Background: This mixed-methods study investigates factors influencing institutional delivery among adolescent mothers (aged 15-19) in Bangladesh. It compares the health outcomes of adolescent mothers and their children with those of adult mothers, while addressing the socio-economic and cultural barriers to healthcare utilization. Adolescent pregnancy poses significant public health challenges in Bangladesh, with many deliveries still occurring outside health facilities despite improvements in institutional delivery rates.

Method: The study employed a mixed-methods design, combining secondary analysis of the 2022 Bangladesh Demographic and Health Survey (BDHS) with primary qualitative data collection. Key Informant Interviews (KIIs) were conducted with healthcare providers, and In-Depth Interviews (IDIs) with adolescent and adult mothers across eight nationally representative sub-districts were used to gain deeper insight into perceptions and barriers related to institutional delivery.

Results: The findings reveal that institutional delivery is significantly influenced by regional factors, husband’s education, antenatal care (ANC) visits, media exposure, and religion. Compared to those with no formal education, husbands who had completed secondary education were associated with a 93% increase in the odds of their wives delivering in a health facility. Women who attended three ANC visits had significantly higher odds of delivering in a health facility (p = 0.023), and those with four or more visits had even greater odds (p = 0.002). Adolescent mothers faced higher risks of undernutrition compared to adult mothers, with regional disparities evident in nutritional status. Children of adolescent mothers had lower rates of stunting, influenced by maternal education, socio-economic status, and healthcare access. Qualitative data showed limited decision-making autonomy among adolescent mothers, with financial, cultural, and religious barriers limiting institutional delivery. Institutional births had higher reported maternal complications, reflecting the referral of high-risk pregnancies.

This study triangulates qualitative and quantitative findings to confirm that adolescent mothers face multiple barriers to institutional delivery, including limited autonomy, economic hardship, and cultural norms, despite greater medical risks and benefits from antenatal care. Early childbearing leads to worse maternal health outcomes due to biological and socioeconomic factors, while better household resources and husband’s education improve maternal nutrition. Child stunting reflects more vulnerability to low-birth-weight impacts.

Discussion: The study highlights key socio-economic, cultural, and healthcare factors affecting institutional delivery among adolescent mothers in Bangladesh and the impact of early childbearing on maternal and child health.

Adolescent mothers in regions like Khulna are more likely to use institutional delivery, especially when their husbands have higher education. Regular antenatal care (ANC) visits and media exposure increase in institutional delivery uptake, but barriers such as financial hardship, traditional home birth preferences, fear of hospital procedures, and limited decision-making autonomy hinder service use.

Early childbearing poses nutritional risks for adolescent mothers, who are more likely underweight due to poor diet and biological immaturity, with regional disparities noted. Interestingly, maternal underweight is less likely when husbands have higher education, and shared healthcare decision-making correlates with better nutrition. Maternal complications are more common in institutional deliveries, likely due to referral of high-risk pregnancies.

Regarding child health, despite early childbearing, children of adolescent mothers show lower stunting rates, possibly due to family support or selection effects, with maternal education and socio-economic status strongly protective factors. Low birth weight is a major risk for stunting, while adequate ANC visits reduce its likelihood.

Overall, the findings point to a multifaceted challenge requiring focused efforts to overcome financial, cultural, and autonomy barriers, engage male partners, and improve health literacy to enhance both maternal and child health outcomes in Bangladesh.

Conclusion: Adolescent mothers in Bangladesh are at elevated risk for poor nutritional and health outcomes. Enhancing institutional delivery rates requires multifaceted approaches including promoting antenatal care, discouraging early marriage, engaging male family members, improving financial and transportation support, and culturally sensitive health education. Strengthening adolescent-friendly services and involving community and religious leaders are recommended to improve maternal and child health outcomes and break the cycle of intergenerational health disparities.

Nasrin Sultana is a Professor of Health Economics at the Institute of Health Economics (IHE), University of Dhaka. She is experienced in teaching and research in Economics and Health Economics more than 23 years. She was the Director of that institute. She has conducted research on several issues including Maternal, neonatal and child health, urban health, gender inequity, estimation of health care cost, health care financing, quality of health care, mental health issue, local level planning.