Access to emergency maternal health care: What is the situation in Bangladesh?

Access to free-of-charge or subsidised emergency obstetric care—pregnancy, post-pregnancy and childbirth health care—is very low in Bangladesh, according to an icddr,b survey, but public-private partnerships and incentive schemes could increase coverage to address key causes of maternal mortality

Basic emergency obstetric healthcare services, like assisted vaginal delivery or basic neonatal resuscitation, are available at only one public healthcare facility per 500,000 individuals in Bangladesh, according to a comprehensive survey of the national health system that was carried out by icddr,b scientists and their international colleagues.  One-fifth of all districts in the country also do not meet the World Health Organization recommendation of at least five public and/or private obstetric facilities per 500,000 individuals.  Going forward, the researchers suggest public-private partnerships to increase access to care for low-income women, or performance-based incentive schemes to retain skilled rural health workers and address regional imbalances in healthcare coverage.

Photo by Asian Development Bank, CC BY-NC-ND 2.0

The researchers found that there are 577 public facilities, 114 not-for-profit facilities and 1696 private for-profit facilities that offer obstetric care services across Bangladesh. This means that Bangladesh has 8.6 obstetric care facilities per 500,000 individuals, but only two are public (free of charge or subsidised). Of these, there is one comprehensive emergency obstetric care facility, which offers more technical services like cesarean delivery, but only one basic emergency obstetric care facility per 500,000 individuals.

Most facilities do not offer basic emergency obstetric care.  The provision of drugs to prevent excessive bleeding after child birth—postpartum hemorrhage, which is a leading cause of maternal mortality—was only available in four out of every five facilities, for example. While assisted vaginal delivery was available, it was not often practiced in the majority of all obstetric healthcare facilities, with most women presumably seeking a private cesarean delivery instead, the researchers report.

Bangladesh may have made great strides in reducing maternal mortality, with a 66% decrease between 1990 and 2010, but studies like these demonstrate that access to skilled healthcare is still poor and that this could be hindering further progress.

Promisingly, however, the survey also found that there were at least six private obstetric healthcare facilities per 500,000 individuals. Low-income women may be priced out of these facilities, but the researchers s highlight the potential of harnessing public-private partnerships, which could make these services available free-of-charge or at subsidized rates.

This research was made possible through funding from the UK Department of International Development, and published in the International Journal of Gynecology & Obstetrics.