Link between gender inequality and women's satisfaction with maternal healthcare services: a cross-sectional study in Khulna, Bangladesh.

Background: Gender inequality within households remains a significant barrier to accessing maternal healthcare services in many low-resource settings, including Bangladesh. Understanding the relationship between the gender inequality faced by women in households and their perceived satisfaction with maternal healthcare services is important.

Objective: This study aims to identify the factors influencing gender inequality and investigate the association between gender inequality faced by women within households and their perceived satisfaction with maternal healthcare services.

Design: Conducted between October and November 2022, employing a cross-sectional design.

Settings And Participants: 150 women who are at their prenatal or postnatal stages are systematically sampled from municipality and subdistrict from Khulna, Bangladesh.

Outcome Measures: Gender inequality within the households is assessed using a validated five-point Likert scale of five items. Participants with an average score below or equal to the median value are considered to be facing gender inequality within households. Satisfaction with maternal healthcare services is measured across five variables using a similar scale. Based on the responses, a standardised score is generated to measure the satisfaction level with maternal healthcare services.

Results: We find that women are around seven times more likely to experience gender inequality in their households if their husbands are engaged in self-employed jobs or skilled labour compared with unemployment (p<0.10). Coercive actions, such as physical assault (odds: 6.428, p<0.01) and preventing women from financially supporting their maternal kin (odds: 14.909; p<0.01), are positively related to gender inequality. Such inequality negatively relates to women's perceived satisfaction with their maternal healthcare services (-1.851, p<0.01). Additionally, traditional home delivery, verbal abuse and the forced use of traditional medication reduce satisfaction levels. On the other hand, increased prenatal care is expected to increase satisfaction with maternal services as perceived by women (0.545, p<0.10).

Conclusions: The study prioritises promoting equity in opportunities for both males and females, with access to maternal health, and educational opportunities within households. Reduced inequality within households may help minimise the extent of coercive behaviour against women. The national maternal health strategy should focus on basic health services for pregnant women, with free prenatal and postnatal check-ups for pregnant mothers to improve their perinatal healthcare services.