Maternal causes behind 13pc deaths

Thirteen percent of the deaths of females aged between 15 and 49 occur due to maternal causes, including haemorrhage and abortion-related complications, says a government survey released recently.

Besides, the estimated maternal mortality rate was 196 per 100,000 live births in 2016, which remained unchanged since 2010, it said.

The study also said the proportion of deliveries through Caesarean section has increased drastically in the country, from 12 percent in 2001 to 31 percent in 2016. When it comes to private clinics, the rate jumps to a staggering 83 percent.

According to WHO guidelines, it should have been between 10 and 15 percent.

The study styled “Bangladesh Maternal Mortality and Health Care Survey 2016” was conducted by the National Institute of Population Research and Training (Niport) while icddr,b provided technical assistance.

It is the latest study by Niport on the matter.

A total of 298,284 households and 321,214 married women were interviewed as part of the survey funded by the Bangladesh government, the United States Agency for International Development and the Department for International Development.

Field data collection started on August 22, 2016 and was completed on February 10, 2017. As many as 90 interviewing teams joined the survey work in six phases, said the latest Niport report on the issue.

The report said cancer accounts for the highest -- 24 percent -- of death of females, aged between 15 and 49, in the country, followed by circulatory diseases (23 percent). The other reasons include suicides and injuries, both six percent. 

The rate of females’ deaths due to maternal causes was 20.2 percent in 2001. It dropped to 14.1 in 2010 and 13.1 in 2016, the report said.

According to the survey report, haemorrhage was the most common cause of maternal deaths, followed by eclampsia, a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, and abortion-related complications.

“Haemorrhage and eclampsia account for 55 percent of all maternal deaths according to BMMS [Bangladesh Maternal Mortality Survey] 2016, slightly higher than BMMS 2010 [51 percent],” it added.

The report adds that the section of people seeking healthcare has remained almost the same between 2010 (68 percent) and 2016 (67 percent).

Convulsion and bleeding are also responsible for maternal deaths amid no supply of related medicines from the government, the report said, adding that 72 percent of the government healthcare centres have no supply of two vital injections -- magnesium sulphate for preventing convulsion; and ergometrine or oxytocin for preventing and controlling bleeding after childbirth.

Meanwhile, although the report estimated the maternal mortality rate to be 196 per live births in 2016, Dr Kazi Mustafa Sarwar, director general of the Directorate General of Family Planning, said the number was 172.

He ruled out the report finding and said, “We compile data regularly. The Niport report doesn’t matches reality.”

HOSPITAL SCENARIO AT A DHAKA UPAZILA  

Recently, this correspondent visited Dhamrai Upazila Health Complex in Manikganj, a nearly two-hour drive from the capital.

Asked, the authorities concerned said there was no supply of magnesium sulphate and oxytocin from the government for over five years.

“We usually manage the medicines from alternative sources,” said Md Fazlul Haque, the upazila health and family planning officer.

In 2018, the number of C-section deliveries was high in the upazila.

Some 2,656 out of 2,667 newborns were born through C-section in hospitals and private clinics, according to records of the health complex.

There were only 611 normal deliveries, of which only 226 happened at the hospital, the records show.

No maternal death was recorded in Dhamrai last year, but four stillborn babies were born then.

C-section is not available at the health complex since March 2018 as the only anesthetist was leave preparatory to retirement (LPR), said hospital sources.

As a result, many were forced to go to private clinics.

One of them was Shakila Akter, 28, who gave birth to her baby boy through C-section at a private clinic in Savar several months ago

“I had to go to the clinic and pay Tk 30,000 for the operation since the health complex has no C-section facility,” she told this correspondent.

Talking to The Daily Star, Khaleda Bari, member of the Obstetrical and Gynaecological Society of Bangladesh, said, “If you compare with the past, the number of C-section has come down.”

When her attention was drawn to the report that said the proportion of the operation has increased, she said, “Neither the doctors nor the patients want to take the risk. But C-section can be avoided in most cases. It is all about ethics; we all have become greedy for money.”

She urged for creating awareness among the people, especially the marginalised ones and those living in rural areas. “Assigning trained midwives in all community clinics could be a major step in this regard,” she added.

Talking to The Daily Star, Dr Kazi Mustafa Sarwar, director general of DGFP, said they were planning to initiate a set of new programmes to improve the situation.

 “C-section is a problem. We have planned to engage the community leaders in raising public awareness about it,” he said.