Abstract

PIP: Operational research, which was supported in part by the World Health Organization's Maternal Health and Safe Motherhood program, has shown that the risk of maternal death is decreased with the use of fully trained and supervised midwives posted in villages, when they are supported by reliable referral facilities. During a 3-year study (1987-89), 6 women died from direct obstetric causes in 39 villages covered by a community-based maternity program in the Maternal and Child Health-Family Planning (MCH-FP) project area of Matlab, Bangladesh; 20 maternal deaths occurred in a control population with an equivalent number of births. Maternal mortality was 114 per 100,000 live births in the project area and 380 in the control area. The midwives followed women throughout their pregnancies; 44% were attended in their homes at least once. The midwives attended 689 (14%) of all deliveries, and actually delivered 9% of the babies. 134 of the 689 (19%) attended deliveries were referred to the Matlab maternity clinic for assistance. 33% of the women were attended by the midwives within 4 days of delivery. 44 of the 1712 women who were attended by the midwives were referred to the clinic for postpartum complications. The program reduced deaths in the following order of importance: abortion complications, postpartum hemorrhage, postpartum sepsis, obstructed labor, and eclampsia. Due to a shortage of trained midwives in Bangladesh, extension of this program is unrealistic; however, women health workers with 18 months training in maternal and child health could be effective in managing cases referred by community health workers. This approach is under evaluation in Matlab.