Maternal mortality still high, though govt disagrees

Shishir Morol. Dhaka | Update:

The health ministry has finally accepted the maternal mortality and healthcare survey report that indicates there are 196 maternal deaths per 100,000  live births. It has also admitted that the government has failed to eliminate two main causes of maternal mortality.    

The National Institute of Population Research and Training (NIPORT) conducted the survey with the assistance of Bangladesh Statistical Bureau (BBS) and several other local and foreign organisations.  The initial report of the 2016 survey was released by the Ministry of Health and Family Welfare on 22 November 2017.  The 106-page report was published, distributed and also posted in the NIPORT website.

The report showed that 196 mothers die every year in giving birth to every 100,000 infants which is higher than that of 194 deaths per 100,000 live births in previous survey carried out in 2010.

The survey shows, 54 per cent of the maternal deaths occur due to main reasons, excessive bleeding and convulsions.

The health ministry, directorate and family planning department, however, refused to accept the survey report and sought to review the survey once again.

The ministry, however, took one and half a years to review the report and has now finally accepted that the country’s prevailing healthcare system is not adequate to decrease maternal mortality.

Prothom Alo investigations have found that the government lacks initiative to provide adequate medicines to treat bleeding and convulsions in mothers.

Economist and former caretaker government adviser Hossain Zillur Rahman told Prothom Alo, “The new data reveals the actual progress. Steps can be taken to identify the programme’s weaknesses.  This could be done by hiding the survey report.”

“The health ministry has done great damage by concealing hiding the survey report instead of reducing the causes of maternal mortality,” he added.

The Bangladesh maternal and health care survey was first conducted in 2001.  The second was in 2010.  The survey is relevant for the local and foreign research and donor organisations, UN organisations and its development goals, as well as government policy makers.

The latest survey was carried out in 2016.  It was to be released by the end of 2017, but the full report has not been published yet, one and a half years since then.  The ministry’s sub-committee has now finalised the review report, which agrees to the data concerning high maternal mortality rates.

However, the director general of the family planning directorate Kazi Mustafa Sarwar did not agree to the review report.  He said, the government has taken many steps to reduce the rate of maternal mortality which, he claimed, declined to 172.

“The survey data is not realistic,” he told Prothom Alo.

The convenor of the committee and the deputy chief of the planning division (Medical Education Division) of the health and family welfare ministry, Abdus Salam Khan, said the final report of the review will be submitted to the relevant committee of the ministry.

Covering up the survey

The health ministry, health directorate and family planning directorate raised questions about the survey method and the quality of the report when the survey revealed that the maternal mortality rate had increased.

NIPORT removed the report from its website on 3 December 2017. Prothom Alo published a report on that on 10 December.

Kazi  Mustafa Sarwar, at the time, told Prothom Alo, “We cannot accept the survey report.”

The deputy director general of NIPORT at the time, Rawnaq Jahan, said that they had formally requested the health ministry to review the survey report.

After that a committee headed by the additional secretary of health ministry was formed.  The committee has a sub-committee consisting  of 14 members. 

The sub-committee, after reviewing the survey, said the method of survey was accurate.  The data is compatible with various sources of information about maternal mortality.  The sources include BBS’s Sample Vital Registration System (SVRS) and the health department’s health bulletin.  Besides, the committee has explained why maternal mortality is not decreasing.

Lack of services and medicines

The review report says, the public and private health institutions are not able to provide standard healthcare services as they have shortage of skilled manpower, guidelines, equipment and logistics.

Most of the centres for child delivery do not have midwives available round the clock, according to a health institution survey conducted in 2014.

Apart from the community clinics, only 3 per cent of the healthcare centres have properly prepared for normal child delivery. It is the responsibility of all government health care organisations of the upazila level and above to provide emergency services. But only slightly above one third of these organisations are carrying out these compulsory tasks. The condition of private hospitals is even worse, but most of these are carrying out C-section surgeries.

Physicians and researchers say , besides trained staff, the health centres are supposed to store Oxytocin to stop bleeding and magnesium sulphate vaccines to stop convulsions. These two drugs are inexpensive and easily available.

However, according to the healthcare survey (2014), almost two-third of the health centres did not have Oxytocin while three-fourths had no magnesium sulphate vaccines.

The government officials contradict each other on the matter. The Prothom Alo correspondent found an upazila health centre did not have either of the medicines on a visit on 13 May.

The health and family planning officer of the health centre said, the supply of both the drugs was irregular.

Director of the health department (Maternal and Child Health Programme) Shamsul Haque said, there is regular supply of medicines in all the health centres.

When asked about the upazila health centre in Khulna , he said, “We will look into the matter.”

Founder of Gonoshasthaya Kendra Zafrullah Chowdhury said, Gonoshasthaya pharmaceutical produces plenty of magnesium sulphate. The price of each vaccine is Tk 20. But the government does not buy drugs from them, he added.

The review committee, however, put forward four recommendations: essential maternal healthcare should be increased, effective measures should be taken to prevent the main causes of maternal mortality, standard services must be ensured in all healthcare centres, and government monitoring should be ensured in the health sector.

*This piece, originally appeared in Prothom Alo print edition, has been rewritten in English by Farjana Liakat

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