In 2010, maternal death became a rare event in Bangladesh. The recently released results of the nationally representative Bangladesh Maternal Mortality and Health Care Survey 2010 tell the story:
In 1989, 574 of every 100,000 pregnant women in Bangladesh died during pregnancy and childbirth. Last year, only 194 of every 100,000 died. This is still too many –in the U.S., only 11 of every 100,000 pregnant women die during pregnancy and childbirth each year. Now on track to meet the MDG5 target in 2015 (shown below), the decline represents an incredible accomplishment in one of the poorest countries in the world, where gross national income is $580 per person.
More research is required, but initial findings suggest that the reduction in higher risk, high parity births through family planning and delayed age at marriage explain a quarter of the decline in maternal deaths.
Another quarter of the decline is linked to increased awareness of the problem -- 68% of women experiencing obstetric complications now seek treatment outside the home, a phenomenon likely mediated by increasing levels of maternal education, household well-being, roads and transport since 2001.
Less information is available on the role of increased availability of essential obstetric management and care. Among the 23% of total births that occurred in a health facility, the majority took place in the for-profit private sector (11.3%) followed by the public sector (10.3%). Only 2% of births were attended in NGO facilities, many supported by USAID.
The results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health. However, the results also suggest that the USAID strategy of investing in non-governmental organizations as primary providers of care may miss the bulk of women giving birth as well as opportunities to increase quality of care and access among needy populations.
Finally, we know about this good news because USAID, AusAID and UNFPA paid to conduct the survey and the Measure Evaluation project provided technical assistance. Yet it would be nice if some impact evaluation was included that would allow the associations and speculation to be replaced with more precise information on what strategies worked and didn’t work to reduce maternal deaths in Bangladesh.
Here is a link to the Executive Summary of the survey