Study reveals factors shaping maternal healthcare choices in Bangladesh, recommends enhanced maternity care

Dhaka, Bangladesh, 26 June 2023: The Research for Decision Makers (RDM) activity of icddr,b with the support from USAID organised a dissemination seminar titled ‘Dynamics in Decision Making for Maternal Healthcare Utilization in Two Areas of Bangladesh: A Cohort Study’ on 25 June 2023, at the Sasakawa Auditorium of icddr,b Mohakhali campus.

During the seminar, Dr Mahbub Elahi Chowdhury, scientist, icddr,b presented the findings of the study, which aimed to explore the decision-making process for choosing and using maternal healthcare. The study focused on five areas in the North-West part of Dhaka city and seven unions in the Baliakandi upazila of the Rajbari district, representing both poor urban and rural settings respectively. From the urban setting, 1,320 and from rural setting, 1,239 pregnant women were enrolled and followed-up during the full course of pregnancy, and until 8 weeks after delivery.

The study revealed that despite having the coverage of more than 90% of at least one Antenatal Care (ANC) from the healthcare facility in both settings, only 1 out of 3 pregnant women in urban and 1 out of 12 women from rural received quality ANC. The low utilization of urine tests and counseling on danger signs were identified as reasons for the low rate of quality ANC in facilities in both settings. And in spite of having the last ANC at healthcare facility in both settings, women still planned for home delivery. Fear of undergoing a Cesarean Section (CS) or episiotomy at healthcare facilities, finding delivery at home cheap, comfortable and religious belief were identified as the factors responsible for the women to prefer home delivery more. Among the facility delivery, majority of the urban women chose public facility and whereas in rural area, majority chose private for delivery. Additionally, it was observed that rural women who initially planned for Normal Vaginal Delivery (NVD) were more likely to end up delivering by Cesarean Section (CS) compared to the urban group. The first-time mothers from the rural area had high tendency to deliver by CS compared to the urban area. This high CS rate in rural areas was attributed to the lack of readiness of public facilities and aggressive marketing strategies adopted by the private facilities.

Based on the study's findings, the scientists have put forth several significant recommendations to improve the quality of maternal healthcare services. To expand and strengthen public facilities for increased utilization for maternity care, establishing dedicated public maternity hospitals like MFSTC in urban areas, 24/7 delivery care services along with diagnostic facilities (USG & Lab test) ensured at Upazila Health Complex (UHC) and above level public facilities were recommended. To control high CS rate, the researchers recommended for developing a system for mandatory recording of each delivery event including indications of CS in all public and private facilities along with reporting to DHIS2 of the Directorate General of Health Services (DGHS). They stressed on the need for a policy for mandatory appointment of at least three graduate midwives at each private facility to promote normal delivery.Additionally, the study suggests continuation of supporting NGOs to bridge maternity care service gaps in urban areas through innovative public-private-partnership (PPP) model.