The Effect of Space, Time and Night-Time Light Intensity on Antenatal Care Coverage in Bangladesh

Abstract This paper presents a small area estimation approach to assess trends in antenatal care (ANC) coverage among reproductive-age women in Bangladesh at various disaggregated levels. A multinomial multilevel time-series model is developed using district level ANC coverage data, categorizing women into three groups having: (i) no ANC visits (ANC0), (ii) 1-3 visits (ANC123), and (iii) four or more visits ( $$\text {ANC4}^{+}$$ <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:msup> <mml:mtext>ANC4</mml:mtext> <mml:mo>+</mml:mo> </mml:msup> </mml:math> ). The model accounts for localized patterns in ANC coverage over time of each group and integrates remotely sensed night-time light intensity data to improve the accuracy of coverage estimates. By incorporating key social, economic and geographic disparities, the small area model allows us to identify regions showing progress, stagnation, or decline in ANC coverage. Compared to direct estimates, the model-based estimates offer greater precision. A spatio-temporal extension of the model further refines these estimates, highlighting localized disparities in maternal health care access over both space and time—often reflected by changes in night-time light intensity. These results can support in identifying areas of low ANC coverage as priority locations for interventions. In Bangladesh, as in many developing countries, the health system operates under a decentralized structure, making district-level statistics crucial for localized planning and decision-making to ensure health equity.