jamil_bangladesh defying all barriers makes impressive progress on saving mothers' lives

7/31/2019 Jamil_Bangladesh Defying All Barriers Makes Impressive Progress on Saving Mothers' Lives

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Kanta Jamil

USAID, Bangladesh

3 May 2012


2/40

574

143

0

100

200

300

400

500

600

700

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015

MDG 5

Target


3/40

Estimate of Maternal Mortality Ratio

2001 Bangladesh Maternal Mortality and Health Use Survey

Sample size ~100,000 nationally representative

2010 Bangladesh Maternal Mortality and Health Use Survey

Sample size ~175,000 nationally representative

Provided MMR estimate for 3 years before the survey

Information was collected on all deaths in the households inthe three years before the survey

For deaths of women under 50 years questions were asked

on whether death occurred during pregnancy, delivery orafter delivery

Verbal autopsy was conducted on all deaths of women inthe reproductive age group to determine causes of deaths


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574

143

322

194

0

100

200

300

400

500

600

700

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015

2010 BMMS

MDG 5

Target2001 BMMS


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Maternal Mortality DeclineContextual Factors

Government of Bangladeshs sustained and

consistent commitment

Excellent Government, NGO and DevelopmentPartner collaboration

Basic MCH Service delivery structure in place sincethe late 1970s

hospitals at district and sub district levels

static clinics at union level providing ANC/PNC

satellite clinics at the community level providing ANC/PNC

Fieldworkers at community/household levels mobilizingcommunities with behavior change and communication

messages


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Maternal Mortality DeclineContextual Factors

Intensive Family Planning Program since late 1970s

GOB programs offering Menstrual Regulation Services

Trained 42,000 traditional birth attendants (1980-2000)

Broader social development

Investment in female education from the 1990s Female empowerment through micro-credit

program since 1980s

Development in Communications


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Facilities upgraded (1990-2001) to provide

comprehensive EmOC

59 District Hospitals (out of 64)

60 Maternal and Child Welfare Centers (out of 98)

3 Upazila Health Complexes (out of 417)


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4 5 9 96 4

4 3

1993 BDHS 1996 BDHS 1999 BDHS 2001 BMMS

facility non-facility

10 913 12


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Decline in infections related to child birth

Tetanus Toxoid immunization

during pregnancy increased

Use of antibiotics becamemore widespread

Training of traditional birth

attendants improved some

practices that reduced infections

26

1989 2001

85At least 1 TT

Source: 1989 BFS; 2004 BDHS


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Decline in unsafe abortions

Increase in contraceptive use from 32% to 54% (1989-2001)reduced unintended pregnancy

Access to Menstrual Regulation provided alternative to

unsafe abortion

Fertility declined by 26% from 4.3 to 3.2 births per

woman

Reduced higher risk births. Fertility fell by 41% among

women age 35+ ; 24% among women age


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Hemorrhage31%

Indirect35%

Other Direct 5%

Abortion1%

Obstructed orProlonged Labor

7%

Undetermined1%


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0 25 50 75 100

Hemorrhage

Eclampsia

Obstructed

Abortion

Other Direct

Indirect

Undetermined

Maternal Mortality Ratio

2001 2010

35%

50%

85%

57%

26%


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Interventions

133 Upazila Health Complexes (UHC) upgraded

to provide comprehensive EmOC

~6,000 Community Skilled Birth Attendants

trained (starting in 2003)

Introduction of demand side finance (DSF) in

phases starting in 2006

2 pilot Upazila in 2006

~33 Upazilas under DSF by 2010 , 53 Upazilas by 2012

Strengthening health systems for MNH in

selected Districts (starting 2007)


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The reasons for the fall are several:

Medical

Socio-economic

Demographic


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Percent of births three years before the survey

9

233

4

0

5

10

15

20

25

30

35

2001 BMMS 2010 BMMS

%

Non-facility Facility

Doubled+


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4 59 9

1217

2329

6 44 3

4

4

4

3

1993

BDHS

1996

BDHS

1999

BDHS

2001

BMMS

2004

BDHS

2007

BDHS

2010

BMMS

2011

BDHS

facility non-facility

10

21

27

2.0% per year

(2001-2011)

9

1312

0.3% per year(1993-2001)

32

16


18/40


19/40

6

10

3

11

1

2

0

5

10

15

20

25

2001 BMMS 2010 BMMS

%

Public Private NGO

4.2 percentagepoints increase

8.6 percentagepoints increase

1.4 percentage

points increase


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2.6

12.2

0

5

10

15

20

2001 BMMS 2010 BMMS


21/40

2.6

12.2

17.2

0

5

10

15

20

2001 BMMS 2010 BMMS 2011 BDHS


22/40

52

35

71

30

0

20

40

60

80

All

Facilities

Public

Sector

Private

Sector

NGO

Sector

10.0% 11.3% 2.0%23.4%

%


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Sought Any Treatment

53

68

0

25

50

75

2001 BMMS 2010 BMMS


25/40

16

29

0

25

50

75

2001 BMMS 2010 BMMS

Sought Any Treatment Sought treatment from health

facilities

53

68

0

25

50

75

2001 BMMS 2010 BMMS


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Additional facilities upgraded

Growth of private sector facilities offering

maternal health services


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28/40


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Availability of mobile phones improved communication

Percent of households owning mobile phones

increased from 3% to 63%

Qualitative study indicates families used mobile

phone for

--Accessing health providers

--Accessing information

--Arranging funds, blood, getting medicine


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58

15

44

2623

45

No Education At least Some Secondary

1993 2001 2010


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From 3.2 to 2.5 births per woman--22% decline

Fertility fell more among older womenwho have relatively high-risk births

-- Fertility fell by 52% among women age 35+

and 18% among women age


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12000

0

6000

12000

18000

2001

MMR:322/100,000 LB

Number of

births:3.7 million

Maternaldeaths:

12,000 annually

Annual Maternal Deaths, 2001


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12000

15800

0

6000

12000

18000

2001 2010

# of women ofreproductive age

(WRA) increased by

29%.

If TFR and MMR

remained at the 2001

levelsthere would

be 15,800 maternal

deaths in 2010 (due

to increase in WRA)

Annual Maternal Deaths, 2001 and2010 (expected)


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12000

7300

3870

650

3990

0

6000

12000

18000

2001 2010

Maternal Deaths declined: 25% due to TFR decline

25% due to TFR decline

4% due to fertility patternchange24% due to MMR decline

Current maternal deathsper year

40%

decline

15800


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576

322

194

The

l a s t h u n d r e d m e t e r s


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Focus on ensuring provision good quality and reliable basic

EmOC services at UHCs and strategically-located

UHFWCs/CCsbacked up by effective referral systems

Service quality is still a concern, particularly with staffing,

staff attendance, logistics (medicines, blood), and skills

Integrated interventions to prevent PPH and Eclampsia

deaths across the continuumcommunity to referral

facility

Private sector is responding to the demand for maternal

health services, but it is too expensive for the poor and the

very high rates of C-sections is a concern


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Care-seekers are still spending time inefficiently onineffective home treatments They are often going toinappropriate or ill-equipped facilities

Education levels will continue to rise two-thirds of

older teenage girls now have some secondary

schooling

Family Planning services must be supported and

strengthened to bring down high risk births


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Congratulations on this

very impressive achievement

The momentum for

further progress is in place


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In both cases - the mother and baby survived

Let us not forget.

Improving maternal health is not only

about preventing deaths

Every woman has the right to have an

enjoyable, rewarding and affordableexperience in giving birth

jamil_bangladesh defying all barriers makes impressive progress on saving mothers' lives

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