The maternal mortality ratio (MMR) is not merely an indicator of maternal health but is also considered to be an important indicator of the health status and well being of a nation. Bangladesh has made a significant improvement in several health indicators. Nevertheless, although the maternal mortality ratio has declined from more than 600 in 1980 to 322 in 2004, it 1, 2 is still one of the highest in the world. Regional variations in MMR are also observed in Bangladesh.
In Bangladesh, pregnancy and delivery-related deaths account for 20 percent of the deaths in women of reproductive age. Ten percent death occurs during delivery, and the one in five occurs before delivery and remaining death after delivery. The leading causes of maternal deaths are hemorrhage (29 percent) and eclampsia (24 percent). Other direct major causes of maternal deaths are prolonged/obstructed labor and puerperal sepsis. The lack of knowledge on maternal health and negative attitude towards seeking delivery care from qualified providers contribute largely to the high rate of maternal deaths in Bangladesh .
The key challenges in reducing maternal and neonatal mortality include lack of access, and inadequate and poor quality of maternal and neonatal health (MNCH) services. Although the government has developed a comprehensive maternal and child health service delivery infrastructure from grassroots to higher levels, there is a significant underutilization of the existing capacity due to both demand- and supply side barriers. These barriers can be well understood in the framework of the three delays: (i) delays in making the decision to seek care for lack of awareness, and social-cultural-gender inequality, (ii) delays in reaching a medical facility due to transportation related obstacles, and (iii) delays in receiving adequate treatment or management at the facility. The first two delays reflect the demand-side barriers while the third delay occurs at the supply-side, which, in turn, affects the demand side barriers.
With impressive progress made in recent years, Bangladesh is one of few developing countries on track to achieve Millennium Development Goal 4 to reduce child mortality. Between 2004 and 2007 child mortality has fallen from 88 per 1,000 live births to 65 per 1,000 live births.1 However, despite this encouraging trend, neonatal mortality in Bangladesh is still high, accounting for more than half of all under-five deaths and more than two-thirds of infant deaths. An estimated 120,000 newborns die every year in Bangladesh. The share of neonatal deaths to infant mortality has increased over the period 2002-2006, largely because there has been little progress in preventing neonatal deaths. Poor neonatal health and under-nutrition of both mothers and children could affect the current success in improving child survival.