Examining the prevalence of and factors associated with facility-based birth services in Bangladesh: a cross-sectional analysis using national data

Facility-Based Birth (FBB) services are essential to reducing maternal and neonatal complications, yet only 53.4% of deliveries in Bangladesh occurred in facilities in 2019. While evidence exists on FBB use and skilled attendants, the role of qualified doctors within FBB remains less explored through a structured analytical approach. Using data from 5304 mothers in the Bangladesh Demographic and Health Survey 2017–18, this study examined the prevalence and determinants of using FBB services and using FBB services performed by qualified doctors through descriptive and bivariate crude odds ratio (COR) and multivariate adjusted odds ratio (AOR) analyses guided by Andersen’s behavioral model. Results show that 50.3% of births occurred in facilities and 38.5% were attended by doctors. FBB utilization was significantly associated with urban residence, antenatal care (ANC), lower birth order, higher maternal and husband education, and household wealth. Urban women were 1.26 times (AOR 1.257; 95% CI: 1.056–1.495; p = 0.010), and the wealthiest 3.58 times (AOR 3.583; 95% CI: 2.599–4.939; p < 0.001), more likely to use FBB services compared to rural and poorest women. Applying Andersen’s model, enabling factors, particularly wealth and media exposure, were the most influential in translating predispositions into actual service use, followed by predisposing and geographical factors. Policy priorities should target high-risk populations and regions, expand media campaigns, introduce transport subsidies or mobile clinics, engage religious and community leaders, and scale up doctor-led ANC to increase the use of FBB services in Bangladesh.