UC San Diego

Background : Each year, an estimated 287,000 women and 3 million newborns in low and middle income countries die of largely preventable causes. Global organizations have adopted a continuum of care model to mitigate these deaths, in which health interventions are conceptualized as a continuous stream of services. This approach remains untested in practice, however. This research aims to explore utilization and linkages within the reproductive and maternal health continuum of care (RMH CoC), and to assess the association between this utilization and newborn deaths. Methods : This analysis used Demographic and Health Survey data to assess (1) retention and inequities within the RMH CoC in Bangladesh (Chapter 2) (2) linkages between services along the RMH CoC in Bangladesh (Chapter 3) and (3) associations between RMH CoC service utilization and neonatal mortality globally (Chapter 4). Specific services analyzed included pre- pregnancy contraceptive use, antenatal care (ANC), skilled birth attendance (SBA) and postpartum contraceptive use. Results : Only 6% of women reported using all four RMH CoC services assessed in Bangladesh. Inequities were clear, with women in the wealthiest quintile having a 10 times higher odds of full utilization than women in the poorest wealth quintile (aOR=10.11, 95% CI 3.82-26.77). Pre- pregnancy contraceptive use was associated with postpartum contraceptive use (aOR=1.71, 95% CI 1.47-1.98), and ANC was associated with SBA among both pre-pregnancy contraceptive users (aOR=2.76, 95% CI 2.20-3.47 for 1-3 ANC; aOR 6.84, 95% CI 5.26-8.88 for 4+ ANC) and non-users (aOR 1.99, 95% CI 1.56-2.53 for 1-3 ANC: aOR 4.30, 95% CI 3.29-5.64 for 4+ ANC). Globally, serial receipt of pre- pregnancy contraception, ANC and SBA was protective against neonatal mortality (AOR=0.61, 95% CI 0.52-0.73). Conclusion : There are clear utilization gaps and pervasive inequities in the RMH CoC in Bangladesh. Linkages within reproductive and within maternal life stages are strong, but require additional support to connect with one another. The measurable neonatal survival benefit seen with the serial use of services along the RMH CoC demonstrates a need for increased attention to early adoption and retention along the continuum to leverage the greatest gains in the face of increasingly limited resources