How prepared are mothers for safe deliveries?

Three in every four women in Bangladesh’s rural hard-to-reach districts may not be well prepared for deliveries, an icddr,b study has indicated.

Birth preparedness and complication readiness is a widely acknowledged strategy for reducing maternal and newborn deaths. It aims to reduce care seeking delays, reaching and receiving care during birth, and promoting skilled care at delivery and in the immediate postnatal period.

Not many mothers are aware of newborn danger signs. Photo: Shumon Ahmed / icddr,b

The findings published in PLOS One indicated that only 24.5 percent of around 3000 recently delivered women were considered well-prepared for deliveries. They were more likely to deliver at health facilities, use skilled birth attendants, practice clean cord care, receive post-natal care from a trained provider within two days of birth for themselves or their newborn and seek care for delivery complications.

Bangladeshi women are increasingly seeking maternal care from health facilities, according to the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS). During 2001 and 2010, maternal mortality rate (MMR) declined significantly, from 322 to 194 maternal deaths per 100,000 live births. However, BMMS 2016 does not provide any evidence that MMR has changed since 2010.

“In retrospect, the observed lack of change in MMR, despite the large increases in maternal health care-seeking practices, not have surprised us as much as it actually did,” says Dr Shams El Arifeen, senior author of the study and senior director of maternal and child health division (MCHD) at icddr,b.

“We should not have been surprised considering that the country has done almost nothing to address the two most common causes of maternal deaths in the past few years, i.e., haemorrhage and eclampsia, and because of the persistently poor quality of care in health facilities,” he observes.

BMMS 2016 does not provide any evidence that MMR has changed since 2010. Photo: Shumon Ahmed / icddr,b

Dr Shams feels that maternal health care seeking from private facilities has increased. “The limited data we have from there indicate equally poor quality of care,” he says.

“Results from this study show that birth preparedness and safe delivery are yet to improve in hard-to-reach rural areas in Bangladesh,” he adds.


Ensuring Safe Motherhood and Child Health

The Safe Motherhood Day every year seeks to raise awareness on glaring gaps in maternity care.

Facility deliveries are important but not sufficient to lower MMR alone, notes the 2016 BMMS supported by USAID and DFID, with technical support from MEASURE Evaluation and icddr,b.

The recent study published in PLOS One also finds that mothers getting at least three antenatal visits from qualified providers and home visits by a health worker during pregnancy were more likely to be prepared for deliveries.

Mothers having educated husbands and better access to media such as newspapers were more likely to be well-prepared,” says Mr Md Moinuddin, statistician with MCHD at icddr,b and an author of the study.

These findings were interesting since factors like husband’s involvement may not be usually considered an aspect influencing improvements in maternal health.

Corroborating with the findings, Dr D M Emdadul Hoque, senior author of another study on recently delivered women, observes that husband’s involvement is crucial to ensure delivery by skilled providers and safe deliveries as well as getting other maternal and newborn health care by skilled providers.

Mothers were more aware about newborn danger signs when their husbands were actively involved in his wife's antenatal, delivery and postnatal care, indicates the findings published in BMC Research Notes.

Facility deliveries are important but not sufficient to lower MMR alone. Photo: Shumon Ahmed / icddr,b

icddr,b researchers working on maternal and child health are investigating how persisting MMR and neonatal death rates can further be lowered. More recently, a study led by the Government of Bangladesh with icddr,b and other stakeholders is planning to explore ways to measure the impact of a comprehensive package of interventions on maternal and neonatal mortality.

“This will be a community-based cluster randomised controlled trial on an estimated 800,000-900,000 population,” adds Dr Hoque, first author of the study protocol published in BMC Public Health.

“We expect that this study will generate strong evidences on the impact of comprehensive package of interventions and the results may help in prioritising, planning, and scaling-up of Safe Motherhood Promotional interventions in other geographical areas of Bangladesh as well as to inform other developing countries of similar settings,” he adds.