Shortage of skilled birth attendants obstacle to reducing maternal mortality rate

The country may not fulfil its target to reduce maternal mortality rate to 2.4 per thousand live births from 3.2 by 2010 due to shortage of skilled birth attendants.
The government in 2001 set the target of reducing maternal mortality to 2.4 per thousand live births by ensuring that at least 50 percent deliveries are attended by skilled personnel. Unfortunately, there has not been much progress in increasing the number of skilled attendants.
If safe delivery could not be ensured, maternal mortality and morbidity would not decline much and the rate of death of newborns, which is now 37 per thousand live births, would remain the same. Even child health situation also could not be improved as expected.
But the fact is that still only 18 percent deliveries are attended by the medically trained personnel, which was 13 percent in 2004, according to the Bangladesh Demographic and Health Survey 2007.
The reasons why the rate of deliveries by skilled medical personnel are so negligible even after investing huge amount of money are mainly absence of field-level activities from 1998-2002 for lack of an action plan, manpower in family planning sector, skilled birth attendants (SBAs) and medical professionals in upazila and union-level health centres.
“A gap had been prevailing soon after an unsuccessful training programme of the traditional birth attendants (TBAs) that took place from 1977-1998,” said Programme Manager of Maternal and Child Health of the Directorate General of Family Planning (DGFP) Ashraf Ali.
As the TBAs were not government employees, they could not be monitored properly and even after receiving the 21-day training, they did not follow it and did not refer the pregnant mothers in critical condition to the nearby healthcare centres, which they were supposed to do.
It created a setback and the government had to look for a different option that started with the SBA training in 2003. Around 3400 family welfare assistants and women health assistants of the health ministry were provided with a six-month training to attend deliveries in rural areas.
According to the DGFP, the number is very negligible, as still some 11,000 SBAs are needed to provide safe deliveries in 4,500 unions across the country.
It is not possible to attain 50 percent deliveries by the skilled personnel that include doctors, gynaecologists, midwives and SBAs by 2010, experts said, adding that institutional delivery is still only 15 percent as people, especially in rural areas, do not want to go to the hospitals and clinics.
“Due to the traditional practice and culture, pregnant women in rural areas show apathy in going to the medical institutions. The number of doctors in upazila and union-level health centres is also very negligible,” said Dr Halida Hanum, former director general of Family Planning Association of Bangladesh.
She recommended including TBAs in SBA training programme to increase the rate of deliveries by the medically trained personnel as it is not so easy to change people's behaviour instantly and still 60 percent of the deliveries in rural areas are attending by TBAs.
The Unicef Child Survival Report 2008 reveals that around 500,000 women die in childbirth every year worldwide and the death rate of the children aged below one year who have lost their mothers is high comparing to that of the children who have mothers.
Majority of the newborn death takes place in South Asian countries and Bangladesh is one of them, the report added.