Bangladesh has made significant strides towards meeting the Sustainable Development Goals (SDGs) by reducing maternal mortality. The Corona epidemic has given him a big push forward. Maternal mortality has increased, the rate of getting maternity services has decreased. Prof. Dr. Krishna Kumar, Senior Consultant, Department of Obstetrics and Gynecology, Bardem Hospital and President, Obstetric and Gynecological Society of Bangladesh (OGSB) spoke to Prothom Alo about the causes of increase in maternal mortality and ways to address this new challenge . Ferdousi Begum.
During the coronal period, experts repeatedly expressed fears that the treatment of maternity mothers would have serious side effects. One year and three months after the start of Corona, maternal mortality has risen by 16 percent, according to the Department of Health.
What is the cause of so many deaths ?
Ferdousi Begum: Not exactly feared, the idea was that maternal mortality would increase. Everything was completely closed in March-April at the beginning of Corona last year. The situation is almost the same until May. It has affected maternal health in two ways. One. Mothers did not come to take care. Two. The service providers could not provide the service. Suddenly no one understood what to do in such a situation. The corona was shifted to the hospital for medical treatment so that more caregivers would not have to stay together. But as the corona patient gets priority, the focus shifts away from maternal health. The situation was similar all over the world.
A mother has to go to the doctor at least four times after conceiving until the child is born. Although the World Health Organization has guidelines eight times. The four-time service rate was one-fourth lower in 2020 than the previous year. If taken as a number, one to two and a half lakhs. Mothers did not take the service or could not take? What happened?
Ferdousi Begum: It is most important to get services in the first phase after pregnancy. The doctors then gave the mother a plan for the entire pregnancy. The problem of each mother is identified by sifting like a sieve. However, even in normal times, mothers do not want to come four times. When I asked them, they said there was no problem, so I didn’t come. The importance of taking the service at least four times cannot be explained to them. It has happened in Corona. Besides, normal services have also been disrupted. Those who came to get the service did not get the service. The department was closed for five days as gynecologists at Mitford Hospital contracted covid. However, as much as is being said in the form of statistics, it may not be. Because, many mothers have taken tele-medicine services. These services did not come to statistics in the first few months of Corona. I came to know this from the information of ICDDRB recently.
- Coronal period has affected maternal health care in two ways. One. Mothers did not come to take care. The service providers could not provide the service.
- As the corona patient gets priority, the focus shifts away from maternal health.
- It is most important to get services in the first stage after pregnancy.
- The quality of hospitals has now declined. There are no right people in the right place.
It is argued that during the coronation period there was a lack of communication and the government paid more attention to coronary patients. There is no lockdown like last year. Fear has also decreased in people’s minds. But in the last one and a half years, last April, the highest maternal mortality was 226 people. Even during the difficult times of last year, maternal mortality was one-third of that per month. Now why are mothers being deprived of services?
Ferdousi Begum: It is very difficult to explain why maternal mortality is so high in April this year. It can be said that the second wave of Corona started at this time. There have also been many unplanned pregnancies during Corona. That too can have an effect. Because, unplanned pregnancies are accompanied by the addition of menstrual regularization or MR. Unsafe MR also leads to death. Even then, the issue of death in April needs to be discussed at the expert and policy-making level with utmost importance to find out the exact cause. Even in normal times there is a season of maternal mortality in the country, at which time the mortality is high. Maternal mortality is usually due to high seizures in winter. Again, after the harvest season, the village families are quite happy, spending leisure time. At that time unplanned pregnancies are more common. That is also the cause of maternal death.
There are two types of information in the country about the maternal mortality rate, there is also controversy. According to the Bangladesh Maternal Mortality and Health Services (BMMS) Survey 2018, the maternal mortality rate in the country is 198 per lakh live births. On the other hand, the Ministry of Health, the Department of Health and the Department of Family Planning claim that the rate is 162. According to the latest Bangladesh Bureau of Statistics (BBS) ‘Report on Bangladesh Sample: Vital Statistics 2019’, the rate is 175. Where is the source of the controversy?
Ferdousi Begum: I have been working in this sector for 35 years and I have seen the number of maternal deaths. From 2001 to 2010, the maternal mortality rate dropped from 322 to 194 per lakh live births. It’s a much bigger achievement. However, maternal mortality should be brought down to 20. Surveys are conducted in the same manner following certain statistics. The calculation for the 2016 survey was taken in 2014-15. I think maternal mortality will be less if we take into account the 2016-17. When the Maternal Mortality Survey was followed in 2001, three types of results were obtained using three methods. As a result, it was difficult for the government to accept BMMS’s 2016 survey.
In line with the Sustainable Development Goals, we need to reduce maternal mortality to 60 per million live births. How did this increased rate of coronation challenge it?
Ferdousi Begum: Corona has definitely left the challenge. As the world suffers from maternal mortality at this time, the SDGs may eventually lag behind the target. But you don’t have to sit for him. The challenge is to keep it in mind and how to get out of this situation, it is necessary to fix its action plan now.
An average of 22 lakh deliveries take place in the country every year. Half of it is at home. According to the Department of Family Planning, the other half is in various service centers. 15 percent of it is in government institutions, 85 percent in private institutions. If the whole data is compiled, will this rate be higher?
Ferdousi Begum: As far as I know, two-thirds of deliveries take place in private hospitals. Earlier, 100% maternal health services were provided in government hospitals. The quality of hospitals has now declined. There are no right people in the right place. The service provider is not enough compared to the service recipient. The manpower shortage is also huge. However, the number of deaths in private hospitals is low. So I don’t think the rate will change if the data of private hospitals is compiled. Usually poor and unaware people give birth at home. If there are complications, come to the hospital. They prefer government institutions.
Why can’t we encourage institutional delivery?
Ferdousi Begum: There is a propaganda that a caesarean section is done as soon as you go to the hospital. There is no alternative but to increase education and awareness to encourage institutional delivery by removing such thoughts. Hospitals also need to be able to provide adequate care to all mothers. The mother who comes to the service for the first time after the pregnancy should plan what kind of complications may occur at home or what preparation she needs in advance for delivery in the hospital.
Mother and baby health risks when giving birth at home. Now what kind of complications are more in the case of maternal mortality?
Ferdousi Begum: The risk of home delivery is much higher. Maternal mortality is more likely to be due to excessive bleeding and convulsions. According to a BMMS survey, 31 percent of maternal deaths in 2010 were due to bleeding. The rate was the same in 2016. Convulsions increased from 20 to 24 percent and monthly regularization (MR) stood at 1 to 6 percent. In case of delivery at the hospital, an injection is given to stop the bleeding before the uterus is removed. The placenta is properly removed. Bleeding occurs when the uterus relaxes. So the uterus is massaged so that the uterus does not become loose. These are done in hospitals. Many are brought to the hospital five to six hours after the complications of home delivery become serious. Then there is nothing to do.
Menstrual regularity (MR) or abortion is one of the issues in pregnancy services. Unsafe abortion also kills the mother. How to deal with it?
Ferdousi Begum: If you think your mother’s life may be in danger, there are government instructions to do MR before 12 weeks of pregnancy on the advice of a doctor. MR has also been used in the country for over a decade. It is estimated that there are 8-10 lakh MR in the country every year. Half of it is on the advice of doctors, the other half is unsafe. Unsafe MRs account for 6 percent of maternal deaths. According to the prescriptions of the doctors, there is talk of taking MR medicine but it is seen to be sold everywhere. Many mothers take it without consulting a doctor. DNC is required in 5% of MR cases. There is considerable health risk if not done in the hospital. Thirty percent of unplanned pregnancies occur in the country. That is why we emphasize on following proper birth control methods, especially long-term methods. Unplanned pregnancies occurred during corona. Many mothers say, ‘I am sitting, taking the child.’ There was also a shortage of birth control materials and services. We repeatedly told the government at the time,
What needs to be done to address the threat posed by public-private gains in reducing maternal mortality?
Ferdousi Begum: Coronation is still going on, but we are more cautious than before. I have understood how to give and take services from being careful. Corona will not go completely, it is necessary to continue the service by following the hygiene rules. In each case, they have seized it, despite obstacles we can scarcely imagine. “
Prothom Alo: Thank you.