Healthcare access among Bihari women in Bangladesh: A mixed-methods study of barriers and community-driven solutions.

BackgroundBihari women in Bangladesh's northern districts of Rangpur and Saidpur represent a historically marginalized, Urdu-speaking ethnic minority who face compounding vulnerabilities in healthcare access. Despite progress under the Sustainable Development Goals, this population remains severely underserved due to intersecting socioeconomic, structural, cultural, and discriminatory barriers.ObjectivesThis study aimed to: (1) evaluate the availability, quality, and utilization of healthcare services among Bihari women; (2) examine socioeconomic, cultural, and systemic barriers, including financial constraints, transportation difficulties, gender norms, and discrimination; and (3) generate evidence-based recommendations for policymakers, healthcare providers, and community organizations to reduce these barriers.DesignConcurrent mixed-methods design integrating structured survey data with in-depth interviews and focus group discussions.MethodsWe administered a survey to 450 Bihari women across 12 camps in Rangpur (n = 200) and Saidpur (n = 250). Ten in-depth interviews (IDIs) and two focus group discussions (FGDs) provided qualitative depth. We analyzed quantitative data using descriptive statistics, chi-square tests, and multinomial and binary logistic regression in SPSS. Qualitative data were coded thematically using NVivo (inter-coder reliability: Cohen's κ > 0.80). Findings were triangulated across data sources. Reporting conforms to the STROBE and COREQ guidelines.ResultsPrivate clinics were the preferred care setting (68%), yet 38% managed ailments at home, primarily because of cost. Financial constraints were the most prevalent barrier (85%), followed by limited health education (70%), transportation difficulties (60%), cultural or social obstacles (45%), and perceived discrimination (40%). Among younger women (aged 18-35), cultural barriers were significantly higher, including the need for male approval (30%) and reproductive stigma (25%). A separate logistic regression model identified financial barriers as the strongest predictor of foregone care (adjusted OR = 3.20, 95% CI: 2.15-4.76), adjusting for age group and occupation. Community-prioritized solutions included financial assistance (90%), health education programs (80%), and camp-based clinics (65%).ConclusionHealthcare access among Bihari women is constrained by interacting financial, structural, cultural, and discriminatory factors, with younger women disproportionately affected by social barriers. Targeted, community-informed interventions, including financial subsidies, camp-based service delivery, and culturally sensitive health education, are required to address these inequities and promote inclusive healthcare within Bangladesh's universal health coverage agenda.