The New Nation - Internet Edition

Dr. A.M.M.Anisul Awwal

National Institute of Population Research and Training (NIPORT - one of the directorates under the Ministry of Health and Family Welfare) is proud to have the opportunity to undertake the long cherished survey on Bangladesh Maternal Mortality and Maternal Health Care Survey 2009-10. To the survey is envisaged to be accomplished with the direct assistance and cooperation of many organizations of national and international origin, and nationally well recognised NGOs, particularly in the field of research and survey on health, Nutrition and Population including social sectors. In this ongoing survey, NIPORT is virtually lucky enough to have heartfelt support and cooperation from various individual experts and agencies as well.

The Government of Bangladesh has invested on maternal health programs with the support from a number of development partners. According to the Millennium Development Goal 5, target of GOB is to reduce the maternal mortality ratio (MMR) to 143 per 100,000 live births by 2015 from 320 (2007), and increase skilled atendance at birth to 50% by 2010. Health, Nutrition and Population Sector Program (HNPSP) has adopted national strategy for maternal health focusing on Emergency obstetric care (EOC) with the view to reduce the MMR, and achieve the MDG goal 5. The strategy also sets out priorities on essential obstetric care and basic maternal care services for early detection and appropriate referral of complicated cases including women's access to resources and improvement of quality of care. It is pertinent to mention that theoretically many of the strategic documents and policy papers are sound and seems to be implement able, but in reality, fails to do so such as establishment of an effective referral system, access to GOB quality care, introduction of EOC in the entire country or implementation of Nutrition program in all the upazilas or introduction of voucher scheme (demand side financing) etc. as safeguard to reduce the MMR to achieve the MDG 5 within the short span of only another 05 years.

During the past 10 years, GOB has strengthened EOC services with the incorporation of few more essential life saving component in the program (such as blood transfusion) at various levels of health service provisions. At the facility level, Comprehensive Emergency Obstetric Care is available in 68 (out of 90) Maternal and Child Welfare Centers (MCWC), all of the 59 district hospitals, all the medical college hospitals, maternal and child health institutes, and the medical university. At the Union level, GOB is upgrading 1500 Health and Family Welfare Centers (out of 4300) to provide basic obstetric care. At sub-district level, 132 (out of 414) Upazila health Complex (UHC) were strengthened to provide CEOC that includes caesarian section with or without blood transfusion.

To expedite the pace of achieving the related MDGs, Government, in the year 2002 has initiated a program to train the community-based skilled birth atendants (CSBA). A significant proportion of the Family Welfare Assistants (FWA) and the Female Health Assistants (FHA) were trained to provide safe and skilled delivery care at home. Even with this noble gesture, till today, only 3800 CSBAs are available to provide the desired maternal health / delivery care services at home. GOB has a vision of producing 13,500 CSBAs (2-3 for each Union) by the year 2015.

In the last two decades, Bangladesh has achieved a lot in various aspects of development In the field of HNPSP, most of the indices are showing positive trends (may be many of the trends are not that much sharp to achieve the MDGs). At present, Infant Mortality Rate (IMR) is only 51 / 1000 live births (also includes neonatal mortality rate which is 31 / 1000 live births), overall nutritional status has improved, childhood mortality has come down, life expectancy at birth has gone up etc. MMR was found to be 322 per 100,000 live births for the period of 1998-2001. The Bangladesh maternal mortality and maternal health care survey 2001 used direct, sisterhood and verbal autopsy methods to figure out the MMR and other health care services available to them. Since 2001, major initiatives to protect the health and life of women have been undertaken, and thus GOB has undertaken the BMMS (2009-10) to know the present MMR, causes, health and family planning services available to them and the trends of mortality and the service availability. It is expected that the preliminary reports of the survey would be available by September 2010 and the final report would be published by December 2010. The survey results would have a significant input in the overall goal setings for the new sector program development (2011 - 2016) under the Ministry of Health and Family Welfare which is scheduled to be launched in July 2011.