Thesis on investigate the barriers to seek maternal services by the women

In Bangladesh, pregnancy and delivery-related deaths account for 20 percent of the deaths in women of reproductive age (NIPORT et al. 2003). Ten percent death occurs during delivery, and the one in five occurs before delivery and remaining death after delivery. The leading causes of maternal deaths are hemorrhage (29 percent) and eclampsia (24 percent). Other direct major causes of maternal deaths are prolonged/obstructed labor and puerperal sepsis. The lack of knowledge on maternal health and negative attitude towards seeking delivery care from qualified providers contribute largely to the high rate of maternal deaths in Bangladesh. The maternal mortality ratio (MMR) is not merely an indicator of maternal health but is also considered to be an important indicator of the health status and well being of a nation. Bangladesh has made a significant improvement in several health indicators. Nevertheless, although the maternal mortality ratio has declined from more than 600 in 1980 to 322 in 2004, it is still one of the highest in the world. Regional variations in MMR are also observed in Bangladesh.

The Health, Nutrition, & Population Sector Programme (HNPSP) 2003-2010 builds on Bangladesh’s achievements in the health sector. It is designed to modernize the country’s health sector & accelerate progress towards reaching the National Strategy for Poverty Reduction (PRSP) goals and health related Millennium Development Goals (MDGs). The recent HNPSP Midterm Review carried out in early 2008 reveals that “MDG targets seem well on tract, but areas of concern relate in particular to maternal and newborn care, where progress is too slow.” The review calls for a fast tracked human resource plan for midwifery services through a midwifery workforce planning subgroup2, among others. In regard to the skilled attendance during childbirth indicator for maternal health, the technical report states that the critical shortage of midwifery skill in the country is the most critical bottleneck, which retards the increase in skilled attendance2,(NNHP mid term review, March/2008).

Maternal & Newborn Health Existing Situation in Bangladesh, two women die every hour due to pregnancy and childbirth related complications, eighty-five percent of deliveries take place at home out of which approximately, 70% are attended by untrained personnel, 14% by trained personnel and 14% by relatives. Only 10% of deliveries take place at health care facilities2.

The government has made concern efforts to improve the maternal and newborn health situation, but the Maternal Mortality Rate is still high, estimated at 298/100,000 in 2006while 600,000 women suffer from maternal complications every year17. The Infant Mortality Rate is 62 per 1000 live births and the Neonatal Mortality Rate is36 per 1000 live births25. Three fourths of the babies born to the women, who die, are estimated to also die within the first year of life. Facts related to maternal, newborn and child health services in Bangladesh given by Bangladesh Demographic Health Survey, 2007 show; 51% of pregnant women attend one antenatal care (ANC) visit, only 17.8% of births are assisted by doctors, trained nurses or midwifes, and 21.9% mother receive post natal care(PNC) from a trained provider within 42 days after birth.

Government’s Efforts to Increase Women’s Access to Maternal and Newborn Health Services: The GOB seeks to create conditions people have opportunities to reach and maintain the highest attainable level of health. The GOB is committed to health sector governance and effective service delivery, especially in the primary and maternal health services.

The MOHFW currently pilots a demand-side financing-maternal health voucher scheme in 33 upazilas which is designed to increase poor women’s utilization of quality maternal health services. Voucher holders can access ANC care, safe delivery and emergency obstetric care such as vacuum extraction and caesarian section, as well as PNC at any of the designated public and private maternal health service providers within the Upazila. In addition, women are also given funds for transportation costs.

The scheme has already significantly increased demand for midwifery services at health facility in the pilot areas. Based on experiences in other countries implementing a similar maternal health voucher scheme, it is likely that the demand for midwifery services at the health facilities will be rapidly increasing. Thus, for cost effective care, services of qualified midwifes will be needed at these health facilities to assist the increased demand for normal for midwifery services.