The preliminary results of the Bangladesh Maternal Mortality and Health Care Survey (BMMS) released on Wednesday in Dhaka showed that the maternal deaths were 196 per 100,000 live births in 2016 when the survey was carried out
An analysis of the survey points to the ‘low quality of care’ for this increasing rate of mortality despite women seeking medical care. It comes as a shock to most health experts as Bangladesh was once globally acclaimed for cutting maternal deaths.
Dr. Ishtiaq Mannan, one of the key analysts of the survey, called it an “alarming” trend. “We have seen a substantial increase of some key indicators like increasing rate of facility deliveries, skill birth attendants, and healthcare utilization rate, but the mortality rate has not dropped.”
“It means the quality of care is not good. It means women went to the hospital, but they received sub-standard treatment,” he added. He reported that, Bangladesh is not the only country that has experienced increased utilization of maternal services with no impact on maternal mortality rate.
“There is international precedence for a stall in MMR decline in low- and middle-income countries, even with increased care in facilities,” he said, “but we expected progress in Bangladesh.”
An analysis of 37 countries in sub-Saharan Africa (SSA) and South and Southeast Asia (SSEA) found a weak association between the MMR and the percentage of deliveries occurring in a health facility. These data suggest that increasing facility delivery is important but not sufficient to lower maternal mortality rate or MMR.
“Quality of care is fundamental to improve maternal health outcomes,” he said. “Most facilities in Bangladesh are not fully ready to provide quality maternity care”. Maternal deaths will only be prevented when women go to facilities and those facilities are fully staffed and equipped with competent health workers and prepared to handle obstetric emergencies when they occur, Dr. Mannan added.
The new survey found only 46% of Upazila and higher level public facilities and 20% of private hospitals had at least one staff member who ever received training in emergency obstetric care (EmOC). It says 30% of public facilities at the Upazila level and above perform Caesarean deliveries, but only 10% have comprehensive EmOC services.
The increase in facility delivery between BMMS 2010 and BMMS 2016 is mostly driven by an increase in births in private facilities when most of the women underwent C-section, according to the study. Service readiness for maternal care is poorer at private facilities compared to Upazila level and higher level public facilities, it has found. Hemorrhage and eclampsia account for 55% of maternal deaths, the study says.
Dr. Mannan has three recommendations to change the situation. “First, we have to improve overall implementation efficiency of any programme or initiatives.” And for that, he suggests ensuring comprehensive standards or quality care, effective coverage of key components for preventing eclampsia and hemorrhage deaths, and good referral system.
The other two recommendations include regulation and quality control of the private sector, and monitoring of quality of care along with the coverage quantity.
BMMS is one of the largest household sample surveys in Bangladesh which covered about 100,000 households in 2001, 175,000 households in 2010, and about 309,000 households in 2016.