Education of household head and maternal healthcare utilization: the case of Bangladesh.

Background: The high maternal mortality ratio in South Asian countries could be attributed to poor maternal healthcare (MHC) utilization. Here household heads (HHs) are the main decision-makers of the households and thus can be key stakeholders in women's MHC uptake. We aim to investigate the role of HHs' education in MHC utilization and explore the educational status of male adolescents who will eventually replace today's HHs in the future.

Method: We investigated antenatal care (ANC), and institutional delivery as two MHC during pregnancy and childbirth using the Bangladesh Multiple Indicator Cluster Survey 2019. Due to the stratified cluster sampling nature of the BMICS 2019, we estimated odds ratios from mixed-effect multiple logistic regression considering women nested within clusters and estimated marginal effects to conclude. Using the Bangladesh Adolescent Health and Wellbeing Survey 2019-20, we estimated region-specific school dropout rates and identified the reasons for and timing of dropout among male adolescents.

Results: The odds of ANC uptake and institutional delivery decreased by lower levels of HHs' education. Marginal effects of HHs' education on institutional delivery across comparable levels of ANC uptake show that less educated HHs diminish the full potential of ANC uptake in facilitating institutional delivery. The heaviest burden (~ 70%) of less educated (up to primary level) HHs was in the northeastern region. The highest rate of school dropout (40%) was also in the northeastern region. Around 60% of dropouts left school before or just after completing primary level. The primary reasons for dropout were lack of interest and financial constraints.

Conclusion: Integrating HHs into MHC programs can be the immediate call for action while averting male adolescents' school dropouts can be the long-term strategy.