Maternal mortality situation in Bangladesh
Abstract. Since the topic of discussion is Maternal Death, I would like to highlight Matri or Motherhood. Motherhood is the responsibility of a woman to conceive a child and take care of it through childbirth or delivery. In simple words, motherhood is the conception and birth of a child. Stillbirth in every thousand live birth 15.[1]
What is maternal death?
Maternal death is what we generally understand as the death of mothers. It is true that everyone will die be it male or female or any other. But to say maternal death, here I will highlight the death of a mother of a certain period. Because women are more at risk of death at this particular time, and the events are before delivery, during delivery, post-delivery death is called maternal death. This often happens around us. Maternal death is a daily occurrence. According to official statistics, 69% of pregnant women die due to childbirth. [2]
In Bangladesh, the death of a mother without any accident from the time of conception to 42 days after delivery is called maternal death. According to UNICEF,, Maternal mortality refers to deaths due to complications from pregnancy or childbirth.[3] According to CDC,A maternal death is defined as a death while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.[4] Maternal death in every 100 thousand live birth 193.[5]
What are the causes maternal mortality in Bangladesh?
Bangladesh is a developing country. Bangladesh Maternal deaths occur due to lack of awareness and complete health care.Maternal death is happening due to some direct and indirect reasons.According to the Ministry of Health and Family Welfare's Maternal and Child Mortality Reduction Strategy Paper, in 2009, 259 mothers died per 100,000 births, currently 165 per 100,000 are dying, An average of 13 mothers die every day..[6]
Among the main causes of maternal mortality, direct causes are very important. Because maternal mortality is increasing due to neglect of these direct factors in Bangladesh.
Direct causes:
Direct obstetric -69% & Injury violence-14% ( Maternal death in Bangladesh )
1.Haemorrhage & Anemia: Haemorrhage is one of the most known direct causes of maternal death in our country. After delivery, women start bleeding and if it is not stopped at the right time then at some point the mother's blood volume decreases. In the last stage, the mother died due to lack of blood. Anemia affects 46% of pregnant women in Bangladesh throw away( 2019)
2.High blood pressure and eclampsia: 20 weeks before the pregnancy, it is called high blood pressure. High blood pressure is really very dangerous for pregnant women.. Many women become afraid of delivery during delivery. They can not understand what to do. Especially those who give birth to children for the first time, this high blood pressure can be seen more for fear. So it has to take action before the blood pressure.
3.Infection:Due to infection, many times complications are seen in childbirth. After pregnancy, women's immunity decreases. A little cold, cold, cough. If there is a little problem with food, there is diarrhea, nausea. Dengue, malaria and rubella viruses can also be transmitted. Which are signs of infection. Which is a death risk for both mother and child.
4.Pulmonary embolism: This is the stage of blood clot formation. Due to which the blood cannot circulate.
5.Cesarean delivery: Currently, the number of cesarean deliveries in the country is increasing. According to the World Health Organization, 51% of children in the country are born through caesarean section. Among them, 83% in private hospitals, 35% in government hospitals, 39% in NGO-run hospitals. Cesarean delivery is more in private hospitals and its reasons are 1. Not getting enough services in government hospitals. 2. Responsibility Complexity. 3. Neglect, etc. Taking advantage of thisgovernment problem, private hospitals are doing more cesarean deliveries. There are some private clinics that operate for a small amount of money but the quality is very poor which preys on the common poor people.
According to the World Health Organization, 10-15% of cesarean deliveries will be performed if there are any maternal complications. This number cannot be more.[7] Obstructed Labour: Any vaginal problem in girls. Vaginal stricture during childbirth causes difficulty in the delivery of the baby. As a result of which the mother and child may die.in the delivery of the baby. As a result of which the mother and child may die.
Indirect causes:
Indirect causes-17% (Maternal death in Bangladesh)
1.Diabetes: Diabetes is an indirect cause. It is hereditary. A pregnant mother may have diabetes, but there is nothing to worry about, but if you consult a doctor or health worker within a certain period, maternal death or any other complications may not occur. But if this is not done, this diabetes can create major problems in maternal health.
2.Heart disease respiratory problems and Jaundice : These two problems are seen in most people nowadays. But when it comes to maternity, it is very important. Environmental pollution is a daily occurrence in Bangladesh. Due to air pollution, water pollution, etc., various types of toxic germs enter the human body. Later complications of heart disease and respiratory problems occur. Women can die during pregnancy in our country due to heart disease and respiratory problems. High blood pressure is also responsible for this. Usually during normal delivery respiratory problems are encountered and the attendant midwives (uneducated workers usually seen in villages) cannot take any action due to ignorance. Which results in maternal death.
3.Anemia and Hepatitis B: Anemia refers to a condition in the body where the amount of red bloodcells in the blood decreases, which affects the amount of hemoglobin. People suffer from anemia. It can happen during pregnancy or even before pregnancy. But the impact is at the time of delivery.Hepatitis B is an HBV (an infectious virus) that is transmitted through the blood, semen, and fluids of an infected person. This virus attacks the body's liver. Although Lakshman was not found at first, some guesses can be made.
4.Lack of nutrition: Due to lack of nutrition, the body becomes sick and maternal death occurs.
5.Exaggeration of customs and rules: Some more rules and regulations are seen among the Hindus of our country. Notable among them: A separate room is made in the backyard for delivery so that the delivery takes place there. Women have to stay there for 21 days/30 days. Many times many unwanted events happen through it.
Apart from the above, there are many causes which can be considered as indirect causes of maternal death such as cardiac disease, HIV related disease, malaria, renal failure etc.
What is responsible for direct and indirect causes!? Aspects of the village are highlighted.?
We know that there are direct and indirect causes of maternal death. But we need to highlight the reasons behind these two.Because no problem is created suddenly. A problem arises because of a mistake. The result of which has to be enjoyed at the end.
1.Inadequacy of skilled midwives: In our country, 71% of births take place at home. That too without any health worker or skilled person. Due to which there is a fear of death of mother and child. And even if skilled workers are available it becomes difficult to ensure.
2.Lack of communication: 75%+ people of the country live in villages. But compared to that they lag behind the city in all areas such as education, healthcare, transport, technology etc. For the same reason they cannot ensure proper health care. There are also some barriers which I will discuss later. It is seen that health related information does not reach villages or remote areas. Due to the distance people do not show much interest in this matter due to which these people are deprived of maternal services or other services.
3.Transportation related problems: Another reason for maternal death is transportation related problems. Especially from remote areas bringing maternal health complications will be delivered on the road or else the mother and child will die. In hilly areas pregnant women are carried to hospital using an object which is carried by two people on their necks.
4.Poverty: It is like a curse. How will they take care of the mother's health if they are forced to bring salt. I mentioned the indirect reasons that if a family could ensure adequate medical care for their pregnant women and give them nutritious food, then the maternal mortality rate would have been reduced due to indirect reasons.
5.Uneducated: An uneducated person can take wrong and bad decisions and that too because of ignorance. Because there needs to be a person in the family who knows a little about this or not. That is why education is very important. Maternal mortality complications can be reduced if at least one of the parents is educated.
Apart from the discussed factors, there are many factors that are responsible for causing maternal mortality. For example: Insignificance, accidents, family quarrels, riots, natural calamities etc.
The barriers to reducing maternal mortality rates in Bangladesh and the barriers to maternity ministry plays the role.
1.Gender Inequality: Due to gender inequality, girls are denied the opportunity to express themselves.determined by their husband or mother-in-law. Due to which there is an obstacle to ensure maternal care which takes the form of maternal death.
2.Social perspective: There are some people in our country who do not want their own good and criticize others when they see good. When pregnant women in the village go to the health center, many elderly women criticize "the new rule that has been introduced, now we have to go to the hospital again. We used to stay at home, then there was no need for doctors and nurses. Everything is a joke". Yes, this is the image of Bangladesh. Where such attitudes are created. We have to get out of it. Treatment must be confirmed.
3.Child marriage: Child marriage is a common phenomenon in Bangladesh. Although it is decreasing a lot from earlier. The reason for the decrease is the empowerment of women. In Bangladesh 52% of girls are married by the age of 18 but 18% are married by the age of 15. If you marry at a young age, it is normal that maternal health complications will arise. Because the girl married at a young age is young herself, what will she understand about child rearing? Therefore, having a baby at a young age poses serious risks to both mother and child. Pregnant women aged 16-19 are twice as likely to die than women over 20, and those who give birth under the age of 15 are five times more likely to die than those aged 20.
4.To ensure family planning: Family planning is the method of how a planning worker manages the family and population. So family planning is necessary from a few days after having a child. A large proportion of unintended pregnancies in Bangladesh are due to lack of family planning. Then it is seen that there is a need to have an abortion, so there is often a risk of maternal death. Currently there are 2.13 children per woman.[8]
5.Reproductive Health: Reproductive health is very important for maternal health. But no such role can be observed in the development of reproductive health in our country. Neglect of reproductive health subsequently affects maternal mortality.
6.Negligence of Nurses and Midwives: In the current context, many mothers and children die due to the inefficiency and negligence of nurses and midwives.
7.Complexity between superiors regarding responsibilities and duties: Health care in Bangladesh is running in two wings. One is health and the other is family planning. In our country BCS (health) is 1st class job. So they stay in hospital. And they look down on family planning. That's why they don't provide the whole service in family planning. And taking such an opportunity in family planning can complete maternal and child health without health services.
8.Superstition: Bangladesh is a country that still follows the wrong rules of centuries ago. Sylhet of Bangladesh has the highest maternal mortality rate. Because most of the areas of Sylhet are still doing maternal care in the old way. They wonder why my daughter or wife will give birth to a man. Also they still cut the pulse of the newborn with a bamboo knife. So here I understand how terrible superstition is taking.
Apart from the above barriers, there are many barriers in our country which are affecting maternal mortality. Bangladesh being a developing country has not yet been able to fully reduce the maternal mortality rate. In order to reduce the maternal mortality rate in our country, we have to face manyobstacles and challenges, whether it is a city or a village. Not only that, the obstacles cannot be tackled by the country alone, so international cooperation is needed and Bangladesh is getting this alone, so international cooperation is needed and Bangladesh is getting this cooperation. It is expected that the maternal mortality rate in Bangladesh will come down very soon.
Effective role in preventing maternal mortality
To prevent maternal mortality, many steps need to be taken. For this reason, the work of Bangladesh government, international organizations and various NGOs is currently ongoing. They are working from divisional level to village level.
1. Reproductive health must be ensured among teenagers. What is reproductive health and why is it necessary?
2. Strict laws should be implemented to prevent child marriage. Because child marriage is more in Bangladesh. Most of the maternal deaths are observed among young girls.
3.Be kind to the health of the mother and the rest of the family should be proactive. Remember first house then after.
4. The freedom of expression of the girls should be ensured. So that the child is not taken against the girl's reluctance.
5.Following birth control procedures can help prevent unintended pregnancies and ensure the prevention of miscarriage. As a result, girls will not become pregnant unintentionally and the risk of maternal mortality will decrease.Men and women should also be informed about the effective use of contraceptives.
6. During delivery, the pregnant woman should be contacted in advance with a skilled midwife. (If Home Delivery)And if there is any serious problem while being taken home then arrangements should be made to take them to the nearest hospital as soon as possible. Any fastest vehicle should be ready.
7. To reduce the complexity in the performance of responsibilities and duties. Responsibility issues between the health sector and family planning are discussed.
8.Superstitions should be stopped from the society. Otherwise, maternal mortality will not decrease but will increase.
9.Government should provide subsidy to ensure maternal health services in rural and remote areas.So that no one goes out of scope. Everyone should be interested in going to clinic or hospital.
10.Everyone should be aware and ensure proper access to government hospitals to reduce caesarean delivery. In addition to the above, many activities have to be undertaken. So that everyone can reduce maternal mortality by being aware. It is important to give importance to maternal health and child health to keep the future of the country and the decade. Therefore, if the mother is good, the child will be good. That is why it is very important for everyone to be aware to reduce the maternal mortality rate by ensuring maternal health.
MDG -5 and Bangladesh.(2000-2015)
Some development goals were set in 2000 by a UN summit. It is said to have originally been conceived in the 1990s. MDG has 8 targets. Number 5 of which is said to improve maternal health. According to MDG-5, maternal health is supposed to improve by 2015, but Bangladesh has not achieved any of it.To achieve MDG-5, Bangladesh needed to reduce maternal mortality by three-quarters between 1990-2015.According to MDG 5, Bangladesh's maternal mortality rate was to be reduced to 143 by 2015. But even then his rate was 290 per lakh people. So it is impossible to achieve this goal.Bangladesh had 6 indicators to reduce maternal mortality. According to MDG, 121 maternal deaths per 100,000 live births in 2022.
5.1 Maternal Mortality Ratio.
5.2 Proportion of Child Births by Skilled Health Workers.
5.3 Contraceptive prevalence rates.
5.4 Adolescent birth rates and indicators.
5.5 Number of antenatal care recipients (four times in total)
5.6 Family planning requirements The obstacles to achieving the MDGs were: home delivery, high rates of malnutrition, lack of skilled midwives and manpower, ensuring antenatal and postnatal care, stopping maltreatment of mothers, uplifting backward communities or groups, ensuring information, social facilities.For example, the maternal mortality rate in Khulna and Sylhet is low and high respectively. The reason behind this is the lack of maternity healthcare and skilled workers.In 1990, the maternal mortality rate in our country was 574, which has come down to 170 in 2013. This has become possible due to the improvement of maternal health at all levels. At present there are more than 13000 community clinics in our country along with 2 lakh family planning workers. At that time, 40% of women did not get prenatal doctor's advice. 82% of women were denied access to skilled midwifery services. 79% of mothers did not receive postnatal care. According to Health Bulletin 2009, 49% of women suffer from anemia during pregnancy. 57% are teenage mothers under the age of 19, with 15-20 suffering disability due to pregnancy complications. 71,000 women are suffering from complications of delayed delivery alone.
What is the current impact or Challenge of MDG-5?
The maternal mortality rate we see today was not the same even a century ago. Its reason is underdeveloped living system. MDG-5 deals with maternal health. Although Bengal could not fully achieve this goal, it has managed to achieve the rest of the goals. I think MDGs are mainly applicable to developing countries. Because the country's economy, environment, politics play a role in achieving a goal. And in order to achieve the goals that MDG-5 was trying to achieve, a lot of financial support is required. Still, Bangladesh has set a precedent among the SAARC countries by reducing the maternal mortality rate. Still, it can be said that what Bangladesh has achieved so far would not have been possible if it had not followed the MDG-5. It's better to plan than not.. Bangladesh accepted that. However, since the MDGs expired in 2015, efforts are now being made to achieve the SDCs. To achieve the MDGs, Bangladesh must overcome these obstacles if it is to reduce maternal mortality. Poor care-seeking behavior
High prevalence of malnutrition
Lack of access to information
Lack of skilled birth care
Deep community norms
High proportion of home delivery
In other words, to put it simply, Bangladesh is in such a good position in maternal health today as a result of working towards the MDG targets, although this amount needs to be reduced and the work is ongoing.
SDG(Sustainable development goal)2015-2030
In 2015, some of the agenda adopted by the United Nations General Assembly to achieve sustainable development include the SDGs. 17 development goals have been identified in SDG. Among them there are 169 targets. Our topic is SDG-3 good health and well-being in the context of Bangladesh.Each country worked towards achieving the MDG targets in 2000-2015. Some countries got it and some countries didn't. Bangladesh has been able to show success in some cases and has not failed in some cases but has come close. So the SDGs are another target currently in the near reach. It is a 15 year plan.First we need to know what are the goals and objectives of SDG-3. SDG-3 aims at good health and well-being.
# Target 3.1: Reduce maternal mortality ratio to 70 for every 100,000 live births by 2030. ** Program: Reduction of maternal mortality. Ensuring skilled midwives or workers are present during delivery.
# Target 3.2 : Reduce neonatal mortality 12 per 1000 live births and under 5 motality Maternal mortality situation in Bangladesh 25 per 1000 live births. ** Program: In order to reduce child mortality in the SDG target, maternal mortality must be reduced. Nutrition, and necessary services must be ensured.
# Target 3.7: Ensure the right to sexual and reproductive health, family planning, information and education for all by 2030. Simultaneously include reproductive health in effective national strategies and programmes. ** Program: Ensuring modern methods for family planning and the number of users who express satisfaction with reproductive health. Proportion of women aged (15-49). According to the National Maternal Health Strategy Paper, the institutional delivery rate should improve from 47 to 85 by 2030. Presently the delivery rate by skilled midwives is 50% which should be increased to 90%. And achieving the SDGs must directly address the factors I have mentioned.
Government policies and activities:
The Bangladesh Population Program works at the field level. Family Planning Association was formed in1953 on the initiative of self and social organizations. In 1960, the government established the Directorate of Family Planning to give importance to the health sector. In 1965, some of the activities started including: family planning, sexual and reproductive health. We have seen many times that the family planning workers used to come to the house and give different kinds of medicine to the mothers, through which they ensured health care. This is still going on. The current healthcare sector stands on a solid foundation. 13000+ community clinics are running in every union in the country. 2 Target health workers are engaged. Skilled midwives are working. Health workers have access to tablets, advanced communication technology. The number of beds, hospitals, wards have been increased in each hospital. Government ambulances are provided at every health complex. The reason for this is the impact of Health Digital Bangladesh. Currently telemedicine services are also available. Government, NGOs, foreign organizations are also working for remote areas or backward communities.The government is working on various programs. Notable among them are working to ensure women's empowerment, gender equality, nutrition etc. A multi-stakeholder workshop was organized at the Bangabandhu International Conference Center on 14 September 2022 under the supervision of UNFPA Bangladesh. Researchers, journalists, students, academics, technology researchers, field level representatives, civil society were present at this conference. Everyone came in one opinion that women's empowerment, ensuring the use of new innovative technologies. It is also said to give importance to family planning, reproduction and sexual health. However, some obstacles remain Hossain Zillur Rahman highlighted the responsibility of the country's stakeholdersFree services were being provided to pregnant mothers in various areas under the supervision of health sector. The work is ongoing in Satkhira, Narsingdi and other areas. Bangladesh has taken various steps to achieve SDG. Among them, the government is giving more focus on maternal and child health. Doctor service is available by calling 16263.
In the current context, the issues that the government should focus on to achieve the SDGs are:
1.Focus on emergency obstetric care to reduce maternal mortality
2. Primary maternal care services to promote good practices including Complexity
3. To address the need for women friendly hospital initiatives
4. Communication for behavior change and development
5. Involvement of professional bodies
6. Participation of stakeholders
7. Promotion of innovation Activities of various international organizations in Bangladesh:
Along with the Bangladesh government, various NGOs and foreign organizations are working to reduce the maternal mortality rate. For example, UNICEF, USAID, FAO, WHO, we often see some people going to villages to collect information about women's health. Especially they are working together to improve our family planning and maternal health.Each event has its own function. For example, UNICEF works with children. FAO's job is to ensure food. WHO's job is to work on health protection.Fao is working in solidarity with family planning to ensure maternal health. Fao provides nutritious food. According to the World Health Organization, by 2022 the maternal mortality rate has been brought down to 105 per lakh.[9] who works to diagnose and control maternal health diseases. This organization has always focused on a few things. For example: using proper contraceptives, following family planning procedures, ensuring treatment of sick mothers, etc.Undp generally regulates and oversees these organizations. According to a UNICEF statistic, about 5,200 women die every year in Bangladesh due to complications during pregnancy, childbirth and childbirth.
Finally, it can be discussed that the reduction of maternal mortality is a big challenge for us. The longer this rate is reduced in the country, the more time it will take to improve.There are various activities going on in our country now. It is hoped that if this trend continues, it will be possible to reduce the maternal mortality rate of Bangladesh soon.
Refference
1.Prothom Alo online newspaper.
(https://en.prothomalo.com/amp/story/bangladesh/1g50fgl2yz)
2.Bangladesh Ministry of Health and Family Welfare 1998)
3.Unicef.
( https://data.unicef.org/topic/maternal-health/maternal-mortality/)
4.Centres for disease control and prevention
(https://www.cdc.gov/reproductivehealth/maternal-mortality/index.html). 5. BSS (Bangladesh sangbad Sangstha)
6..Bangla News24.com & Bangladesh Sangbad Sangstha
(https://www.banglanews24.com/health/news/bd/833845.details) &
(https://www.bssnews.net/bangla/national/46102)
7. Dw.com
8.BBS
9.DBC News.
(https://dbcnews.tv/articles/15b502983c3aed)
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