Dr' Jahangir Hossain, Health Adviser

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Community Interventions for reducing Maternal
Death Bangladesh Experiences
Women Deliver Conference London, UK 18 20
October 2007

• Dr. Jahangir Hossain, Health Adviser
• CARE-Bangladesh

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Maternal Health Situation in Bangladesh

• Most densely populated country with pop. 134
  million 876 per Sq Km
• Each year 4 million women get pregnant, 0.6
  Million women develop life threatening
  complications 0.2 million use EOC services.
• Most births (80-90) occur at home with TBAs who
  may be trained or not.
• Around 12,000 to 15,000 women die every year from
  maternal health complications (MMR-320, NMR-41)
• Nine million women suffer from lasting
  complications of pregnancy and childbirth, such
  as fistulae, uterine prolapse etc

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Project Overview

• Goal Reduce maternal mortality and morbidity
  through identifying and removing barriers, which
  lie between women and the EmOC (Emergency
  Obstetric Care) facilities.
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• Objectives To increase the use of delivery care
  especially EmOC services by the women with
  obstetric complications
• Project areas Five Villages from each of Six
  Upazilas (Sub-district)
• Population covered 64,409
• Duration November 2006 to October 2008

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Key Interventions to Address Three Delay
Key barriers
Phases of delay
Interventions to address the delays
Promotion of birth planning (BP) emergency
Preparedness (GoB CARE)
Lack of knowledge Believes, norms No advance
planning Womens status Passive role of husband
Delay 1 Decide to seek care (Household)
Establish community support system (GoB CARE)
Cost Transportation Distance Collective supports
Delay 2 Reach medical facility (Community)
Training, equipments Monitoring,
supervision Accountability Poor friendliness
Delay 3 Receive adequate (QoC) treatment
Improve capacity of the facilities to provide
quality of care (QoC) (UNICEFGoB)
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Birth Planning (BP)

• Birth Planning is a process through which
  pregnant women and relevant family members are
  provided with messages to construct a plan for
  both normal delivery and if complications arise.
• Target Pregnant women and Household decision
  makers including husband
• Channels GoB frontline workers, community
  volunteers, TBA, School teachers
• Support to Channels Training, OJT, follow-up
• Materials Birth Planning Card with messages
  emphasize on clean delivery, danger signs and
  emergency preparedness

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Community Support System

• Collect case studies on maternal death,
  understand norms, culture, mapping out local
  resources to support MNH
• Identify and prepare local natural proactive
  leaders
• Support local leaders to organize community
  meeting
• Share and analyze the local evidence on MNH, and
  identify appropriate solutions
• Develop community structures (committee) to
  manage identified activities and resources
• Facilitate participatory monitoring to assess the
  achievements and promote sharing

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Results

• The decision makers of 70 household reached with
  birth planning messages
• All 30 pilot villages have established CmSS, of
  them 24 have emergency fund, 8 have own
  transportations (van, boat etc.)
• The met need for EmOC in the project areas is 75
• Out of 123 women who used EmOC services, 104
  women used support from CmSS
• CmSS addressed other social issues like dowry,
  VAW, early marriages, post flood recovery etc.
• The approach of CmSS has now become part of
  Bangladeshs national maternal health strategy
  (major potential for scale-up)

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Lessons Learned

• Targeting husband and HH decision makers is
  important to enhance the decision making process
• Use of multiple channel reinforcing the BP
  messages and reach most of the target populations
  
• CmSS is an effective approach for creating a
  supportive environment for women in the community
  and providing marginalized women access to EmOC
• Collective voices of the community make the
  service providers accountable
• Approach creates peer pressure to prevent harmful
  practices by traditional healers
• Has the potential to address broader social and
  womens issues like Violence against Women, early
  marriage and dowry

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• Thank
• You
• All