The sexual and reproductive health care market in Bangladesh: where do poor women go?

Abstract

This article was published in the Reproductive Health Matters [ © 2011 Reproductive Health Matters. ] and the definite version is available at : http://dx.doi.org/10.1016/S0968-8080(11)37551-9 The Journal's website is at: http://www.rhm-elsevier.com/article/S0968-8080(11)37551-9/abstractIn Bangladesh, the formal public health system provides few services for common sexual and reproductive health problems such as white discharge, fistula, prolapse, menstrual problems, reproductive and urinary tract infections, and sexual problems. Recent research has found that poor women and men resort to informal providers for these problems instead. This paper draws on interviews with 303 providers and 312 women from two rural and one urban area of Bangladesh from July 2008 to January 2009. Both informal and formal markets played an important role in treating these problems, including for the poor, but the treatments were often unlikely to resolve the problems. Providers ranged from village doctors without formal training to qualified private practitioners. The health system is heavily marketised and boundaries between "public" and "private" are blurred. There exists a huge, neglected domain of sexual and reproductive health needs which are a source of silent suffering and for which there are no trained health staff providing treatment in government facilities. The complexity of this situation calls for engaged debate in Bangladesh on how to improve the quality of existing services, discourage or prevent obviously harmful practices, and develop financing mechanisms to enable women to access effective treatment, regardless of the source, for these neglected problems.Publishe

The informal health sector and health care-seeking behaviour of mothers in urban Dhaka slums

“…The role of informal medical markets and providers in the country continues to be neglected, yet recent empirical research reveals that poor women and men rely on informal providers for responding to a wide range of health problems. The spread of the informal sector has often been much faster than the capacity of the state and other key actors to establish regulatory arrangements to influence its performance (Rashid et al 2011). Its rapid growth has created both opportunities and challenges.…”

“…Traditional healers who were interviewed appeared to possess no ill-feeling towards other types of providers, and did not claim that medications or medical treatments administered by pharmacy owners, physicians or others were ineffective or detrimental. Indeed research has documented that some traditional healers are now including in their treatment practices medicines and pills purchased from pharmacies (Rashid et al 2011).…”

“…It has been reported that some 'doctors' who sit in pharmacy shops and charge a fee to see patients are not medically qualified. Such arrangements are viewed by both the pharmacy owner and the doctor as beneficial (Rashid et al 2011). However, financial incentives and profit margins mean that most pharmacists prefer to treat patients themselves, and while some do refer patients, they generally do so through informal relationships.…”

Sexual and reproductive health and rights in changing health systems

“…However, these need to be matched by improvements in quality of services. There is growing evidence from community groups working on the ground in a number of countries that weaknesses in the availability of beds and personnel combined with insufficient training in the face of growing demand leads to a number of questionable practices: women are discharged from the labour wards too soon after delivery; practices during delivery include routine episiotomies, application of excessive fundal pressure, unecessary oxytocin injections and other practices meant to speed up the delivery; unnecessary caesarean sections become the norm; and poorly trained personnel are unable to recognise or manage obstetric emergencies before it becomes too late to save the life of the woman (Chopra et al, 2009;Limwattananon et al, 2011;Oladapo, Daniel, & Olatunji, 2006;Rashid et al, 2011;Wahed, Moran, & Iqbal, 2010). This has led to a growing discussion in Latin America of the incidence of the phenomenon of so-called 'obstetric violence' as a characterisation of the serious quality failures that may result.…”

“…Snow et al (2014) documents persistent inequalities in access to SRHR causing harm especially to women in the lowest two wealth quintiles, with 'key services … in shockingly short supply'. Furthermore, indirect evidence on HIV-and abortion-related and maternal deaths of adolescents suggests widespread gaps in access to health care (Chopra, Daviaud, Pattinson, Fonn, & Lawn, 2009;Houweling, Ronsmans, Campbell, & Kunst, 2007;Rashid, Akram, & Standing, 2011;Tilahun, Mengistie, Egata, & Reda, 2012). Santhya and Jejeebhoy (2014) provide evidence on the persistence of inequalities and gaps in SRHR among adolescents, especially girls.…”