Access to a Skilled Birth Attendant in Bangladesh: What We Know and what Health System Framework can Teach Us

Abstract

Despite some visible progress in some areas of health sectors, Bangladesh is still struggling to sustain efforts towards decreasing Maternal Mortality Rate (MMR). Evidence shows that there is lower access to skilled birth attendant in Bangladesh. Access to skilled birth attendants (SBAs) during delivery has been identified as an effective mechanism to significantly reducing MMR. Previous studies have focused on socio-demographic characteristics of women including cultural and religious dynamics with communities with limited attention to the health system. Using the World Health Organisation's health system strengthening framework, this paper analyses how health system 'architecture' playing role in create fragile platform for the women to access skilled birth attendants. It draws emphasis on governance and policy, financing, health information, workforce, service delivery, medicines and commodities including infrastructure. As governance is the dominant factor and plays critical role in determining success of all facets of the health system, this paper further proposes a systematic strategy that seeks to mitigate the identified challenges. Lessons from this study are relevant to guiding policy makers in Bangladesh as well as in other resource-constrained settings in making evidencebased decisions regarding strengthening the health system to access a skill birth attendant to make birth safer for both mothers and newborns.

Trend and projection of skilled birth attendants and institutional delivery coverage for adolescents in 54 low- and middle-income countries, 2000–2030

“…Additionally, with the introduction of 'maternity waiting homes', coverage was further expanded particularly in rural areas [29]. In Bangladesh, improvements could be linked to recent initiatives that have focused on the training of additional community-based-and traditional birth attendants amid the high rates of home deliveries (62.2%) [30], as well as mortality-informed ('Maternal and Perinatal Death Review') targeting of services quality [27]. Furthermore, a recent systematic review study also suggested that capacity building of healthcare providers on clinical quality, clinical audits and feedback, financial incentives to beneficiaries, pay-for-performance, supportive supervision, community engagement, collaborative efforts and multidimensional interventions approaches help to improve maternal and newborn health services in South Asian countries [31].…”

Women’s education and coverage of skilled birth attendance: An assessment of Sustainable Development Goal 3.1 in the South and Southeast Asian Region

“…The scenario worsens with limited number of health care professionals work in remote and rural areas, which is particularly applicable for countries such as Afghanistan, Bangladesh, India and Pakistan [78][79][80]. These add to the extra travel cost to access SBA services, which again is cheaper through home delivery by a TBA [81,82].…”

Child Mortality and Morbidity Reduction: A Great Achievement for Bangladesh

“…9 The government has been working to remove the main bottlenecks affecting maternal, new-born and child health which are: poor health-seeking behavior and use of traditional birth attendants rather than trained midwives in health facilities for deliveries. 10 A number of misconceptions about harmful traditional practices are still prevalent as part of accepted cultural practice resulting in physical and psychological harm to the mother and child. Of particular concern is child marriage and practices associated during pregnancy and delivery including nutritional taboos.…”