. The difference in costs between survey years was statistically significant (p < 0.001). Pooled regression analysis showed that higher household wealth was associated with higher costs in the selected delivery‐type models. Other associated factors varied by delivery type and included maternal age, employment status, ANC visits, BMI, husband's age and education, birth order, geographic region, and place of residence.
Conclusion: There were significant differences in the amount of OOP costs of childbirth by type of delivery and year of survey. Despite a decline in average costs between 2014 and 2022, costs for C‐section deliveries remained consistently the highest. Socioeconomic and geographic disparities highlight the unequal financial burden of childbirth in Bangladesh and support the need for policies to improve financial protection and equitable access to maternal health care.
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BibTeX
@article{sultana2026trend,
title = {{The Trend of Out‐of‐Pocket Costs for Child Delivery Care in Bangladesh During 2014–2022: A Cross‐Sectional Study}},
author = {Sabrin Sultana and Mohammad Nayeem Hasan and Bodrunnahar Barna and Isratul Jannat Mim and Sohagi Akhter and Mst Fahima Khatun and Muhammad Abdul Baker Chowdhury and Md Jamal Uddin},
journal = {Health science reports},
year = {2026},
month = nov,
doi = {10.1002/hsr2.73428},
url = {https://europepmc.org/article/PMC/PMC13728998},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - The Trend of Out‐of‐Pocket Costs for Child Delivery Care in Bangladesh During 2014–2022: A Cross‐Sectional Study
AU - Sabrin Sultana
AU - Mohammad Nayeem Hasan
AU - Bodrunnahar Barna
AU - Isratul Jannat Mim
AU - Sohagi Akhter
AU - Mst Fahima Khatun
AU - Muhammad Abdul Baker Chowdhury
AU - Md Jamal Uddin
PY - 2026
DA - 2026/11/01
JO - Health science reports
DO - 10.1002/hsr2.73428
UR - https://europepmc.org/article/PMC/PMC13728998
AB - Background and Aims: In Bangladesh, out‐of‐pocket payments are the primary means of covering childbirth‐related expenses, often placing a substantial financial burden on households and disrupting family livelihoods. This study examines trends in out‐of‐pocket (OOP) expenditures and identifies the factors influencing childbirth costs between 2014 and 2022, highlighting differences across delivery types and socio‐demographic groups. Methods: This study analyzed 12,752 ever‐married women aged 15–49 who reported out‐of‐pocket costs for childbirth within 2 years before each survey, we pooled data from the 2014, 2017–2018, and 2022 Bangladesh Demographic and Health Surveys (BDHS). Out‐of‐pocket costs for home delivery, institutional normal delivery, and cesarean section (C‐section) delivery expenses were the main outcome variables. Maternal age, employment status, antenatal care (ANC) visits, household wealth, body mass index (BMI), husband's education, birth order, geographic division, and place of residence were important independent variables. Descriptive statistics, ANOVA, t‐tests, and log‐linear regression were used to investigate associations. Results: The mean OOP of C‐section delivery was the highest ($369.84), followed by institutional normal delivery ($102.78) and home delivery ($27.38). The mean cost of C‐section delivery decreased from $501.46 in 2014 to $285.14 in 2022, while the cost of institutional normal delivery decreased from $116.23 to $93.03. The difference in costs between survey years was statistically significant (p < 0.001). Pooled regression analysis showed that higher household wealth was associated with higher costs in the selected delivery‐type models. Other associated factors varied by delivery type and included maternal age, employment status, ANC visits, BMI, husband's age and education, birth order, geographic region, and place of residence. Conclusion: There were significant differences in the amount of OOP costs of childbirth by type of delivery and year of survey. Despite a decline in average costs between 2014 and 2022, costs for C‐section deliveries remained consistently the highest. Socioeconomic and geographic disparities highlight the unequal financial burden of childbirth in Bangladesh and support the need for policies to improve financial protection and equitable access to maternal health care.
SN - 2398-8835
ER -