Pregnancy is a complex and long-term biological transition in a woman’s life with many associated health complications. Most pregnancies that result in natural vaginal births involve minor complications, such as nausea and vomiting, headache, blurred vision, puffy face or shortness of breath. On the other hand, major health problems during pregnancy include high blood pressure, convulsion, gestational diabetes, or pregnancy infections. When women experience several of these complications, they are deemed to be carrying a high-risk pregnancy, which contribute to poor outcomes for mother and baby, requiring special medical attention. However, the concept of high-risk pregnancy has not received the same level of attention in the literature as childbearing in general. The present study therefore examined high-risk pregnancies in Bangladesh from a socio-demographic viewpoint.
This study specifies an entrenched pattern of high-risk pregnancies in Bangladesh. The results of the present study identified a significant proportion of women in Bangladesh have experienced a number of health complications during pregnancy. Also, a significant number of women had multiple complications that contributed to an increased chance of pregnancy risks, either low or high. The findings on the relationship between women’s autonomy, childbearing practices and pregnancy risks illustrate that all three dimensions of women’s autonomy, when no other variables were included in the analysis (Table 4, Model 1), had significant influences on high-risk pregnancies. Earlier studies identified some indirect influences of autonomy indicators on pregnancy health status. It was found that freedom to go outside the home for healthcare purposes resulted in better maternal outcomes [9, 26, 29]. Independence in mobility can enable women to gather relevant information about pregnancy health, complications and remedy measures, thus contributed to healthy outcomes. In addition, high level of decision-making power about contraception, having children at a favourable time, spacing and number of children, as well as decision about own and child’s healthcare also contributed to better pregnancy outcomes. In this context, decision-making autonomy, women’s freedom of movement and ability to spend money when necessary to access maternal healthcare facilities reduce the prevalence of several health complications during pregnancy by ensuring higher levels of antenatal care utilization, which in turn decreases the chances of high-risk pregnancy. In this way, all three dimensions of maternal autonomy were found to be associated with sound pregnancy health.
This study explores that the high-risk pregnancy is strongly affected by childbearing practices and the use of antenatal care services. Akin to other developing countries, adolescent pregnancy is prevalent in Bangladesh and is subject to experience more complications. Our study demonstrates that the teenage and late pregnancies are more likely to possess several life-threatening complications. Teenage mothers are more likely to be less educated and less autonomous, and are lacking in awareness and experience regarding the danger signs of pregnancy complications. Thus they are less likely to receive proper prenatal and antenatal care to safeguard themselves from life-threatening complications. At the same time, some health complications during teenage pregnancy are triggered because of the biological effects of early childbearing. This phenomenon has also been focused in some earlier studies [14-16, 30-32]. Our study mimics the exposition of previous research that caesarean deliveries, preterm birth and stillbirths are likely to be more prevalent for grand multiparous (more than three children) women [19, 33]. Our empirical study demonstrates that high-risk birth interval, high birth order, and adolescent or delayed childbearing increase the risk of multiple complications during pregnancy which in turn leads to high-risk pregnancy outcomes.
Earlier studies investigated the adverse effects of short birth intervals on pregnancy health [20, 28, 35]. Women with very short birth intervals experienced anaemia, gestational diabetics and high-blood pressure which contributed increased risks of premature or low birthweight babies. This study also explored that short birth intervals of less than 18 months contributed to multiple health complications during pregnancy, and thus had significant effect on high-risk pregnancies. In addition to this, maternal health complications could occur due to the adverse biological effects of high parity and short birth intervals. Generally, in high order births (more than three) women experience multiple and life-threatening complications. Grand multiparous women are older and less likely to have accessed antenatal care, which results in an increased risk of maternal complications and poor neonatal outcomes [16, 18, 34]. The results also showed a significant relationship between high-risk pregnancies and maternal healthcare utilisation. Only one-half of women in the study had received sufficient antenatal care during pregnancy. Women who received sufficient antenatal care and who received treatment for health complications were more likely to experience sound pregnancy health and reduced chances of high-risk pregnancies.