What is the actual maternal mortality rate?

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What is the actual maternal mortality rate in Bangladesh? According to the latest NIPORT (National Institute of Population Research and Training) survey, it is 196. However, the director general of the family planning directorate, Kazi Mustafa Sarwar, has said that the report is not accurate. He claims Bangladesh’s maternal mortality rate to be 172. NIPORT’s report is based on their survey conducted in 2016. Upon what does the DG of the family planning directorate base his figure?

Prothom Alo published a report on Saturday, pointing out that maternal mortality was still high in Bangladesh, but the government was not accepting this. It mentioned how the authorities were concealing the findings in the NIPORT report, rather than making it public.

The primary report of NIPORT indicated that the maternal mortality rate had risen in 2016 as compared to that of 2010. The health ministry, health directorate and the family planning directorate at the time had questioned the veracity of the NIPORT survey. They rejected it as inaccurate.

A committee headed by the additional secretary of the health ministry was formed to review the NIPORT survey. The committee formed a sub-committee which reviewed the report and found it to be correct.

So the fact remains that maternal mortality did not decrease from 2010 to 2016. On the contrary, the rate increased from 194 to 196. That spells bad news because the world over, maternal mortality rates are falling, not rising.

In Bangladesh, the various health indicators have been improving: average life expectancy is increasing and infant mortality is falling. Stunted growth in children is also decreasing. There has also been improvement in the nutrition of women and children. So why had not the rate of maternal mortality decreased?

The NIPORT report pointed to some reasons. The main to causes of maternal death during childbirth is excessive bleeding and convulsions. Fifty-four per cent of maternal deaths during childbirth are due to these two reasons. Yet neither of these two reasons is so serious that it can cause death to be inevitable. There are inexpensive medications to treat both the bleeding and the convulsions. But two-thirds of the government healthcare centres do not receive a regular supply of the drug Oxytocin used to stop excessive bleeding. And three-fourths of these health centres do not have magnesium sulphate to treat the convulsions. It is most unfortunate that these two essential drugs are not available when needed, leading to the death of mothers during childbirth. The matter cannot be overlooked. Priority must be given to ensuring adequate supply of Oxytocin and magnesium sulphate to the government health clinics.

Initiative must be taken to improve the quality of service at the maternal health care departments of the government and private healthcare centres. Trained midwives must be on duty round the clock and the centres must have adequate equipment and medical supplies. The quality of maternal health care must be improved. Negligence and corruption in the health sector must be stopped. A strong accountable system must be put into place.

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