Explaining the role of socioeconomic, healthcare access and infrastructural shifts in nutritional transition among women in Bangladesh between 2004 and 2018

Shifts in socioeconomic factors, healthcare access, lifestyle and infrastructure facilities have resulted in increased body mass index (BMI) of populations in developing countries. These shifts result in a large increase in overweight and obese individuals, with a corresponding decline in the number of those who are underweight. Although this nutritional transition among women in Bangladesh is evident, studies elucidating such change are scarce. This study aimed to explain how socioeconomic, healthcare access and infrastructural shifts contributed to the nutritional transition among women of childbearing age in Bangladesh between 2004 and 2018. Repeated cross-sectional study of respondents who participated in the latest five rounds of Bangladesh Demographic Health Surveys (BDHS) from 2004 to 2017–18. Applying counterfactual decomposition techniques to data from the latest five rounds of BDHS, this study examined how variations in observed nutrition-related determinants, and returns to them across rounds, contributed to the nutritional transition among women of childbearing age. Shifts in nutritional outcomes were primarily attributed to gains in partner's education, improved access to healthcare, a decline in breastfeeding practice and the number of births. Wealth accumulation, contraception and improved sanitation facilities appeared as secondary contributing factors. Additionally, this study identified that the BMI gap widened between the lower and the upper quantile of the distribution over the study period. Addressing the rise in BMI and the prevalence of overnutrition is imperative for the future health of the population in Bangladesh. Considering the study findings and existing national nutrition policies and programmes, it is evident that targeted policy interventions, programmatic approaches and multisectoral collaborations are essential.