TY - JOUR
T1 - Maternal mortality in Bangladesh
T2 - A Countdown to 2015 country case study
AU - El Arifeen, Shams
AU - Hill, Kenneth
AU - Ahsan, Karar Zunaid
AU - Jamil, Kanta
AU - Nahar, Quamrun
AU - Streatfield, Peter Kim
N1 - Funding Information:
The case study was supported through Countdown to 2015 for Maternal and Child Survival by the Bill & Melinda Gates Foundation, the UK Department for International Development through ICDDR,B and by the United States Agency for International Development (USAID) through the Measure Evaluation project. The maternal mortality estimates in the BMMSs were produced by Han Raggers of the Netherlands. We acknowledge the contribution of Nitai Chakraborty of Dhaka University, Bangladesh, in preparing the working data files for the analysis. The work could not have been done without the full support of the Countdown to 2015 Secretariat and SRG throughout this case study. We also thank Cesar Victora, Jennifer Bryce, Jennifer Requejo, Andres de Francisco, and Peter Berman for reviewing and providing very valuable feedback on the draft manuscript. We also thank the institutions and individuals who had made the BMMS 2001 and 2010 possible. Both the surveys were implemented under the authority of the National Institute of Population Research and Training (NIPORT) of the Government of the People's Republic of Bangladesh with funding by the Government of the People's Republic of Bangladesh, USAID Bangladesh, and AusAID. The technical support for BMMS 2001 and 2010 came from MEASURE Evaluation, MEASURE DHS, Johns Hopkins University, ICDDR,B, and Kanta Jamil of USAID Bangladesh. The data from both the surveys were collected and processed by Associates for Community and Population Research (ACPR) and Mitra and Associates. The authors' views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government.
Publisher Copyright:
© 2014 Elsevier Ltd.
PY - 2014/10/11
Y1 - 2014/10/11
N2 - Background Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.Methods We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regressionFindings The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253391) in 19982001 to 194 deaths per 100 000 livebirths (149238) in 200710, an annual rate of decrease of 56%. This decrease rate is slightly higher than that required (55%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal deathInterpretation The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This fi nding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in BangladeshFunding United States Agency for International Development, UK Department for International Development, Bill and Melinda Gates Foundation.
AB - Background Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.Methods We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regressionFindings The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253391) in 19982001 to 194 deaths per 100 000 livebirths (149238) in 200710, an annual rate of decrease of 56%. This decrease rate is slightly higher than that required (55%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal deathInterpretation The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This fi nding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in BangladeshFunding United States Agency for International Development, UK Department for International Development, Bill and Melinda Gates Foundation.
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U2 - 10.1016/S0140-6736(14)60955-7
DO - 10.1016/S0140-6736(14)60955-7
M3 - Article
C2 - 24990814
AN - SCOPUS:84908217272
SN - 0140-6736
VL - 384
SP - 1366
EP - 1374
JO - The Lancet
JF - The Lancet
IS - 9951
ER -