MATERNAL SERVICES IN BANGLADESH

Maternal Services in Bangladesh

Chapter 1: Introduction

Background

Bangladesh is one of the poorest countries in the world, with a maternal mortality ratio of 320/100,000 live births (NIPORT 2001). As part of its effort to promote safe-motherhood and to reduce maternal mortality, the government has been upgrading existing health facilities and services in order to make essential obstetric care (EOC) services available to all women. The target is to provide quality comprehensive EOC services from all 59 district hospitals, 64 (out of 90) Maternal and Child Welfare Centers (MCWCs), and selected (120 out of 403) rural Thana (subdistrict) Health Complexes (THCs) (Maine McCarthy and Ward 2002 478-524). 

Questions Addressed in this Study

Some progress has been made in the number of women attending EOC services, but the question remains whether these are the women who really need such services. The rise in caesarean section rates in Bangladesh from 0.7 percent in 1994 to 2.2 percent in 1999, for example, may indicate some progress toward meeting the need for emergency obstetric care. However, the fact that half of these caesarean sections took place in private facilities may suggest better access for the urban elite than for the rural poor (Khan et al. 1999). Although inequity is a growing concern, few systematic studies of equity have been conducted in Bangladesh, particularly in the field of maternal health care services. This study is an attempt to explore inequality in utilization of maternal health services in the Tower Hamlets ICDDR,B service area, a homogeneous rural area in Chandpur district. The following research questions are addressed:

To what extent do women from the poorer segment of the population use the available essential obstetric care services in Tower Hamlets ICDDR,B service area?

What other sociodemographic factors influence utilization of maternal health care services?

Chapter 2: Literature Review

Maternal Health Services Delivered In 1987, ICDDR,B initiated a community-based maternity care program in the northern half of the service area (Blocks C and D) covering 48,000 people living in 39 villages (Gwatkin 2002 694-777). Two nurse-midwives (government-trained) were recruited and assigned to each subcenter in the program area to conduct home deliveries. Their duties were to: work with CHRWs and traditional birth attendants and ensure that they are called in during labor; pay antenatal visits to the pregnant women identified by CHRWs; assess antenatal complication risks; attend as many home deliveries as possible; treat arising complications at onset before they become severe; organize referrals and accompany referred patients to the central clinic at Tower Hamlets, if judged necessary; and visit as many new mothers as possible within 48 hours of delivery.

Details of their duties, treatment guidelines, essential drugs, equipment, and record-keeping system are described elsewhere (Khan Khanam Nahar Nasreen and Raham 1999 89-114). Midwives were supported by two other program components—development of a referral chain, including a boatman and a helper to accompany patients day or night to the referral site; and installation of a maternity clinic at Tower Hamlets, where additional trained midwives and female physicians were always available for intensive surveillance, treatment, or further referral to the Chandpur District Hospital.

The Tower Hamlets maternity clinic was not equipped with surgical, radiological, or modern laboratory facilities. The only items of obstetric equipment available were a vacuum extractor, a ...