Looking beyond the numbers
A TEENAGE girl named Zannat used to come to our house in Mirpur occasionally to help my mother with household work, some six or seven years ago. I'll never forget her ever-smiling face. A few years ago, I came to know from her elder sister that she died after giving birth to a baby girl. Her sister could not tell me the cause of her death. She said Zannat was never taken to any medical facility during or after delivery.
One or two years after Zannat's death, her elder sister also died after giving birth to a baby girl, due to severe bleeding. She was in her early 40s. The baby was delivered at home without the help of any medical practitioner. Her relatives said she had never gone to a doctor during her pregnancy.
In a span of five years, the two sisters had met untimely deaths due to childbirth related complications. Neither of these deaths were documented.
Recently, a leading daily in Bangladesh has reported, based on their investigation, that the maternal mortality rate (MMR) in the country has not dropped in the last two years. In fact, it has increased.
The report came as a big surprise in the backdrop of reports and discussions over the years that have made us think that Bangladesh has been doing quite well in reducing child and mater- nal mortality rate. We were hopeful that by 2030 Bangladesh would be able to reduce maternal mortality rate down to 70 per every 100,000 live births, which is the Sustainable Development Goal (SDG) 3.
But now we have come to know that we have actually failed to achieve even the Millennium Development Goal (MDG) 5.
In order to achieve the MDG-5, the MMR should have come down to 143 per one lakh (a hundred thousand) live births by 2015. Since we have failed to achieve the MDG-5 by 2015, it seems, achieving SDG-3 will be quite a challenge because in order to achieve that target, we would have to reduce MMR by 64% in the next 12 years.
According to the World Health Organisation, the maternal mortality rate came down to 176 per 100,000 live births in 2015 from about 399 in 2000 in Bangladesh – the fourth highest drop in the region.
And the UNDP's human development report 2016 has revealed that in 2015 the ratio was 178 in Pakistan and 258 in Nepal. Clearly, we did better when compared to some other South Asian countries, yet we still could not meet MDG-5.
The reasons behind this setback are many. Although we hear all the time that more and more expectant mothers are taking medical assistance during their pregnancy, there are still a large number of women – around 63% according to medical practitioners and organisations who work with maternal health – giving birth at home, without any assistance from any birth attendant.
The two major causes of maternal death in the country are eclampsia (high blood pressure during the advance stage of pregnancy) and postpartum haemorrhage (severe bleeding after childbirth).
According to WHO, in 2015 there were an estimated 5,500 maternal deaths in the country, and postpartum haemorrhage was the main cause of these deaths.
What is tragic is that such deaths are preventable. A study done by the Lancet, a UK-based medical journal, has found that there is a low-cost and widely available drug named tranexamic acid (TXA) which could save the lives of one in three mothers who would otherwise die from excessive bleeding after childbirth.
Early marriage is another reason for the increase in the maternal mortality rate. The risk of death from pregnancy related complications are extremely high among girls who get pregnant before they turn 18.
Thus, if we want maternal mortality rate to drop child marriage must be prevented. Also, annul- ment of the special provision in the Child Marriage Restraint Act is a must. Because under this provision, a girl can be married off even if she is not 18 under special circumstances.
A dearth of doctors, nurses and other skilled health care workers in rural areas still remains a major challenge in reducing maternal mortality rate. For safe childbirth in rural areas such skilled medical practitioners must be made available at the upazila (sub-district) level.
As the daily Prothom Alo has reported, the number of maternal deaths could actually be much higher than the government estimates, as a large number of pregnant women remain unregistered. According to the news report, government officials working at the field level do not even register all the cases of maternal deaths. Also, there is little information about expectant mothers who live in remote areas. Therefore, registering pregnant mothers across the country and bringing them under antenatal care is very important in order to reduce maternal deaths.
The cases of Zannat and her elder sister are blatant examples of deaths not documented. If these deaths are any indication, there must be countless such cases throughout the country. A country that has a long way to go before we can claim we have done enough to reduce maternal deaths. — The Daily Star/Asia News Network