BACKGROUND: Ensuring universal access to delivery healthcare services is a core Sustainable Development Goals target to be achieved by 2030. However, in pursuing this target, Bangladesh, like other low- and middle-income countries (LMICs), is now facing an escalation in cesarean section (CS) deliveries, with almost all facility-based deliveries ending in CS. This places an additional burden on the healthcare system as well as maternal and child health. This study aims to explore the association between access to facility-based normal delivery services and health facility-level factors in Bangladesh. METHODS: We analyzed data from 3,171 mothers and 1,524 healthcare facilities extracted from the 2017-18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. These datasets were linked via GPS coordinates of clusters where mothers resided and healthcare facilities were located. The outcome variable was facility-based normal delivery (yes/no). Explanatory variables included health facility readiness (management and infrastructure), availability of normal delivery services at the nearest facility, readiness for normal delivery care, and average distance from mothers' homes to the nearest facility offering such care. A multilevel logistic regression model assessed associations between facility-based normal delivery and health facility factors, adjusting for individual, household, and community-level characteristics. RESULTS: We found 26% access of facility based normal delivery. The likelihood of facility-based normal delivery was found to be increased with higher scores for management (adjusted odds ratio (aOR) 1.24
95% CI, 1.01-1.62) and infrastructure (aOR, 1.20
95% CI, 1.01-1.60) of the nearest healthcare facility to mothers' homes. Furthermore, a one-unit increase in the availability and readiness of the nearest healthcare facility to provide normal delivery care was associated with 2.10 (95% CI, 1.14- 3.12) and 3.15 (95% CI, 1.16-5.11) times higher likelihoods of facility-based normal delivery, respectively. The likelihood of facility-based normal delivery decreased by 20% for every kilometer increase in the distance from mothers' homes to the nearest healthcare facility. CONCLUSION: This study's findings suggest that healthcare facilities' availability and readiness are important in ensuring facility-based normal deliveries in Bangladesh. It calls for policies and programs to enhance the capacity of facilities to provide normal delivery care.