Age at initiation of childbearing and maternal healthcare utilisation in South and Southeast Asia: a multi-country analysis of demographic and health surveys

Background: Age at initiation of childbearing (AICB) may be associated with maternal healthcare utilisation. This study examined AICB patterns and their associations with maternal healthcare use across eight South and Southeast Asian countries. Methods: Data were drawn from the latest available Demographic and Health Survey rounds in Bangladesh, India, Indonesia, Maldives, Nepal, Pakistan, the Philippines and Timor-Leste. The analysis included women aged 15-49 whose first live birth occurred within five years before the survey. AICB was classified as early (<20 years), mid (20-29 years) or late (≥30 years). Country-specific logistic regression models assessed the outcomes: four or more antenatal care (ANC) visits, first-trimester ANC, full ANC, institutional delivery and a postnatal check, adjusting for sociodemographic and partner-related characteristics. Results: Mean AICB ranged from 19.98 years in Bangladesh to 24.38 years in Maldives. Early AICB was most prevalent in Bangladesh (54.3%) and Nepal (36.5%); late AICB was most common in the Philippines (15.0%) and Maldives (10.4%). Associations varied by country and outcome. Early AICB was associated with lower adjusted odds of four or more ANC visits in Bangladesh, Indonesia and Pakistan, and lower odds of first-trimester ANC in India, Indonesia, Nepal and the Philippines. Late AICB was associated with higher odds of full ANC in Bangladesh, India and Nepal. Postnatal care associations differed across countries. Conclusions: Associations between AICB and maternal healthcare utilisation were heterogeneous across countries and service indicators. Context-specific strategies should address gaps in timely ANC, completion of recommended ANC components, institutional delivery and postnatal follow-up.