Towards 4+5 Briefing Paper 4. Progress towards MDG5: Explaining the reduction in maternal deaths in Bangladesh

Abstract

Between 1990 and 2003, pregnancy-related deaths in Bangladesh fell from 514 deaths per 100,000 live births to 400. Verbal autopsy estimates, which exclude accidental or injury-related deaths, estimate the maternal mortality ratio (MMR) to be lower at 322 per 100,000 live births. Whilst Bangladesh has made progress towards achieving the MDG5 of reducing maternal mortality, there are still over 11,000 maternal deaths every year, and to achieve the government’s target of reducing the MMR by three quarters by 2015, the rate of decline must increase three-fold. In Matlab, a rural area in Bangladesh, data on maternal mortality has been available since 1976 through the Health and Demographic Surveillance System (HDSS) of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The ICDDR,B surveillance site in Matlab is divided into ICDDR,B and Government health service areas, with each covering a population of approximately 110,000. In 1987 a Safe Motherhood Strategy was launched in the ICDDR,B service area, which aimed to increase the coverage of births attended by a skilled health professional. This involved posting trained midwives in health centres, establishing a clinic providing basic emergency obstetric care (BEmOC) in Matlab town, and providing transport to the clinic or referral to a comprehensive emergency obstetric care (CEmOC) facility when necessary. The Towards 4+5 Research Programme Consortium is supporting researchers at ICDDR,B to review over 215,000 pregnancies and 769 maternal deaths in Matlab during 1976 and 2005. This review has made it possible to compare the impact of different health interventions provided in the ICDDR,B and Government service areas, and to identify the factors that have contributed to the decline in maternal mortality