Does gender inequality matter for access to and utilization of maternal healthcare services in Bangladesh?

There is a high prevalence of gender gap in Bangladesh which might affect women's likelihood to receive maternal healthcare services. In this backdrop, we aim to investigate how gender inequality measured by intrahousehold bargaining power (or autonomy) of women and their attitudes towards intimate partner violence (IPV) affects accessing and utilizing maternal health care services. We used Bangladesh Demographic and Health Survey (BDHS) data of 2014 covering 5460 women who gave birth at least one child in the last three years preceding the survey. We performed logistic regression to estimate the effect of women's autonomy and their attitude towards IPV on access to and utilization of maternal healthcare services. Besides, we employed different channels to understand the heterogeneous effect of gender inequality on access to maternal healthcare services. We observed that women having autonomy positively influenced attaining five required antenatal care (ANC) services (AOR: 1.17; 95% CI: 0.98-1.41) and women's negative attitudes towards IPV were positively associated with five ANC services (AOR: 1.42; 95% CI: 1.02-1.97), sufficient ANC visits (COR: 1.55; CI: 1.19-2.01), skilled birth attendant (SBA) (AOR: 1.43; 95% CI: 1.05-1.94) and postnatal care (PNC) services (AOR: 1.44; 95% CI: 1.12-1.84). Besides, rural residency, religion, household wealth, education of both women and husband were found to have some of the important channels which were making stronger effect of gender inequality on access to maternal healthcare services. The findings of our study indicate a significant association between access to maternal healthcare services and women's autonomy as well as attitude towards IPV in Bangladesh. We, therefore, recommend to protect women from violence at home and mprove their intrahousehold bargaining power to increase their access to and utilization of required maternal healthcare services.