Safer abortion and better emergency care among factors decreasing maternal mortality in Bangladesh

October 11, 2007

Better access to safe abortion services and emergency obstetric care are among the factors which have led to a massive decrease in maternal mortality in Bangladesh during the last 30 years. These are the conclusions of authors of an Article in this week's Women Deliver Special Issue of The Lancet. Further, the study shows that achievement of Millennium Development Goal Five's (MDG5) goal of reducing maternal mortality by 75% could be possible for Bangladesh.

Dr Carine Ronsmans, London School of Hygiene and Tropical Medicine, UK, and colleagues from the International Centre for Diarrhoeal Research, Bangladesh (ICDDR, B) analysed data collected between 1976 and 2005 for around 200000 inhabitants of Matlab, Bangladesh, in adjacent areas served by either the ICDDR,B or by the government. Maternal deaths due to obstetric causes, abortion-related causes and other causes were analysed separately.

The researchers found that mortality fell by 68% in the ICDDR,B region and by 54% in the government region throughout the 30 year period. Maternal mortality remained stable between 1976 and 1989, but decreased substantially after 1989, by an average 5% a year. The speed of decline in the ICDDR, B area was faster following the introduction of the skilled-attendance strategy for births introduced in 1990; but this was found to be not statistically significant. Abortion-related mortality also fell substantially post-1990, at a rate of 9% per year.

Further, educational differentials for maternal mortality were substantial -- if a woman had had more than eight years of schooling, she was less than a third as likely to die than a woman with no formal education. For abortion mortality, this difference was even more pronounced -- maternal mortality for women with no education was more than 11 times higher than for those with at least eight years of schooling.

The authors say: "The fall in maternal mortality over 30 years occurred despite a low uptake of skilled attendance at birth. Part of the decline was due to a fall in abortion-related deaths and better access to emergency obstetric care; midwives might also have contributed by facilitating access to emergency care. Investment in midwives, emergency obstetric care, and safe pregnancy termination by manual vacuum aspiration have clearly been important. However additional policies, such as those that bring about expansion of female education, better financial access for the poor, and poverty reduction, are essential to sustain the successes achieved to date."

They conclude: "This study has shown that achievement of MDG-5 is not an impossible dream for Bangladesh."

In an accompanying Comment, Dr Mushtaque Chowdhury, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh, say that Ronsman and colleagues' findings "challenges the current wisdom of promoting skilled birth attendants for all deliveries."

He concludes: "Each year, more than 12,000 women die during labour and up to 42 days postpartum in Bangladesh, and the factors affecting such deaths are many and complex. Reduction of maternal deaths thus requires a multipronged attack from all conceivable fronts -- obstetric and non-obstetric. Interventions based on both are likely to have maximum and sustained effects."
The paper associated with this release is below:

Full contacts

Dr Carine Ronsmans, London School of Hygiene and Tropical Medicine, UK T) +44 (0) 20 7927 2190 / +44 (0) 7731 782857 E)

Dr Mushtaque Chowdhury, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh T) +88-02-9881265 Ext. 2201 E)


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