Maternal death rate rises
Though Bangladesh has achieved much progress in reducing maternal mortality ratio in the last two decades, a government study shows the rate has gone up in recent time.
According to Bangladesh Maternal Mortality and Health Care Survey 2016, the ratio has increased to 196 deaths per 100,000 live births from 194 in 2010.
The finding is in stark contrast to the percentage of women taking maternity care and safe delivery facilities nowadays. The number of women receiving maternity care has increased to 43 percent in 2016 from 19 percent in 2010, while births in health facilities have increased to 47 percent from 23 percent in the same period.
The researchers involved with the survey identified that poor quality of healthcare, lack of capacity of health service providers, and shortage of readiness to provide the existing facilities are the major reasons for the increase of the mortality rate.
The National Institute of Population Research and Training (NIPORT), under the health and family welfare ministry, conducted the survey through interviewing 3,21,214 married women, aged 13-49, in 2,98,284 households across the country in three years since 2013.
The findings were revealed during a seminar at a hotel in the capital yesterday.
The government, USAID and UK-based Department for International Development (DFID) funded the survey, while MEASURE Evaluation and icddr,b provided technical support.
The report says haemorrhage and eclampsia (convulsions) are responsible for about 55 percent of maternal deaths, which accounts for around 13 percent of all adult female deaths.
Meanwhile, the percentage of caesarean deliveries in the country has increased to 31 in 2016 from 12 in 2010, which is alarming, says the preliminary report of the study.
The private sector dominates the market in providing delivery care. About 83 percent of the total caesarean deliveries take place in private facilities.
According to the report, C-section delivery rates in Bangladesh now greatly exceed the levels expected to be medically necessary.
The World Health Organization (WHO) suggests that a reasonable rate of medically necessary C-section is between 10 percent and 15 percent of all births, but in Bangladesh, the rate is twice as high (31 percent).
Over the years, the government has given a lot of effort to reduce maternal deaths and achieved remarkable success.
While the rate was 574 per 100,000 live births in 1990-91, it fell to 194 in 2010. Bangladesh aims at a maternal mortality target of 105 by 2022.
Talking to The Daily Star, Kanta Jamil, one of the key researchers, said that although the percentage of accessing maternal care and institutional delivery had increased, the quality of healthcare was not up to the mark.
“There are many private clinics built across the country, which give most of maternal care. Who are they? How much quality service do they provide?” she asked.
The researchers, however, claimed that the mortality ratio had not increased; rather it “remained stalled”. A few government officials said the rate was going downward.
Speaking at the seminar, Director General of Directorate General of Health Services (DGHS) Prof Abul Kalam Azad said, “The study was conducted with the data of 2013-2015, but the situation has improved in 2017.”
“We need to focus more on institutional delivery and ensure proper care of the infant during the first 24 hours of their birth,” he said. About the increase of caesarean deliveries in private clinics, he said monitoring and observation would have to be increased to check their business.
Zahid Maleque, state minister for health and family welfare, said they could not accept the findings of the survey; the government was doing its best to reduce the mortality rate.
Rownaq Jahan, director general of NIPORT; Md Rafiqul Islam Sarker, director (research) of NIPORT; Caroll Vasquez, director (OPHNE), USAID in Bangladesh, and Kazi Mustafa Sarwar, director general, Directorate General of Family Planning, were present at the programme, among others.
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