Decision Making Capacity and Constraints Faced by Rural Women while Seeking Maternal and Child Health Care Services in Northeastern Bangladesh

Main Article Content

Eshita Deb
Mitu Chowdhury
Indrajit Kundu
Modhumita Bhattachirjee Pia
Kanij Fatema


The aim of the study was to determine the association between rural women’s decision-making power and the constraints faced by them while seeking Maternal and Child Health care services in northeastern Bangladesh. The study sample consisted of 150 mothers living in northeastern Bangladesh who had accessed institutional MCH care services during their pregnancy, childbirth and the postpartum period. Data were collected through a structured questionnaire using simple random sampling technique from January-April, 2018 and analyzed using descriptive statistics, decision making index and constraints facing indexing method through SPSS and Microsoft Excel. The study results showed that, decisions about treatment-seeking, consultation with the doctor during the prenatal and postnatal period, institutional birth preference and use/not use of contraceptives was always taken by the husband because the index was closer to the weighted value 200. But while making decisions about purchasing household daily needs, medicines, taking the first child or having more than two children, both husband and wife participated equally. On the other hands, constraint facing index showed that lack of medicine and vaccination, unhealthy environment and unprofessional behavior of the clinic’s people with CFI 651, 316 and 304 respectively, were the most commonly faced constraints by the rural women which discouraged them to seek institutional MCH care services. Though rural women were not completely suppressed in the northeastern region of Bangladesh, healthcare-seeking decisions were completely under the supervision of the men of families. Along with the socio-economic barriers, unprofessionalism, unavailability and mismanagement of the offered services also discouraged them to access institutional MCH care services. Awareness building among the rural people, especially in the recipients of this service along with Government and policy maker’s intervention to ensure a better quality of MCH care services can change the scenario of MCH care-seeking attitude of rural women in northeastern Bangladesh.

Maternal and Child Health (MCH) care services, decision making capacity, constraints, Northeastern Bangladesh, rural women, Sylhet region.

Article Details

How to Cite
Deb, E., Chowdhury, M., Kundu, I., Pia, M., & Fatema, K. (2019). Decision Making Capacity and Constraints Faced by Rural Women while Seeking Maternal and Child Health Care Services in Northeastern Bangladesh. Asian Journal of Agricultural Extension, Economics & Sociology, 35(4), 1-11.
Original Research Article


Munshi, Rakesh, Sang-Hyop Lee. Child immunization in Madhya Pradesh, National Family Health Survey subject reports. Number 15, IIPS, Mumbai, India; 2000.

Kerber KJ, Graft-Johnson JEd, Bhutta ZA, Okong P, Starrs A. Continuum of care for maternal, newborn and child health: From slogan to service delivery. Lancet. 2007; 370:1358-1369.

NIPORT. Bangladesh maternal mortality and health care survey, 2010; 2012.

Bishwajit G, Feng D, Tang S, Yaya S, He Z, Udenigwe O, Sharmistha G, Feng Z. Women’s decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey. BMJ Journals. 2017; 7(9).

UNICEF. The state of the world’s children, UNICEF, New York; 2000.

Prata N, Sreenivas A, Vahidnia F, Potts M. Saving maternal lives in resource poor settings: facing reality. Health Policy. 2009; 89:131-148.

Titaley CR, Hunter CL, Heywood P. Why don't some women attend antenatal and postnatal care services: A qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia. BMC Pregnancy Childbirth. 2010;10:61.

McNamee P, Ternent L, Hussein J. Barriers in accessing maternal healthcare: Evidence from low-and middle-income countries. Expert Rev Pharmacoecon Outcomes Res. 2009;9:41–8.

Amin R, Shah NM, Becker S. Socio-economic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: A cross-sectional analysis. Int J Equity Health. 2010;9:9.

Islam N, Islam MT, Yoshimura Y. Practices and determinants of delivery by skilled birth attendants in Bangladesh. Reprod Health. 2014;11:86.

Deo KK, Paudel YR, Khatri RB. Barriers to utilization of antenatal care services in Eastern Nepal. Front Public Health. 2015; 3:197.

Akeju DO, Oladapo OT, Vidler M. Determinants of health care seeking behaviour during pregnancy in Ogun State, Nigeria. Reprod Health. 2016;13:32.

Ganle JK, Obeng B, Segbefia AY. How intra-familial decision-making affects women's access to, and use of maternal healthcare services in Ghana: A qualitative study. BMC Pregnancy Childbirth. 2015; 15:173.

Story WT, Burgard SA. Couples' reports of household decision-making and the utilization of maternal health services in Bangladesh. Soc Sci Med. 2012;75:2403–11.

Fikree FF, Pasha O. Role of gender in health disparity: The South Asian context. BMJ. 2004;328:823–6.

Bishwajit G, Sarker S, Yaya S. Socio-cultural aspects of gender-based violence and its impacts on women’s health in South Asia. 2016;5:802.

Abdullah MS. antenatal and postnatal health care seeking behavior of indigenous women: A study of the patro community in Sylhet. Master thesis, Department of social relation, East West University, Dhaka, Bangladesh; 2015.

Haider SJ. Baseline survey of communication program for reducing maternal mortality and violence against women. Research and Evaluation Associates for Developments (READ), Dhaka; 2000.

BBS. Statistical Yearbook of Bangladesh. Bangladesh Bureau of Statistics. Ministry of planning, Government of the people’s republic of Bangladesh; 2016.

Fatema K. Bargaining power of women in intra-household decision making and their participation in farm and non-farm activities: Evidence from Bangladesh, MS thesis submitted to Department of Agricultural, Food and Environmental Policy Analysis. Rheinische Friedrich–Wilhelms –Universität Bonn, Germany; 2017.

Afrad MSI. Farmer’s attitudes towards vegetable cultivation in Dumki Upazila of Patuakhali district. M.S thesis, submitted to Department of Agricultural Economics, Bangladesh Agricultural University, Mymensingh; 2002.

Upul Senarath, Nalika Sepali Gunawardena. Women’s autonomy in decision making for health care in south Asia. Asia-Pacific Journal of Public Health. 2009;21(2):137-143.

Banik BK. Barriers to access in maternal healthcare services in the northern Bangladesh. South East Asia Journal of Public Health. 2016;6(2):23-36.

Anwar Islam, Tuhin Biswas. health system in Bangladesh: Challenges and Opportunities. American Journal of Health Research. 2014;2(6):366-374.

Mitra, Al-Sabir SNA, Cross AR, Jamil K. Bangladesh demographic and health survey 1996-1997. Dhaka and Calverton, Maryland: National Institute of Population Research and Training (NIPORT). Mitra and Associates, and Macro International, Inc; 1997.

National Institute for Population Research and Training (NIPORT), Mitra and Associates, Bangladesh and MEASURE DRS, ICF International, USA. Bangladesh Demographic and Health Survey, Preliminary Report 2011; 2012.

Pell C, Meñaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P, Pool R. Factors affecting antenatal care attendance: Results from qualitative studies in Ghana, Kenya and Malawi. PLoS One. 2013;8(1):537-547.

Bangladesh Ministry of Health and Family Welfare August 2000: Health Policy. Dhaka Bangladesh Ministry; 2000.

Goodburn EA, Gazi AR, Chowdhury M. Beliefs and practices regarding delivery and postpartum maternal morbidity in rural Bangladesh. Studies in Family Planning. 1995;26(1):22-32.

Bremmer M, Van Den Broek G. Refusal for referral among pregnant women in the MCH-FP area Matlab: July 1993 - July 1994. Student Report, University of Amsterdam; 1995.

Afsana K, Rashid SF. The challenges of meeting rural Bangladeshi women's needs in delivery care. Reproductive Health Matters. 2001;9(18):79-88.