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Home >> Thematic Area >> Safe Motherhood
 Safe Motherhood

The health and family planning programme of Bangladesh has made remarkable progress in the last two decades as evident from the decline in fertility rate, infant and child mortality rates. The reduction in maternal mortality in the past 15 years is 22%, right on target towards Millennium Development Goal (MDG) of a 75% reduction between 1990 and 20151. However, the Maternal Mortality Ratio (MMR) is still high (320 per 100,000)1. An estimated 600,000 suffer maternal complications every year. Worldwide data indicate that for every maternal death there are a number of women who suffer from chronic complications such as fistula, uterine prolapse, chronic pelvic pain, secondary infertility and urinary incontinence2.

Source: BMMS (reference 1)

The prevalence of obstetric fistula in Bangladesh is 1.69 per 1,000 ever-married women3. One of the most tragic consequences of maternal deaths is that about three-fourths of the babies born to the women who died also die within the first year of life. The infant mortality is 65 per 1,000 live births with a neonatal mortality rate of 41 per 1,000 live births. There is no significant reduction in infant and neonatal mortality rate. Neonatal mortality rate level is inextricably linked to health of the mother during pregnancy.

An important contributory factor to the high level of maternal mortality, the Total Fertility Rate (TFR), has declined to 3 after a decade of stagnation at 3.34. The Contraceptive Prevalence Rate (CPR) has increased to 58% (modern methods) (an increase by 4%). There are marked differentials in MMR and TFR rates between the divisions as shown in Chart 1 and Map 1. The rates are highest in Sylhet and Chittagong. The differentials between different economic quintiles are also marked as shown in Charts 2 and 3.

The findings from the Bangladesh Maternal Health Services and Maternal Mortality Survey (BMMS) indicated that maternal deaths accounted for 20% of all causes of death among women of reproductive age1. Haemorrhage, eclampsia, prolonged/ obstructed labour, puerperal sepsis and abortion-related deaths are reported as the main causes of death.

Source: BMMS

A significant decrease in abortion-related deaths was reported and has been attributed to the improved accessibility to Menstrual Regulation (MR) services. The survey reported that the majority of the deaths occurred in the postpartum period.

The BMMS reported that awareness among women about complications was low. The most common complications reported were pre-eclampsia followed by prolonged/obstructed labour and postpartum bleeding. The reason for the low percentage of reported cases of postpartum bleeding could be due to the fact that very few with the complication survived. Retained placenta, excessive vaginal bleeding and signs of eclampsia were considered by the women as potentially life threatening. 60% of those with life threatening complications sought treatment, the most common reasons for seeking treatment were convulsions followed by prolonged labour and retained placenta. Among women with perceived complications, only 32% sought treatment from a qualified practitioner.

Source: HNPSP: Status of performance indicators. 2002

A high percentage did not seek treatment or sought treatment from an unqualified provider. The most common cause for not seeking care was cost followed by the perception that there was no need. Among the ones who perceived a life threatening complication, 26% recognised the problem immediately and sought treatment and 55% sought treatment within six hours. The travel time to a facility was less than two hours. The patients were attended to within an hour of reaching the facility. The above findings point to the delays in recognition of life threatening problems.

Poverty and status of women are the root causes of the problem of high maternal mortality and are linked to underlying and immediate causes of death. 33% of the population lives below poverty line. As discussed in the preceding section, even when women recognized life-threatening complications, they did not utilise a facility because of "too much cost"1. Transportation and lack of permission from the family were lesser obstacles to seeking care1. Although the services in the government facilities are free, the utilization by the poor is very poor. A recent study by DFID has shown that the public sector services are mostly being utilized by the first two richest quintiles. The utilization of government facilities by the poor is a major concern of the health planners and development agencies. The low level of literacy among women is another contributory factor.

Early childbearing is another important risk factor for maternal death. According to the current fertility rate (Bangladesh Demographic and Health Survey (BDHS) 2004), on an average, women will have 22% of their births before reaching the age of 204. The data from the BDHS 2000 showed that in rural areas 35% of the adolescents have begun childbearing, the highest percentage being in Khulna followed by Rajshahi . Chart 4 shows the inter-divisional variations.

Abortion is not legal in Bangladesh. However, MR for pregnancies less than 6 weeks of gestation is allowed. The reported rate of abortions is 5%1. MR contributes to another 2.4%1 and the percentage of stillbirths is 2.5%1.

1. NIPORT, ORC Macro, JHU and ICDDR, B: Bangladesh Maternal Health Services and Maternal Mortality Survey 2001.
2. Population Reference Bureau: Making Pregnancy and Childbirth safer. 1998
3. EngenderHealth: Situation Analysis of Obstetric Fistula in Bangladesh. A Report. 2003. ( funded by UNFPA, Bangladesh)
4. NIPORT, Mitra and Associates, Macro International Inc: Bangladesh Demographic and Health Survey 2004. Preliminary Report.
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