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. 2023 Jun 9:13:07002.
doi: 10.7189/jogh.13.07002.

Maternal mortality in Bangladesh: Who, when, why, and where? A national survey-based analysis

Aniqa Tasnim Hossain  1 , Abu Bakkar Siddique  1 , Sabrina Jabeen  1 , Shusmita Khan  2 , M Moinuddin Haider  1 , Shafiqul Ameen  1 , Tazeen Tahsina  1 , Nitai Chakraborty  2 , Quamrun Nahar  1 , Kanta Jamil  3 , Shams El Arifeen  1 , Ahmed Ehsanur Rahman  1
Affiliations

Maternal mortality in Bangladesh: Who, when, why, and where? A national survey-based analysis

Aniqa Tasnim Hossain et al. J Glob Health. .

Abstract

Background: Despite a notable decline in recent decades, maternal mortality in Bangladesh remains high. A thorough understanding of causes of maternal deaths is essential for effective policy and programme planning. Here we report the current level and major causes of maternal deaths in Bangladesh, focusing on care-seeking practices, timing, and place of deaths.

Methods: We analysed data from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS), conducted with nationally representative sample of 298 284 households. We adapted the World Health Organization's 2014 verbal autopsy (VA) questionnaire. Trained physicians reviewed the responses and assigned the cause of death based on the International Classification of Diseases (ICD-10). We included 175 maternal deaths in our analysis.

Results: The maternal mortality ratio was 196 (uncertainty range = 159-234) per 100 000 live births. Thirty-eight per cent of maternal deaths occurred on the day of delivery and 6% on one day post-delivery. Nineteen per cent of the maternal deaths occurred at home, another 19% in-transit, almost half (49%) in a public facility, and 13% in a private hospital. Haemorrhage contributed to 31% and eclampsia to 23% of the maternal deaths. Twenty-one per cent of the maternal deaths occurred due to indirect causes. Ninety-two per cent sought care before dying, of which 7% sought care from home. Thirty-three per cent of women who died due to maternal causes sought care from three or more different places, indicating they were substantially shuttled between facilities. Eighty per cent of the deceased women who delivered in a public facility also died in a public facility.

Conclusions: Two major causes accounted for around half of all maternal deaths, and almost half occurred during childbirth and by two days of birth. Interventions to address these two causes should be prioritised to improve the provision and experience of care during childbirth. Significant investments are required for facilitating emergency transportation and ensuring accountability in the overall referral practices.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant information interests.

Figures

Figure 1
Figure 1
MMR by background characteristics, presented in deaths per 100 000 live births.
Figure 2
Figure 2
Timing of maternal deaths, presented in percentages and numbers (% (n)) (n = 175).
Figure 3
Figure 3
Causes of maternal death by timing of death, presented in percentages (n = 175).
Figure 4
Figure 4
Place of maternal deaths by place of birth, presented in percentages (n = 175).
Figure 5
Figure 5
Care-seeking practices of the deceased women by type of provider, presented in percentages (n = 175).
See this image and copyright information in PMC

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