Fact Sheet: Bangladesh Bangladesh is located in Southern Asia, bordering the Bay of Bengal between Burma and India. With an estimated 156 million people, it is one of the world’s most populous countries. Bangladesh suffers the highest incidence of poverty in South Asia, where nearly half the population is living below the poverty line. And largely as a result of that, its maternal health rates had been among the worst in the world. According to a study released in 2010, Bangladesh was one of eleven countries that, when combined, were responsible for approximately 65% of maternal deaths around the world.i However the most recent government survey released in February 2011 shows a dramatic drop in maternal mortality rates, putting the country on target to meet the 2015 deadline of UN Millennium Development Goal 5. The main issues that continue to confront Bangladesh are the lack of health care workers, and that even where skilled attendants ARE available the population often does not utilize them due to a combination of awareness, education and cultural concerns.

Historically, Bangladesh has faced high rates of maternal mortality but has recently made great strides in reducing those rates

■ Bangladesh has reduced maternal mortality by 40% over the last nine years.ii ■ Bangladesh’s maternal mortality ratio is estimated at 194 per 100,000 live births,

dropping from 322 per 100,000 in 2001.iii ■ Bangladesh needs to further reduce maternal mortality by 25% in order to meet the

2015 MDG 5.iv ■ In a 1999-2000 survey addressing obstacles to accessing care, it was found that 80%

of women felt there was no adequate healthcare facility nearby, 50% mentioned a lack of confidence in the service and problems with accessing services and 70% could not meet the financial requirements for treatment.v

■ The main causes of maternal mortality in Bangladesh arevi: 1) Bleeding and post-partum hemorrhage (29%)1, 2) Eclampsia (24%), 3) Obstructed labor (10%), and 4) Abortion (5%)

1 The recent survey shows a 25% reduction in deaths from bleeding and post-partum hemorrhage and a 50% reduction in eclampsia related deaths.

The population of Bangladesh is large and young and childbearing typically begins at a young age

■ In 2000, about 50% of women were married by the time they were 15 years old, and in 2003 the average age at first marriage was 16.vii

■ The majority of women have had a child by the age of 19, and in 2003 the average age at first birth was 18.viii

Bangladesh is facing a severe health care worker shortage ■ In 2001 less than 18% of births were attended by medically trained personnel.ix ■ In 2010 only 23% of births took place at a health care facility.x ■ The lack of skilled providers at health clinics explain over 60% of deaths during

childbirth and 40% of post-partum hemorrhage death. xi ■ 80% of maternal deaths occur at home.xii

Childbirth rates are in decline ■ The government of Bangladesh is strongly dedicated to family planning and instituted a

national comprehensive family planning agenda. ■ The total fertility rate declined from 3.3 births per woman in 2001 to the current 2010

rate of 2.5, a decline of 22%.xiii ■ The contraceptive use rate increased among married women from less that 10% to

more than 50%.xiv ■ Only 15% of married women report and unmet need for family planning.xv

The challenges of maternal health differ for Bangladesh’s urban and rural populations

■ Urban areas contain about 15% of the population but 35% of doctors and 30% of nurses.xvi

■ Rural women bear on average one more child than their urban counterparts. ■ In 2007, 36% of women living in urban areas had a skilled provider present during

childbirth compared to only 13% of women living in rural areas.xvii

Educating girls makes a difference ■ The 2010 Maternal Health Care survey found that the increase in female education rate

and reduction in child marriage were main contributors to the reduction of the maternal morality rate.xviii

■ In Bangladesh, women with eight or more years of education had a maternal death rate nearly three times lower than women without any formal education.xix

■ Women with secondary and higher education are 13 times more likely to use medically trained personnel for delivery than women with no education.xx

■ In 2001 the government started offering free education for girls up to the 12th grade Girls' enrolment in secondary schools jumped from 1.1 million in 1991 to 3.9 million in 2005.xxi

■ 2010 survey showed the percent of women with minimum secondary education who use health care facilities for pregnancy related complications rose from 17% in 2001 to 52%.xxii

i World Health Organization, et al. Trends in Maternal Mortality 1990-2008. http://www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/index.html iiBRAC. Dramatic Fall in Maternal Mortality in Bangladesh. Feb 13 2011. http://www.brac.net/node/832 iii Ibid. iv Hasib NI. Maternal Deaths Drop Sharply. Bdnews24. Feb 13 2011. http://bdnews24.com/details.php?id=187182&cid=13 v The Department of Family and Community Health. Bangladesh and Family Planning: An Overview. World Health Organization, Regional Office for South-East Asia. vi Bangladesh Maternal Health Service and Maternal Mortality Survey (BMMS) 2001. National Institute of Population Research and Training, ORC Macro, Johns Hopkins University, Dhaka, December 2003. vii The Department of Family and Community Health. Bangladesh and Family Planning: An Overview. World Health Organization, Regional Office for South-East Asia. viii Ibid. ix Ahmed, T. & Jakaria, S.M. (2009) Community-based skilled birth attendant in Bangladesh: attending deliveries at home. Reproductive Health Matters; 17(33): 45-50 x Hasib NI. Maternal Deaths Drop Sharply. Bdnews24. Feb 13 2011. http://bdnews24.com/details.php?id=187182&cid=13 xi Chaudhury, R.H., (2008). Multi-sectoral determinants of maternal mortality in Bangladesh. United Nations Economic and Social Commission for Asia and the Pacific. Presented at Workshop on Addressing Multi-Sectoral Determinants of Maternal Mortality in the ESCAP region. 1-13. xii World Health Organization Bangaldesh. Skilled Birth Attendants Information. http://www.whoban.org/skill_birth_training.html xiii Hasib NI. Maternal Deaths Drop Sharply. Bdnews24. Feb 13 2011. http://bdnews24.com/details.php?id=187182&cid=13 xiv The Department of Family and Community Health. Bangladesh and Family Planning: An Overview. World Health Organization, Regional Office for South-East Asia. xv Ibid. xviDussalt G. et al. Not enough here, too many there: understanding the geographic imbalances in the distribution of the health workforce. Human Resources for Health. 2006(4:12) xviiWorld Health Organization. Bangladesh Country Profile. Department of Making Pregnancy Safer. http://www.who.int/making_pregnancy_safer/countries/ban.pdf xviii Staff Correspondent. Maternal Mortality Rates Down. The Daily Starr, 14 Feb 2011 xix Chaudhury, R.H., (2008). Multi-sectoral determinants of maternal mortality in Bangladesh. United Nations Economic and Social Commission for Asia and the Pacific. Presented at Workshop on Addressing Multi-Sectoral Determinants of Maternal Mortality in the ESCAP region. 1-13. xx Ibid. xxi Integrated Regional Information Networks (IRIN). Bangladesh: Educating Girls lowers maternal death rate. 11 June 2010. http://www.unhcr.org/refworld/country,,,,BGD,,4c15ef0ec,0.html xxii Hasib NI. Maternal Deaths Drop Sharply. Bdnews24. Feb 13 2011. http://bdnews24.com/details.php?id=187182&cid=13