Does healthcare voucher provision improve utilisation in the continuum of maternal care for poor pregnant women? Experience from Bangladesh

Shehrin Shaila Mahmood, Mark Lyons-Amos, Shahidul Hoque, Mohammad Nahid Mia, Asiful Haidar Chowdhury, Syed Manjoor Ahmed Hanifi, Mohammad Iqbal, R. William Stones, Sasee Pallikadavath, Abbas Bhuiya

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Background: Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh. Following a steep decline in the maternal-mortality ratio over the past decade in Bangladesh, progress has plateaued at 196/100,000 live births. A voucher scheme was initiated in 2007 to reduce financial, geographical and institutional barriers to access for the poorest. The current paper reports the effect of vouchers on the use of continuum of maternal care.

Methods: Cross-sectional surveys were carried out in the Chattogram and Sylhet divisions of Bangladesh in 2017 among 2400 women with children aged 0-23 months. Using Cluster analysis groups were formed based on utilization of antenatal care, facility delivery and postnatal care. Clusters were regressed on voucher receipt to identify the underlying relationship between voucher receipt and utilisation of care while controlling for possible confounders.

Results: Four clusters with varying levels of utilization were identified. A significantly higher proportion of voucher-recipients belonged to the high-utilisation cluster compared to non-voucher recipients (43.5% vs. 15.4%). For the poor voucher-recipients, the probability of belonging to the high-utilisation cluster was higher compared to poor non-voucher recipients (33.3% vs. 6.8%) and the probability of being in the low-utilisation cluster was lower than poor non-voucher recipients (13.3% vs. 55.4%).

Discussion and conclusion: The voucher programme enhanced uptake of the complete continuum of maternal care and the benefits extended to the most vulnerable women. However, a lack of continued transition through the continuum of maternal care was identified. This insight can assist in designing effective interventions to prevent intermittent or interrupted care-seeking. Programs that improve access to quality 38 healthcare in pregnancy, childbirth and the postnatal period can have wide-ranging benefits. A coherent continuum-based approach to understanding maternal care-seeking behaviour is thus expected to have a greater impact on maternal, newborn and child health outcomes.
Original languageEnglish
Article number1701324
Number of pages10
JournalGlobal Health Action
Publication statusPublished - 11 Dec 2019


  • RCUK
  • MRC
  • MR/N006267/1
  • maternal health
  • continuum of care
  • poor pregnant women
  • atenatal care
  • postnatal care
  • cluster analysis
  • maternal health voucher scheme


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