Maternal morbidity in rural Bangladesh: where do women go for care?

Abstract

Objective: Assess the complications experienced and subsequent care-seeking behaviour of rural women and their knowledge about the complications of pregnancy and childbirth. Methodology: A structured questionnaire was used for interviewing 2,105 rural Bangladeshi women who delivered within one year of the survey. They were interviewed in their homes between May and August 1996. In this study, maternal morbidity refers to any compilations reported by women during their last pregnancy, delivery and/ or within 42 days after delivery. Results: Obstetric complications were experienced by 66% of the women, and commonest among these were prolonged labour, fever, bleeding, and oedema. The older and higher parity women, and those with less education, were more likely to develop complications, and stillbirths were four times higher among those with complications. Among all the women who had complications, 41% consulted village practitioners, 18% went to homeopaths, and 6% went to traditional healers. Thirty-seven percent of the women went to nobody. Husbands were the principal decision-makers for consultation with service providers. Use of institutional facilities and/or trained providers was positively associated with women's education, parity, their knowledge of obstetric complications and average monthly family expenditure. Women's knowledge about complications of pregnancy and childbirth was limited. Most women knew about prolonged labour and malpresentation, but very few knew about bleeding, retained placenta, and convulsion. A majority knew nothing about postpartum complications. Thirty-seven percent of the women received antenatal care from medically trained personnel, like paramedic, and doctors. Ninety-two percent of all the deliveries took place at home, and only 7% of the complicated cases delivered at the health facility. Eighty-nine percent of the women had a livebirths, nearly 3% had stillbirths and rest had either induced or spontaneous abortion as the outcome of their last pregnancy. Conclusion: Very few women in rural Bangladesh know about the common complications of pregnancy and childbirth, and most do not seek medical help for these. Also, use of government health facilities for the management of obstetric complications is poor. Therefore, efforts need to be strengthened for raising community awareness emphasizing on the importance of seeking medical help for obstetric emergencies. As an effort toward this the Operations Research Project of ICDDR.B has designed an intervention on emergency obstetric care at the thana level