Spatiotemporal variations in the prevalence and determinants of maternal delivery at home in Bangladesh, 2012-2022: A population-based cross-sectional study

Background Despite remarkable advancements in reducing maternal and neonatal mortality, maternal delivery at home continue to pose a significant public health challenge in many low- and middle-income countries including Bangladesh. Although the incidence of maternal delivery at home has declined substantially over the past decade, pronounced disparities persist across geographic, socioeconomic, and demographic dimensions in Bangladesh. A nuanced understanding of the spatiotemporal patterns in the prevalence and determinants of maternal delivery at home is essential for designing targeted interventions. This study investigates the spatial variations in the prevalence and determinants of maternal delivery at home in Bangladesh over time. Methods We analyzed data from the Multiple Indicator Cluster Survey conducted in 2012–13 and 2019 as well as the Bangladesh Demographic and Health Survey conducted in 2022 to compare district-level estimates for maternal delivery at home. Descriptive statistics and multivariable logistic regression were employed to assess the prevalence and determinants of maternal delivery at home. Results The prevalence of maternal delivery at home declined from 68.1% in 2012-13 to 34.9% in 2022 in Bangladesh. However, significant geographical disparities persist. The prevalence of maternal delivery at home was higher in the Barisal (48.9%), Chattogram, Sylhet, and Mymensingh divisions. The lowest rates were observed in Dhaka and Khulna. At the district level, remote areas such as Bandarban, Rangamati (55.9%), and Bhola presented higher rates of home deliveries. Multivariable logistic regression analysis identified several significant predictors of home delivery. Compared with those with secondary or higher education, women with no formal education were more likely to deliver at home. Limited ANC visits (≤3 visits) significantly increased the likelihood of home birth. Rural residence, lower household wealth, multiparity (≥3 children), and lack of media exposure were also significant determinants of home delivery. Conclusions Despite progress in reducing home deliveries, persistent geographic and socioeconomic disparities highlight the need for targeted interventions. Strengthening healthcare infrastructure in underserved regions, improving maternal health awareness, increasing ANC utilization, and addressing financial barriers through subsidies and incentive programs can further reduce the number of home births. Future research should explore the influence of cultural and religious factors to develop context-specific policies that promote equitable access to facility-based childbirth.