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This study provides evidence on the principal determinants of high-risk fertility – a level of fertility, which is measured through maternal age (less than 20 years and/or more than 34 years), a large number of children (more than 3), and short birth interval (less than 18 months) in Bangladesh. More specifically, this study explores the influences of women’s autonomy in decision-making, physical mobility and economic matters on high-risk fertility. Also, the socioeconomic attributes of women are used to explain this relationship. To identify the amount of variations in high-risk fertility at different geographic units across the country, a multilevel approach is applied considering individual, community and district levels by using a large nationwide dataset (BDHS 2017–2018). The findings of the present study indicate women’s autonomy in decision-making have strong significant effects on high-risk fertility; however, freedom of movement and economic autonomy do not have any significant effects. Furthermore, women’s education, religion and place of residence are found to be strong determinants of high-risk fertility, which also partially mediate the relationship between high-risk fertility and decision-making autonomy. High-risk fertility also varies at district level across Bangladesh.

How does autonomy of women influence maternal high-risk fertility? Evidence from a nationwide cross-sectional survey in Bangladesh