Association Between Maternal Continuum of Care Utilization and Childhood Undernutrition in Bangladesh: Findings from Nationally Representative Surveys

Background/Objectives: Antenatal Care (ANC), delivery assisted by Skilled Birth Attendants (SBA), and Postnatal Care (PNC), collectively referred to as Continuum of Care (CoC), are platforms for delivering maternal and child nutrition interventions essential for optimal child growth. The study objective is to estimate the association between maternal utilization of CoC and childhood undernutrition in Bangladesh. Methods: Data were obtained from two nationally representative cross-sectional surveys, including Bangladesh Demographic and Health Survey (BDHS) 2017–18 and BDHS 2022. Childhood undernutrition was assessed using five indicators: (1) stunting, (2) wasting, (3) underweight, (4) any undernutrition (presence of any of first three conditions), and (5) multiple undernutrition (presence of at least two of first three conditions). Multivariable logistic regression models were used to estimate survey-specific and pooled associations. Results: Maternal utilization of full CoC was significantly associated with 51%, 35%, and 48% lower odds of childhood wasting, underweight, and multiple undernutrition in the BDHS 2022 sample, respectively. Receiving a PNC within 48 hours of delivery was significantly associated with 15% lower odds of stunting and any undernutrition in the BDHS 2017–18 sample and 17% lower odds of stunting and any undernutrition in the pooled sample. No significant differences in the survey-specific effects of maternal utilization of full CoC and its components on childhood undernutrition were observed; however, relatively stronger protective effects were evident in BDHS 2022 compared to those in BDHS 2017–18. The association between maternal utilization of full CoC and childhood stunting was not significant. Conclusions: The effectiveness of maternal utilization of CoC in preventing acute and concurrent forms of childhood undernutrition in Bangladesh has improved over time. However, substantial gap exists in translating these benefits to a reduction in chronic childhood undernutrition.