Background: Despite numerous efforts, South Asia is the second most leading region for maternal mortality and morbidity. Although there have been notable advancements on this continent, progress in maternal healthcare access has been slow. Inequalities remain in different maternal health services across diverse population groups. The aim of this study is to better understand the socioeconomic inequalities in maternal healthcare access in South Asian countries. Methods: Two databases (MEDLINE and Google Scholar) were searched for identifying studies. Studies with data on socioeconomic factors, maternal healthcare, inequality, and South-Asian countries were included. Mixed method appraisal tool was used for quality assessment of the identified studies. Results: A total of 55 studies from India, Nepal, Bangladesh, Afghanistan and Pakistan were included in the final analysis. Overall, quantitative study showed that maternal healthcare access is linked to economic status, education, occupation, and women’s autonomy. Qualitative studies demonstrated poverty, lack of awareness of complication and service and inability in decision making on healthcare was the reason for not accessing maternal health care. Significant finding from this review includes effect of education mostly evident after secondary education and paternal occupation was significant rather than maternal occupation. Conclusion: Findings of this review indicates a large disparity in access to maternal health care services. Policymakers should create interventions and financial schemes that are tailored to the mothers from low socioeconomic background.

Background: Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017–2018. Materials and Methods: A weighted population-based sample of 8759 ever-married reproductive-aged women (15–49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Results: Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Conclusions: Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh.

Background: Anaemia in pregnancy is linked to low birthweight, preterm birth and maternal death. Bangladesh has had no publicly documented national haemoglobin survey of pregnant women since 2011, and WHO revised its cut-offs in 2024. We estimated national prevalence under these cut-offs, described haemoglobin across gestation, and compared 2025 with 2011. Methods: We analysed venous haemoglobin from 1,933 of 2,711 eligible pregnant women in the nationally representative Bangladesh Multiple Indicator Cluster Survey 2025. We reanalysed capillary haemoglobin from 352 pregnant women in the Bangladesh Demographic and Health Survey 2011. Anaemia was haemoglobin below 11.0 g/dL in the first and third trimesters and below 10.5 g/dL in the second. Survey-weighted modified Poisson models estimated prevalence ratios (PR). Results: In 2025, 53.2% (95% CI 50.6 to 55.8) of pregnant women were anaemic and 22.3% (20.2 to 24.5) had moderate or severe anaemia. A single 11.0 g/dL cut-off gave 60.7%. Prevalence was 42.1% in the first trimester and 67.7% in the third. Mean haemoglobin was lowest in month 6 and only 0.23 g/dL higher in months 8 and 9 than in months 5 and 6. Prevalence was similar across wealth, education and division. It was higher in Hindu women (adjusted PR 1.27, 95% CI 1.12 to 1.45) and slightly higher in urban women (1.13, 1.02 to 1.26). Under identical rules, prevalence was 42.9% (37.1 to 48.8) in 2011 (adjusted PR for 2025, 1.33, 1.15 to 1.54; 1.29, 1.11 to 1.50 with haemoglobin rounded as in 2011). The difference was concentrated in urban women (2.36, 1.62 to 3.42) rather than rural women (1.14, 0.97 to 1.35); the interaction had p<0.001. An assay offset of 0.4 g/dL removed the national difference but not the urban one. Conclusions: About half of pregnant women in Bangladesh are anaemic, two in three by the third trimester, across all social groups. We found no evidence that anaemia has declined since 2011, and urban women appear to have lost their earlier advantage. Antenatal programmes need universal reach into late pregnancy, and surveys need harmonised haemoglobin methods.

Background: Brick kilns are a major source of air pollution in Bangladesh. Their effects on child respiratory health and lead exposure have not been studied nationally with blood measures. Methods: We linked a 2018 to 2019 satellite map of 6,978 kilns to the 3,149 displaced clusters of the Bangladesh Multiple Indicator Cluster Survey 2025. Exposure was the number of kilns within 5 km. Outcomes were cough and acute respiratory infection (ARI) symptoms in 23,357 children under 5 years, and venous blood lead in 10,622 children aged 12 to 59 months. We fitted survey-weighted modified Poisson models with district fixed effects. Diarrhoea and interview timing relative to the firing season served as negative controls. Findings: Three in four children (75.4%, 95% CI 73.6 to 77.1) lived within 5 km of a kiln, and 20.3% (18.7 to 22.0) had ten or more. Exposure rose with wealth. Compared with no kiln, ten or more kilns were not associated with cough (adjusted prevalence ratio [PR] 1.05, 0.96 to 1.16), ARI symptoms (1.21, 0.90 to 1.62) or blood lead of 5 µg/dL or more (0.94, 0.85 to 1.03; crude PR 1.27, 1.14 to 1.41). Per 10 kilns, the ARI PR was 1.11 (1.01 to 1.21), but a spline showed no association (P=0.153). Cough was not associated with kiln density at the peak of firing (PR per 10 kilns 1.00, 0.96 to 1.05) but was in May and June (1.10, 1.04 to 1.17). The lead result held in all sensitivity analyses. Interpretation: At survey resolution, living among more kilns was not linked to blood lead. Weak respiratory associations, absent at peak firing, fit confounding by place better than an acute effect of kiln smoke. Studies with exact locations should measure effects within 1 to 2 km of kilns. Funding: None.

Background: Heat in pregnancy is linked to preterm birth and stillbirth, but its link with neonatal death in South Asia is unclear. We estimated this association in Bangladesh and separated the role of prenatal heat from that of the season in which a child is born. Methods: We included 46,752 live births (February 2015 to May 2025) from the Bangladesh Multiple Indicator Cluster Survey 2025 birth history. Each birth was linked to daily maximum temperature from the ERA5 reanalysis at the location of its survey cluster. An extreme heat day was a day on which the maximum temperature reached the cluster's 95th percentile of daily maximum temperature for 2014 to 2024. Because gestational age was not recorded, we counted extreme heat days in estimated trimesters, dated back 280 days from birth. Weighted Poisson regression with fixed effects for district, division by calendar month of birth, and year of birth compared births within the same place, season and year. Extreme heat 28 to 55 days after birth, which cannot cause a neonatal death, served as a negative control exposure. Results: There were 1,039 neonatal deaths (22.7 per 1,000 live births, 95% CI 21.1 to 24.4). Mortality was highest for births in December to February (26.5 per 1,000, 23.0 to 29.9) and lowest in September to November (17.3, 14.5 to 20.0). Pregnancies had a mean of 13.5 extreme heat days (95% CI 13.4 to 13.6), rising from 4.0 for births in 2018 to 29.5 for births in 2024. The primary estimate was for the estimated third trimester. Per 5 extreme heat days, its adjusted rate ratio was 1.06 (0.98 to 1.15), a risk difference of 1.4 per 1,000 births (-0.6 to 3.3). The rate ratio was 1.04 (0.98 to 1.09) for the whole pregnancy and 0.92 (0.77 to 1.09) for the last 4 weeks of pregnancy. The negative control window showed no clear association (0.92, 0.79 to 1.08). Third trimester estimates were similar with MERRA-2 temperature (1.04, 0.97 to 1.12) and with a fixed 1991 to 2020 threshold (1.07, 1.00 to 1.14). Without control for calendar month of birth, each 1 degree C higher mean third trimester maximum temperature was associated with lower mortality (rate ratio 0.96, 0.93 to 0.99). Conclusions: In this national birth-history analysis, neonatal mortality varied by season of birth and was highest for births in December to February. When births were compared within the same district, season and year, estimated prenatal extreme heat was not clearly associated with neonatal death. The confidence intervals did not exclude modest increases in risk, and both gestational age and heat exposure were estimated with error. Studies of prenatal heat and newborn survival should control for season of birth, because season can hide or create an apparent effect of heat.