Household out-of-pocket expenditure for normal and caesarean childbirth in Bangladesh

Institutional childbirth rates have been rising rapidly worldwide, including in Bangladesh. This study aims to examine out-of-pocket expenditure (OOPE), financial distress, and associated factors related to institutional childbirth in Bangladesh using nationally representative household data. This study analysed secondary data from the Bangladesh Demographic and Health Survey 2022. A generalised linear model (GLM) with a log link and gamma (γ) distribution was used to assess the associations between explanatory variables (e.g., mother's age, education, place of delivery) and the OOPE of childbirth. The average self-reported OOPE per institutional childbirth was USD 201.64 (median USD 180.24). C-section deliveries incurred the highest average OOPE (USD 253.01; median USD 212.05), while normal deliveries averaged USD 83.71 (median USD 53.01). Access to electronic media, wealth status, and place of delivery were significant predictors of OOPE for normal deliveries, while maternal age, education, and delivery location influenced C-section costs. These results indicate that financial distress was more common among C-section deliveries (20%) than among normal deliveries (12%). The concentration index (-0.234) showed financial distress was more concentrated among poorer households. To reduce the financial burden of institutional deliveries, it is essential to strengthen social protection mechanisms, expand health insurance coverage, and ensure equitable access to quality maternal healthcare—key steps toward achieving universal maternal health coverage and reducing preventable maternal and neonatal complications. • Although institutional deliveries are highly beneficial, have significantly increased childbirth costs. • The average cost per caesarean and normal vaginal delivery was approximately USD 253 and USD 84, respectively. • Financial distress was disproportionately concentrated among poorer households.