Maternal mortality rate still high

Haemorrhage, eclampsia major causes, health facilities not prepared to address, lifesaving drugs scarce

Manzur H Maswood | Published: 00:17, May 28,2019


Apparently perturbed the government withheld publishing the findings of the Bangladesh Maternal Mortality and Health Care Survey 2017 as it shows that the high rate of maternal mortality remained unchanged in Bangladesh.
The health ministry reviewed the findings for 18 months and found that the survey report had correctly found that maternal mortality rate rose to 196 per one lakh live births from 194 in 2010.
Between 2001 and 2010, the maternal mortality rate declined significantly: from 322 to 194 per 1 lakh live births.
The maternal mortality rate is 30 in Sri Lanka, 174 in India and 178 in Pakistan, according to the World Health Organization.
It is in this dismal backdrop, that the Awami League-led government would celebrate the Safe Motherhood Day 2019 today.
The 2017 survey identified hemorrhage and eclampsia as the major causes of the high maternal mortality rate in Bangladesh as the supply of lifesaving drugs to the health facilities could not be ensured.
The health facilities were also handicapped in providing comprehensive obstetric and gynecological services to the mothers before and after deliveries.
Public health experts identified that the government did not address the issues relating to maternal healthcare after Bangladesh achieved remarkable progress between 2001 to 2010.
Between 2001 and 2010, the maternal mortality rate declined significantly due to reduced fertility rate, increased access to maternal health care and the use of maternal health services during delivery as well as antenatal and postpartum periods together with improvement in socioeconomic conditions.
After the 2017 survey found a deterioration in in the maternal mortality rate, the health ministry and the departments under it, the Directorate General of Health Services and Directorate General of Family Planning took the denial mode saying that the maternal mortality rate should have declined.
After disclosing the survey report on November 22, 2017, the health ministry withdrew it two weeks later and formed a committee to review and analyze its loopholes, though it was jointly done by the health ministry, the National Institute of Population Research and Training, the International Centre for Diarrhoeal Disease Research, Bangladesh, the USAID and the UKAID with support from a few foreign universities.
The review committee, headed by Abdus Salam Khan, deputy chief of health ministry’s medical education and family planning division found no flaws in the survey.
Abdus Salam Khan told New Age Monday, ‘The review has been completed last week and we found no flaws in the survey.’
‘The committee members have signed the review report and we think the report is objective,’ he said.
Abdus Salam said that the review report had been submitted to the health ministry.
The survey report found out the maternal mortality rate and also identified the causes why the maternal mortality rate did not decline.
It found that the quality of maternal health care as ‘poor’.
The survey also found that most of the country’s healthcare facilities are not fully ready to provide quality maternal care.
‘Only three per cent of facilities were ready to provide quality normal delivery services,’ it found.
The survey also found that 30 per cent of the country’s public health facilities at upazila and the higher levels go for cesarean deliveries though only 10 per cent of them have the facilities to provide comprehensive emergency obstetric care and 96 per cent of the private health facilities go for the cesarean section though only 16 per cent of them has the facilities for emergency obstetric care.
Specifically, the survey also found that 55 per cent of the maternal deaths occur in Bangladesh due to hemorrhage and eclampsia.
‘But these risk factors remained unchanged since 2010 with little progress to address these causes through timely intervention,’ it found.
Lifesaving drugs for preventing hemorrhage and eclampsia are not also supplied to the health facilities.
The survey also found that misoprostol that prevents hemorrhage was available only for 17 per cent of the births.
Besides, only 40 per cent of the health facilities were supplied with injectable oxytocin to stop hemorrhage and only 28 per cent with injectable magnesium sulphate to treat eclampsia.
Community Clinics are not supposed to get these lifesaving drugs.
Another reason cause of the high maternal mortality rate was identified as over 50 per cent deliveries are occurred at home.
Directorate General of Health Services maternal and child health care programme head Moshayerul Islam told New Age that they rejected the survey report.
Asked why lifesaving drugs for hemorrhage and eclampsia were not supplied to all the health facilities, he admitted that there could be occasional supply problems which would be addressed.
Obstetrical and Gynecological Society of Bangladesh president Sameena Chowdhury said that at least 15 mothers die every day though these deaths are preventable.
‘The mothers are not dying because of diseases we cannot treat, rather they are dying because we are yet to take the decision that their lives are worth saving,’ she said.
Gonoshasthaya Kendra founder Zafrullah Chowdhury said that the lifesaving drugs for hemorrhage and eclampsia were available in the market and the costs of those drugs are merely ranges between Tk 15 to Tk 20, but the government has apathy to supply those to the mothers.
He blasted the government for withholding the survey report and said that it tantamount to deceiving the people.
The survey report should be made public for taking the lesson that maternal mortality rate reduction is a vital issue for Bangladesh, he said.
Zafrullah also said that training and employing midwives were of crucial importance for reducing maternal mortality rate but little attention was being paid here.

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