Understanding health insurance coverage and its socio-demographic associations among women in Bangladesh: Evidence from the 2022 Bangladesh Demographic and Health Survey

Abstract

Health insurance is vital for healthcare financing and aligns with the 2030 Sustainable Development Goal agenda. Women of reproductive age face unique barriers to affordable care due to higher health risks and caregiving responsibilities. This study aims to estimate the proportion of women with health insurance coverage (HIC) and to identify factors associated with such coverage. Data were drawn from the latest round of the Bangladesh Demographic and Health Survey 2022, comprising a total sample of 19,987 women. Unadjusted odds ratios (UORs) with 95% confidence intervals (CIs) were reported. The median age of the women was 32.0 years (interquartile range: 25.0 - 39.0). Only 0.3% of respondents reported having HIC. The odds of having HIC were significantly higher among the women in the study who had an account with a bank or other financial institution (UOR: 2.27; 95% CI: 1.36 - 3.79), those with post-secondary education (either themselves or their husbands), those in the richest wealth quintile (UOR: 3.32; 95% CI: 1.45 - 7.60), and those with adequate media exposure (UOR: 2.78; 95% CI: 1.41 - 5.47). The study highlights the need for promoting higher education for both sexes, addressing wealth-based disparities, and leveraging mass media to increase the uptake of HIC.

Keywords

Health insurance / Women / Reproductive age / Bangladesh / Bangladesh demographic and health survey 2022

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

References

[1] Al Fidah, M.F., Haider, T., Roy, D., Hossain, M.E., & Efa, S.S. (2024). Temporal trends of diarrheal diseases and associated treatment responses among children aged under five: Insight from the multiple indicator cluster surveys from 2006 to 2019. Pediatrics Neonatology, 66:203-208. https://doi.org/10.1016/j.pedneo.2024.03.010

[2] Al Fidah, M.F., Islam, M.R., Rahman, M.M., Chisti, M.J., Faruque, A.S.G., Ahmed, T., et al. (2025). Community-level expenses for under-5 diarrhoeal cases prior to reporting at Dhaka hospital: A cross-sectional analysis in Bangladesh. Clinical Epidemiology Global Health, 31: 101846: https://doi.org/10.1016/j.cegh.2024.101846

[3] Caley, M., & Sidhu, K. (2011). Estimating the future healthcare costs of an aging population in the UK: Expansion of morbidity and the need for preventative care. Journal Public Health (Oxford), 33(1):117-122. https://doi.org/10.1093/pubmed/fdq044

[4] Chauluka, M., Uzochukwu, B.S.C., & Chinkhumba, J. (2022). Factors associated with coverage of health insurance among women in Malawi. Frontiers Health Services, 2:780550. https://doi.org/10.3389/frhs.2022.780550

[5] Croft, T.N., Allen, C.K., & Zachary, B.W. (2023). Guide to DHS Statistics. ICF. Available from: https://www.dhsprogram.com/pubs/pdf/dhsg1/guide_to_dhs_statistics_dhs-8.pdf [Last accessed on 2025 Apr 13].

[6] Dowou, R.K., Atanuriba, G.A., Adzigbli, L.A., Balame, S.K., Tahidu, I., Aggrey-Korsah, J., et al. (2024). Determinants of health insurance coverage among women in Mauritania: A multilevel analysis. BMC Public Health, 24(1):229. https://doi.org/10.1186/s12889-024-17691-y

[7] Ewerling, F., Raj, A., Victora, C.G., Hellwig, F., Coll, C.V., & Barros, A.J. (2020). Swper global: A survey-based women’s empowerment index expanded from Africa to all low- and middle-income countries. Journal Global Health, 10(2):020434. https://doi.org/10.7189/jogh.10.020434

[8] Field, E., Pande, R., Rigol, N., Schaner, S., & Moore, C.T. (2021). On her own account: How strengthening women’s financial control impacts labor supply and gender Norms. American Economic Review, 111(7):2342-2375. https://doi.org/10.1257/aer.20200705

[9] Health Economics Unit and MoHFW. (2025). Health Insurance. URL: Bangladesh National Portal. Available from: https://heu.gov.bd/site/page/2a89bd26-1b0b-4c33-84a5-bb486d92dc8c/http%3a%2f%2fheu.gov.bd%2fsite%2fpage%2f2a89bd26-1b0b-4c33-84a5-bb486d92dc8c%2f [Last accessed on 2025 Apr 13].

[10] Huq, N.M., Al-Amin, A.Q., Howlader, S.R., & kabir, M.A. (2015). Paying out of pocket for healthcare in Bangladesh - a burden on poor? Iranian Journal Public Health, 44(7):1024-1025.

[11] Kansanga, M.M., Asumah Braimah, J., Antabe, R., Sano, Y., Kyeremeh, E., & Luginaah, I. (2018). Examining the association between exposure to mass media and health insurance enrolment in Ghana. International Journal Health Planning Management, 33(2):e531-e540. https://doi.org/10.1002/hpm.2505

[12] Kessy, S.A., Tibenderana, J.R., Gimonge, J., & Moshi, F.V. (2024). Determinants of healthcare insurance coverage among women of reproductive age in Tanzania: A multilevel mixed effect analysis. PLoS One, 19(12):e0302806. https://doi.org/10.1371/journal.pone.0302806

[13] NIPORT and ICF. (2023). Bangladesh Demographic and Health Survey 2022. Bangladesh: NIPORT.

[14] Paul, P. (2024). Bangladesh’s Insurance Landscape: Progress and Prospects. URL: The Daily Star. Available from: https://www.thedailystar.net/supplements/national-insurance-day-2024/news/bangladeshs-insurance-landscape-progress-and-prospects-3556131 [Last accessed on 2025 Apr 13].

[15] Peduzzi, P., Concato, J., Kemper, E., Holford, T.R., & Feinstein, A.R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal Clinical Epidemiology, 49(12):1373-1379. https://doi.org/10.1016/S0895-4356(96)00236-3

[16] Shao, L., Wang, Y., Wang, X., Ji, L., & Huang, R. (2022). Factors associated with health insurance ownership among women of reproductive age: A multi country study in sub-Saharan Africa. PLoS One, 17(4):e0264377. https://doi.org/10.1371/journal.pone.0264377

[17] Tsala Dimbuene, Z., Muanza Nzuzi, R., & Nzita Kikhela, P.D. (2022). Poverty, education and health insurance coverage among women of reproductive ages in the democratic republic of the Congo: A cross-sectional and multilevel analysis. BMJ Open, 12(12):e064834. https://doi.org/10.1136/bmjopen-2022-064834