IN recent years, Bangladesh has made solid progress in reducing mortality rates among children under age 5. Part of its success can be traced to the expansion of community-level health interventions. Accelerated progress will depend on expanded and more equitable provision of antenatal care and skilled birth attendance.
Starting from a low base, the country has already achieved a rapid expansion of coverage in both areas. The proportion of babies delivered in health facilities increased from 8 per cent to 37 per cent between 2000 and 2014. Antenatal coverage by skilled providers also rose, from 33 per cent to 64 per cent.
Nevertheless, large disparities remain. The wealth gap in access to skilled antenatal care has declined only marginally. Coverage is 36 per cent for the poorest women and 90 per cent for the wealthiest. The ratio of poor-to-rich women benefitting from skilled birth attendance in 2014 was about one to four, with two of the country's divisions – Sylhet and Barisal – lagging far behind the rest of the country. And fewer than one third of women received the recommended minimum of four antenatal care visits in 2014.
On a more positive note, Bangladesh has been making progress towards equity in terms of deliveries that take place in health facilities. In 2004, the ratio of poorest-to-richest women delivering in a health facility was 1 to 12. By 2014, the ratio had improved to one to four.
Recognizing that sustained improvements in maternal and child health will require a greater reduction in disparities between different social and economic groups, the government has introduced a range of equity targets for key interventions. The targets form the basis for monitoring coverage in low-income communities, urban slum areas, poor-performing districts and areas with ethnic minorities, such as the Chittagong Hill Tracts in south-eastern Bangladesh. Taken together, they represent a potential pathway to equity for the country's most disadvantaged mothers and children.
Source: National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International, Bangladesh Demographic and Health Survey 2014: Key indicators, Dhaka, Bangladesh, and Rockville, Maryland, USA.