Bangladesh is on track to meet the 2015 deadline for U.N. Millennium Development Goal 5 (50 percent reduction in maternal deaths). The Bangladesh Maternal Mortality and Health Service Survey [PDF] jointly funded by the Government of Bangladesh, USAID, Australian Aid (AusAID) and the United Nations Population Fund (UNFPA) found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in 9 years.
The decline in direct obstetric deaths is most likely the consequence of better care seeking practices and improved access to and use of higher-level referral care. The decline in total fertility rate due to the successful family planning program has reduced exposure to high risk pregnancies and has thus prevented a large number of maternal deaths.
USAID’s program in Bangladesh has historically been very strong in family planning through the world’s largest social marketing program for non-clinical contraceptive methods and through the public sector for long-acting permanent methods. We can confidently say that our long and unwavering investments in family planning have had direct impact in lowering the total fertility rate, and thus the maternal mortality rate, in Bangladesh. Over the past five years, USAID has also invested in scaling up active management of the third stage of labor to prevent postpartum hemorrhage in the public and NGO sector.
The USAID program has also long invested in promoting and providing antenatal care through the NGO sector which linked women to the health system thus contributing to increased awareness and care-seeking for obstetric complications. USAID and CDC’s long term commitment to the in depth training of local scientists has resulted in the creation of Bangladesh’s premiere research institute, the International Center for Diarrheal Disease and Research, Bangladesh (ICCDDRB) which has the capacity to effectively guide valid and reliable research efforts such as the 2010 Bangladesh Maternal Mortality and Health Care Survey (BMMS).
USAID supported and provided technical leadership in implementation of the 2001 and 2010 BMMS to monitor the performance of the overall maternal health program. Without these two surveys it would not be possible for Bangladesh to monitor its progress towards achieving the MDG 5 goal.
Amanda Glassman, Director of Global Health Policy and a research fellow at the Center for Global Development, wrote “the results are also a good reminder that investments in family planning and girls’ education drive much of maternal health outcomes, and that USAID investment in social marketing of family planning and health seems to be paying off in improved health (see blog post).”
The Bangladesh Ministry of Health and Family Welfare is scaling up emergency obstetric care and active management of the third stage of labor; the Ministry has also recently approved distribution of Misoprostol tablets to all pregnant women shortly after delivery to prevent postpartum hemorrhage. There is also increasing availability of Magnesium Sulphate for management of pre-eclampsia. The predominance of hemorrhage and eclampsia deaths and deaths after delivery indicate a need to strengthen access to treatment for these two conditions, improve referral systems, and improve referral level care.
Every year, USAID provides basic health care services to nearly 20 million Bangladeshis, including provision of low-cost, quality family planning services and maternal and child health care. With USAID and international support, under-five mortality rates have declined by more than 50 percent in Bangladesh since 1990. USAID has trained and mobilized community health workers to provide critical maternal and child health care to supplement broader health interventions and support country-level capacity. Bangladesh already received a country award from the United Nations for significant progress in reaching MDG 4 (reducing child mortality) during the MDG Summit in New York on September 19.
The Government of Bangladesh and the United States jointly rolled out President Obama’s Global Health Initiative in Bangladesh on November 23. GHI in Bangladesh will focus on providing quality services to reduce maternal and child mortality, resuscitate family planning programs, improve nutrition status among children under age five, and strengthen overall health systems over the next five years.