Trend in the utilization of antenatal care during pregnancy among the adolescents in Bangladesh: Evidence from national survey data 2012/2013 and 2019

Introduction: Pregnancy during adolescence is a global health problem and the leading cause of maternal mortality. This study was aimed to explore the trends of the utilization of prenatal care or antenatal care (ANC) services during 2012/2013 and 2019, and to identify the factors associated with the use of ANC among adolescents in Bangladesh. Methods: This study was based on the secondary data set of two consecutive surveys of Bangladesh Multiple Indicator Cluster Survey (MICS) 2012/2013 and 2019. Results: The prevalence of utilizing ANC among Bangladeshi adolescents is in increasing trend; however, as per WHO recommendation, the prevalence of utilizing 4 + ANC visitswasverylowin2019(34.1%),whichwas26.2%in2012/2013.Educationalstatus of the adolescents, area of residence, household wealth status, administrative division, and status of watching television were independent predictors of receiving 4 + ANC visits among the pregnant adolescent girls in Bangladesh. Conclusions: The status of ANC among Bangladeshi adolescents is still very low. Awareness building programs among adolescents and their family members through health education interventions should be taken.

or antenatal care (ANC) provides a scope to prevent or treat or manage the complications related to delivery. 1,5,7 ANC is a broad aspect including medical procedures and care provided to the mothers during pregnancy and crucial to maintain a healthy pregnancy state and ensure safe childbirth. 8 The components of ANC include "risk identification, prevention and management of pregnancy-related or concurrent diseases, and health education and health promotion." 9 Previous studies reported most of the obstetric and gynecological problems related to pregnancy and childbirth can be prevented through ANC. 10 Utilization of ANC services also influence skilled birth attendants. 11 Evidence shows that adolescent pregnant girls are less likely to utilize ANC and demographic and socioeconomic factors such as education, employment, place of residence, geographical variations, birth order, and parity were associated with the use of ANC. 12 WHO recommended that every pregnant woman should have at least four ANC visits during pregnancy. 9 According to the Bangladesh Demography and Health Survey report 2014, about 19.2%, 50.3%, and 30.5% of Bangladeshi adolescent pregnant girls received no care, one to three times, and 4+ times ANC service, respectively, during pregnancy. 12 As adolescent pregnancies are highly prevalent in Bangladesh, data on the utilization of ANC among this group are very limited. Thus, it is important to understand the current trends, where progression has been done, where to invest additional resources, and who to specifically target to scale up the overall situation. Considering the vulnerability of adolescent girls due to early pregnancy, significance of ANC in protecting maternal and child health, and to fill the research gap this study was aimed; to explore the trends of utilization of ANC services during 2012/2013 and 2019, and to identify the factors associated with the use of ANC among the adolescents in Bangladesh.

METHOD
This study was based on the secondary data set of two consecu-

Antenatal care
Participants were asked, "Did you see anyone for antenatal care during your pregnancy (yes/no)?" If "yes," "How many times did you receive antenatal care during pregnancy?" From the above responses, a new variable was generated "Utilization of antenatal care" and the responses were categorized as "No visit," "1 visit," "2-3 visits," and "4+ visits." Data were collected retrospectively from the participants based on recall of events from their last pregnancy.

Study variables
The demographic and socioeconomic status of the participants were considered as the independent variables of this study.

Statistical analysis
Data set were cleaned before formal data analysis. Both descriptive and inferential statistics were run to calculate the number and frequen-

RESULTS
Trends in the utilization of ANC among adolescent girls during 2012/2013 and 2019 are presented in Figure 2.

CONFLICT OF INTEREST
The authors declare to have no conflict of interest.

ETHICS APPROVAL
As this study was based on a secondary data set, ethical approval was not required. However, the survey protocol of MICS was approved by the technical committee of the Government of Bangladesh lead by the Bangladesh Bureau of Statistics (BBS), and we received authorization from the MICS team to use the data set for analysis.