Academic journal article International Perspectives on Sexual and Reproductive Health

The Role of Pregnancy Outcomes in the Maternal Mortality Rates of Two Areas in Matlab, Bangladesh

Academic journal article International Perspectives on Sexual and Reproductive Health

The Role of Pregnancy Outcomes in the Maternal Mortality Rates of Two Areas in Matlab, Bangladesh

Article excerpt

CONTEXT: The Motlab Maternal Child Health-Family Planning (MCH-FP) project provides maternity care as part of its reproductive health services. It is important to assess whether this project has reduced maternal mortality and, if so, whether this was due to differences between the MCH-FP area (which received project services) and the comparison area (which did not) in pregnancy rates, pregnancy outcomes or case-fatality rates.

METHODS: Data from the Matlab Demographic Surveillance System on 165,894 pregnancies over the period 1982-2005 were used to calculate four measures of maternal mortality for the MCH-FP and comparison areas. Mortality risk was examined by type of pregnancy outcome and by area, and bivariate and logistic regression analyses were used to generate unadjusted and adjusted odds ratios, respectively.

RESULTS: The maternal mortality rate of 35 deaths per 100,000 women of reproductive age in the MCH-FP area was 37% lower than that in the comparison area (56 deaths per 100,000). In both areas, the maternal mortality risk was considerably higher for pregnancies that ended in induced abortion, miscarriage or stillbirth than for those that resulted in live birth (odds ratios, 4.2,2.0 and 17.4, respectively). The difference in maternal mortality rates between the two areas was mainly a result of the MCH-FP area's lower pregnancy rate and its lower case-fatality rates for induced abortions, miscarriages and stillbirths.

CONCLUSIONS: Interventions to increase contraceptive use; to reduce the incidence of induced abortion, miscarriage and stillbirth; to improve the management of such outcomes; and to strengthen antenatal care could substantially reduce maternal mortality in Bangladesh and similar countries.

International Perspectives on Sexual and Reproductive Health, 2010,36(4): 170-177

Each year, more than 350,000 women die from pregnancy-or delivery-related causes and the vast majority of these deaths occur in developing countries. (1) Each pregnancy puts a woman at risk of maternal death, but women who have induced abortions, miscarriages or stillbirths have been found to be at a higher risk of maternal mortality than those who have live births. (2-4) Most induced abortions in developing countries are performed in unsafe conditions (5) and carry a high risk of mortality. (6) Miscarriages have been found to carry a lower risk of maternal mortality than induced abortions, while stillbirths have been associated with a higher risk of maternal death than have live births. (4)

Bangladesh, a country with unfavorable socioeconomic conditions, has been a family planning success story, achieving a relatively low level of fertility-2.7 births per woman-according to data from 2004 to 2007. (7) For the period 1998-2001, the nation had a moderate level of maternal mortality-322 deaths per 100,000 live births-especially considering its poorly managed and inefficient health infrastructure and low rate of institutionalized deliveries; (8) nationwide, about 15% of deliveries take place in facilities. (9) Regional data suggest that about 4%, 6% and 3% of pregnancies end in induced abortion, miscarriage and stillbirth, respectively. (9)

BACKGROUND

Matlab, a rural subdistrict of Bangladesh, is well known for its Demographic Surveillance System (DSS) and its Maternal Child Health-Family Planning (MCH-FP) project, which provides intensive family planning and maternal and child health services in half of the area covered by the DSS. (10-12) The other half, known as the comparison area, receives the normal government services, which are similar to those in the MCH-FP area but of lower quality and intensity. Moreover, these services do not include safe motherhood care, which may significantly improve maternal health.

Maternity Care in Matlab

Most deliveries in Matlab take place at home in the presence of traditional birth attendants, though institutional deliveries have been increasing in the MCH-FP area in recent years. …

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