|Author(s):||S. Kamal*1, M. Islam2|
|Affiliation(s):||1Department of Mathematics, 2Department of Economics, Islamic University, Kushtia, Bangladesh|
|Keywords:||Bangladesh, safe motherhood, antenatal care, skilled birth attendant, child delivery, facility place.|
Promoting safe motherhood practices has been a foremost global health agendum. Two decades since the initiation of the safe motherhood initiative, maternal mortality is still soaring high in most developing countries. Despite the international calls to reduce maternal mortality by three-quarter by 2015, Bangladesh still has unexpectedly high maternal mortality rate, suggests the need to understand the progress and challenges of safe motherhood practices.
Data for this study have been taken from the last five consecutive nationally representative Bangladesh Demographic and Health Surveys (BDHSs) conducted during 1993-2007. The surveys gathered detailed information from women on socioeconomic status, demographics, childbirths histories and maternal health care services utilization, knowledge and awareness of HIV/AIDS, sexually transmitted diseases etc. Both bivariate and multivariate statistical techniques have been applied to investigate the relationship between the dependent variables: receiving antenatal care (ANC) service, seeking assistance from skilled birth attendants (SBA) and use of medical facility place for childbirth and a set of independent variables of socioeconomic and demographic factors. Data have been analyzed by SPSS version 17.
Receiving ANC services has increased by two fold from 25.9% in 1993-1994 to 51.7% in 2007. Seeking assistance from SBA has been almost double from 9.5% to 18.1%, while use of medical facility place for safe delivery has increased by four times from a low level of 3.5% to 14.7% during this period. The proportion of women who made at least four antenatal visits has increased from 5.5% in 1993-1994 to 20.6% in 2007. The most pronounced reason for not receiving ANC service in the 2007 BDHS was that check-up was not needed (72.0%), followed by service costs (25.0%), did not know of need for care (7.0%) and were not permitted to leave house by husbands (5.0%). The multivariate logistic regression analyses revealed that women’s age, place of residence, religion, access to mass media, sex of household head, wealth index, wantedness of pregnancy and birth order were the significant (p<0.001) determinants of Maternal Health Care Services (MHCS) utilization. ANC visit was also significant important factor for seeking assistance from SBA and delivery of child at facility place. MHCS utilization also varied significantly (p<0.01) across the administrative regions of the country. Women’s education appeared as the most single determinant of MHCS utilization. Although within one and a half decade a significant progress has been made in safe motherhood practices, the findings of the study reveal poor utilization of maternal health care services in Bangladesh. Still half of the women yet not receive ANC services and the vast majority of the women perform their childbirth by the assistance of unskilled and traditional birth attendance. Only a small proportion of women use medical facility place for child delivery. Harmful traditional practice of child delivery at home, ignorance among women regarding its adverse outcome for both mother and child and service costs are the most important challenges in the MHCS utilization. Poverty and ignorance are two vital impediments of safe motherhood practices in the country. Skilled services should be reached and available to the poor with subsidized costs. Awareness should be created among women addressing the long run adverse effect of harmful traditional practices of child delivery at home and the benefit of modern maternity care services utilization through Information, Education and Communication (IEC) programme to promote safe motherhood practices in Bangladesh.