Determinants of maternal and newborn health and survival in three rural areas of Bangladesh

Bangladesh has achieved impressive reductions in maternal deaths during the past two decades, but has not shown much progress in the use of skilled providers at childbirth or in postnatal care from trained providers. Both the Government and NGOs were implementing various interventions aimed at improving the health of mothers and newborns in the study area for this thesis. An in-depth knowledge of existing maternal and newborn care practices, and of related beliefs, is essential to assessing the success of such maternal and newborn care interventions, and to understanding the challenge improving the situation presents. Fieldwork was carried out in three unions of Ramu upazila in rural Bangladesh -Khuniapalong, Joarianala and Fatehkharkul. A total of 1,326 interviews were conducted, with data weighted to reflect the 1,783 women who were eligible to be interviewed. In addition, 40 in-depth interviews were conducted with different stakeholders. Women in Khuniapalong were appreciably poorer and less educated than those in Joarianala, who in turn were poorer and less educated than those in Fatehkharkul. Although most women had sought antenatal care (ANC), little more than a quarter of deliveries had been attended by skilled personnel. Women with higher secondary or higher education, in wealth quintiles 3-5, resident in Fatehkharkul, having a first birth, and having received a voucher/card for ANC and other services were especially likely to have received ANC three or more times from a trained provider. Over three-quarters of births had occurred at home, including almost all ofthose in Khuniapalong. Delivery complications, having received a voucher/card for free ANC, delivery and PNC services, residence in Fatehkharkul, belonging to wealth quintile 4 or 5, the birth being a first birth, having higher secondary or higher education (woman and her husband), and having had three or more ANC consultations were all predictive of hospital delivery. Skilled assistance at home births was related to having a first birth, experiencing complications, having had four or more ANC visits, belonging to the highest wealth quintile, and residence in Fatehkharkul. More than 70 percent of women had consulted somebody for postnatal care (PNC), but almost all PNC providers in Khuniapalong and two-thirds of those in Joarianala were unskilled, along with 40 percent of those in Fatehkharkul. Use of a skilled birth attendant was associated with having skilled PNC for both mothers and newborns, and with essential newborn care practices like clean cord care, immediate drying and wrapping, delayed bathing and early initiation of breastfeeding. These practices are still frequently not followed, being intertwined with cultural beliefs. Qualitative data showed that not consulting trained ANC and PNC providers and not using skilled birth attendants were associated with perceiving them to be ' not needed' . Skilled attendance at delivery and postpartum care for mother and newborn are crucial to improving the mother and newborn health situation in rural Bangladesh. Equitable coverage by health interventions along with community empowerment are keys to overcoming harmful cultural beliefs and norms around childbirth and thereby improving maternal and newborn health