Bangladesh

White Ribbon Alliance Bangladesh is working to ensure that the government delivers on its commitment to train 3,000 midwives by 2015 and to ensure the availability of essential drugs for maternal health. WRA Bangladesh aims to spread community based awareness programs targeting youth and to use SMS mobile technology to share information on maternal health programs.

Decline in Deaths Revealed in Health Service Survey; MDG5 Targets Provided

Maternal Mortality in Bangladesh has declined by 40 percent in the Last Decade

The second Bangladesh Maternal Mortality and Health Service Survey (BMMS 2010) was conducted from January 18 to August 6, 2010 with the major objectives of:

• Providing a maternal mortality estimate for the period 2008-2010;
• Determining whether Maternal Mortality Ratio (MMR) had significantly declined from the 1998-2001; and
•  Ascertaining the causes of maternal death. Interviews were carried out in a national sample of 175,000 households, interviewing married women ages 13-49, as well as investigating any deaths of women of reproductive ages, especially maternal and pregnancy related deaths.

The BMMS 2010 revealed that the current MMR is 194 deaths per 100,000 live births, a 40 percent decline from the estimate of 322 per 100,000 generated by a similar 2001 survey. Bangladesh appears to be on track to achieve the Millennium Development Goal 5 (MDG 5) target of reducing the MMR to 143 deaths per 100,000 live births by 2015.

The rate of decline was at an average of 5.5 percent per year, compared to the average annual rate of reduction of the 5.4 percent required for achieving MDG 5. The preliminary findings suggest that this decline has been driven in part by increases between 2001 and 2010 in the use of health facilities for
deliveries (from 9 to 23 percent). This was a consequence of improved access to care, substantially better education among women, improved awareness of services and the need for care and better economic conditions.

Maternal mortality during pregnancy and during delivery has also declined, by 50 percent. In contrast, the reduction in post partum maternal deaths was only by a third. In BMMS 2010, haemorrhage and eclampsia are the dominant direct obstetric causes of deaths, responsible for more than half of the MMR. Abortion related deaths declined from 5 percent in 2001 to 1 percent of the MMR in 2010. Indirect obstetric causes of deaths account for about a third of maternal deaths.

The Last Hundred Meters of reaching the MDG5 target

Attaining MDG5 will require further efforts to achieve a further 25 percent deduction in MMR. Some recommendations of reaching the target include:

• Ensuring effective family planning to lower fertility to replacement level and below, which will shift births away from high parity higher risk births.
• Increased use of skilled birth attendants, more facility deliveries and quicker treatment seeking for complications.
• Strengthening of access to treatment and improving referral systems and referral level of care.
• Distribution of Misoprostol tablets to minimize the risk of haemorrhage and Magnesium Sulphate for management of pre-eclampsia.
• Improved access to upgraded facilities at Upazila and Union levels. Plans are in place to expand such access, but staffing issues will need to be addressed, as well as essential logistics including blood transfusion.

Conclusion

These findings were presented on February 13, 2011 at a seminar chaired by Mr. Md. Humayun Kabir, Secretary, Ministry of Health and Family Welfare. The Chief Guest was Dr. A.F.M. Ruhul Haque, Honourable Minister, Ministry of Health and Family Welfare, Government of Bangladesh health and human welfare professionals, researchers and academics. The BMMS 2010 was funded by the Government of Bangladesh, USAID, AusAid and UNFPA and carried out by National Institute of Population Research and Training (NIPORT) with technical assistance from ICDDR, B MEASURE Evaluation, UNC-CH,USA and USAID/Bangladesh.