Increased Use of Facilities Helped Reduce Maternal Mortality in Bangladesh

By Doskoch, P. | International Perspectives on Sexual and Reproductive Health, December 2014 | Go to article overview

Increased Use of Facilities Helped Reduce Maternal Mortality in Bangladesh


Doskoch, P., International Perspectives on Sexual and Reproductive Health


A variety of factors--some related to health care provision and some not--have contributed to the recent dramatic decline in maternal mortality in Bangladesh, a wide-ranging analysis suggests. (1) Data from the Bangladesh Maternal Mortality Surveys indicate that between 2001 and 2010, the country's maternal mortality ratio fell from 322 to 194 maternal deaths per 100,000 live births, equivalent to an annual rate of decline of 5.6%. One likely reason for the decline was increased access to and use of health facilities (for example, the proportion of births that occurred in facilities tripled), though other factors, such as reductions in births to high-risk groups, probably also played a role. Overall, the authors estimate that half of the maternal deaths that otherwise would have occurred in 2010 were averted because of decreases in the risk of maternal mortality and other trends.

At present, Bangladesh is one of only nine countries on track to achieve Millennium Development Goal 5, which encouraged countries to try to reduce their maternal mortality ratio by 75% of its 1990 level by 2015. To explore the reasons for Bangladesh's success, Arifeen and colleagues used data from several sources, notably the 2001 and 2010 Bangladesh Maternal Mortality Surveys, which collected data from nationally representative samples of about 100,000 and 174,000 households, respectively. Respondents provided information about their social and demographic characteristics, birth histories, health seeking behaviors and related topics. In addition, interviewers conducted verbal autopsies with relatives of all women aged 13-49 who had died in the three years before each survey; at least two independent physicians reviewed each case to assign a cause of death. To interpret trends in the mortality findings, the analysts drew on other data sources, including the Bangladesh Demographic and Health Surveys conducted between 1993 and 2011 and various government policy documents and technical reports.

The researchers calculated maternal mortality ratios (maternal deaths per 100,000 live births) and rates for the three years preceding each Maternal Mortality Survey. In addition, they conducted Poisson regressions to identify variables associated with changes in the risk of maternal death between 2001 and 2010, and used a nonlinear decomposition method and other calculations to analyze these changes.

The survey data indicated that between 2001 and 2010, the maternal mortality ratio for the previous three years declined from 322 maternal deaths per 100,000 live births to 194 per 100,000. This decrease is equivalent to an annual decline of 5.6%, slightly higher than the 5.5% annual rate required for countries to meet Millennium Development Goal 5. The rate of decline was similar in urban and rural areas.

Examination of government documents revealed that the decline in maternal mortality coincided with government initiatives to shift provision of health services from home-based care to community clinics, and with major investments in health care that resulted in the upgrading of facilities that provide emergency obstetric care, the training of skilled birth attendants and the strengthening of health education efforts. Moreover, the number of facilities offering routine and emergency delivery services rose substantially between 2001 and 2008, particularly in the private sector. For example, the number of private facilities providing comprehensive emergency obstetric care increased from 562 to 1,463. As a result, between 2001 and 2010, the proportion of women who lived within a hour of a public or private facility that provided delivery services increased from 74% to 91%, and the proportion who lived with two hours of such a facility increased from 93% to 99%. …

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