Maternal mortality in Bangladesh: Learning from the past, moving towards the future

It is exciting times in the field of maternal health, as we get closer to the year 2015 where a three-quarter of reduction in the maternal mortality ratio (MMR) is aimed (Millennium Development Goal-5). However MDG-5 has seen the least progress compared to the other development goals. Bangladesh is one of these examples. Although home delivery is still a universal norm, a steady fall has been occurring in MMR since 1990s. This study aims to understand this trend within the political, economical and cultural context of the country, while looking for promising strategies to be implemented in the future. Key-informant interviews with government, international organization and non-governmental organization officials involved in safe motherhood policy and programs have been conducted; government/agency reports and documents, unpublished drafts, and published research on maternal health have been used and various health facilities have been observed. The strengths and the weaknesses of the current programs have been identified and skilled birth attendance (community and facility level) has been analyzed. Social development, a constantly emerging issue from the interviews, has been discussed within the context of maternal health. Two promising interventions, community-based misoprostol in preventing postpartum hemorrhage and health center intrapartum care as a national strategy have been analyzed for the feasibility of implementation and acceptability in Bangladesh. The ongoing improvements in the healthcare infrastructure and capacity building for health care professionals are promising steps toward a facility based intrapartum care strategy, however changing cultural preferences and government policies in the short term are not feasible. Home delivery without any skilled care being common especially in resource-poor areas, and women's lack of decision-making power for their health make the community-based misoprostol intervention both an effective and empowering strategy in improving women's lives in Bangladesh with a caution on the possible side effects and misuses.