IFGH 2012: Why Some Women Die and Others Survive Maternal Complications: Findings from the Qualitative Assessment of Bangladesh Maternal Mortality Survey (BMMS), 2010

Authors:Blum LS., Sultana M., Bilkis S., Nahar Q., Akhtar R., Streatfield PK.


Author Affiliations:International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B)

Option 1– Scientific / Empirical Research Findings Presented as – Poster (unable to present)

Aims:

A nationwide survey shows an impressive reduction in maternal mortality in Bangladesh, declining from 322 to 194 in 9 years, with hemorrhage and eclampsia the leading causes of death. Little is known about the circumstances that prevent or encourage women with complications to use emergency obstetric care.

Methods:

Qualitative research was carried out alongside with the national survey between March 2010 and January 2011. Maternal deaths were sampled from the survey, near-misses were identified from health facilities located in areas where the deaths occurred. Methods included in-depth interviews with people most familiar with maternal death (15) or near-miss (16) that had occurred due to hemorrhage and eclampsia within past 18 months.

Results:

Informants from both groups demonstrated limited knowledge of delivery-related complications and where to seek treatment. Maternal deaths were more likely to obtain initial treatment with informal providers, delaying care seeking to facilities, while near-miss women generally first sought facility care. Additional household level delays to care seeking faced by women who died included older family members’ opposition to facility care, odd night time, and money was not readily available. Once care was sought, maternal deaths were more likely to go to a facility that was unable to provide appropriate treatment, either because of the unavailability of doctors or required services, forcing women to visit multiple facilities before obtaining appropriate care. Data showed that eclampsia was easier to recognize, signaling the need for formal care, while hemorrhage was difficult to identify, with the majority of deaths never accessing facility services.

Conclusions:

Prior to childbirth, women and family members should be informed about pregnancy-related complications and where to seek appropriate care. Health officials must ensure that EmOC services are functioning and rapid referral systems are in place.