Bangladesh has seen an enormous fall in maternal mortality over the last three decades, due in large part to better access to safe abortion services, as well as emergency obstetric care, according to a report published in The Lancet, special issue Women Deliver. The report is hopeful that the MDG5 (Millennium Development Goal Five), which aims to reduce maternal mortality by 75% will be achieved in Bangladesh.
Dr Carine Ronsmans, London School of Hygiene and Tropical Medicine, UK, and team from the International Centre for Diarrhoeal Research, Bangladesh (ICDDR, B), studied information gathered between 1976-2005 for approximately 200,000 people of Matlab, Bangladesh, in adjacent areas served by either the ICDDR, B or the government. Other causes of death, such as obstetric causes or abortion-related causes were examined separately.
According to their findings, mortality dropped by 68% in the ICDDR, B region – there was a drop of 54% in the government region during the 1976-2005 period. It was not until 1989 that maternal mortality started to fall significantly (5% annually). The introduction of the skilled-attendance strategy for births in 1990 coincided with the beginning of a faster decline in the ICDDR, B area. However, the researchers say this factor is not statistically significant. Mortality due to abortion fell at 9% annually after 1990.
They also found that a woman who attended school for at least eight years was less than a third as likely to die during pregnancy or within the first 42 days after giving birth, compared to a woman who never went to school. A woman with no formal education at all was 11 times more likely to die as a result of an abortion than a woman with at least 8 years’ schooling.
“The fall in maternal mortality over 30 years occurred despite a low uptake of skilled attendance at birth. Part of the decline was due to a fall in abortion-related deaths and better access to emergency obstetric care; midwives might also have contributed by facilitating access to emergency care. Investment in midwives, emergency obstetric care, and safe pregnancy termination by manual vacuum aspiration have clearly been important. However additional policies, such as those that bring about expansion of female education, better financial access for the poor, and poverty reduction, are essential to sustain the successes achieved to date,” the authors explain.
They conclude that the achievement of MDG-5 is not an unattainable dream for Bangladesh.
Accompanying Comment
Dr Mushtaque Chowdhury, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh, write that Ronsman and teams’ findings “challenge the current wisdom of promoting skilled birth attendants for all deliveries. Each year, more than 12 000 women die during labour and up to 42 days postpartum in Bangladesh, and the factors affecting such deaths are many and complex. Reduction of maternal deaths thus requires a multipronged attack from all conceivable fronts – obstetric and non-obstetric. Interventions based on both are likely to have maximum and sustained effects.”
(Maternal mortality is defined as the death of a woman during pregnancy or in the 42 days following birth due to causes directly or indirectly associated with the pregnancy.)
The Women Deliver Conference – October 18-20
The maternal health of women is crucial for families to survive, for economies to thrive, and cuts to the very heart of our society. The aim of The Women Deliver Conference is to focus global attention on the investment needed to save the lives and improve the health of women, mothers and newborns globally.
These issues, as well as pregnancy complications and induced abortion rates are all discussed in depth at the Women Deliver special issue of The Lancet.
Written by: Christian Nordqvist