Maternal Health Inequity in Bangladesh - Research Paper Example

Running head: MATERNAL HEALTH INEQUITY IN BANGLADESH Name Course Institution Tutor Date Abstract Maternal health is a rampant problem for developing countries in the world today. The United Nations set millennium development goal five to cater for health issues in developing nations. Bangladesh is a developing country that is faced high poverty levels and inequalities. In such a situation, women and children are the most affected both socially and in terms of health matters. The inequality in social economic statuses of the majority poor in Bangladesh is translated to inequity in maternal healthcare for women. There have been several evidential surveys both quantitative and qualitative that have substantiated these claims. There have been several efforts both internally and externally that have been geared towards dealing with women health and their maternal issues. Bangladesh is a country where more than a third of the population live in impoverished poverty conditions. The World Health Organisation (2010) acknowledges that the country has poor parental health, poor nutrition, inadequate postpartum care, and maternal health access. As a result, it has the second highest maternal morbidity rates, close to sub-Saharan African countries. This puts many Bangladeshi women at risk of infections, disabilities and even death whenever they are pregnant, giving birth or during the postnatal period. In this review, literature regarding maternal health in the country from various sources will be studied and presence of pertinent issues will be evaluated. Introduction Maternal health has been one of the major health problems in the world especially in the third world developing nations. Poverty and inadequacy of resources have been cited as the main causes of this problem that has been prevailing for years in these countries. According to The United Nations through the World Health Organisation (WHO), (2010) a majority of women do not receive any kind of maternal healthcare expertise during pregnancy and labour in developing countries. The issue of maternal health inequity is so rampant in the world today that it was placed among the millennium development goals by the United Nations (Baum, 2008, p. 14). Though the situation has improved in many countries across the world, some nations still lag behind and many people especially women and children lose their lives annually as a result of maternal inequity (Walton & Schbley, 2013). Across the world, over 50 million women give birth without any medical or skilled assistance (WHO, 2012). A majority of these people are found in developing nations. It is estimated that the mortality rate in developing nations is fifteen times higher than in developed nations. This depicts the height of inequality between the two kinds of nations. Thus is the reason why improvement of maternal healthcare for women was placed at millennium development goal number five (MDG 5) (RajmoniSingha.2012, p. 55). Maternal healthcare in Bangladesh One such country affected by the problem of maternal inequity is Bangladesh. The country is located in the south Asia region and it borders Burma and India. It has a population of over 140 million people with a majority of them being Muslims. Being a developing nation, it has immense challenges in terms of poverty, health, economical and social problems. Its poverty level is at 33.3% with a similar number of the population being above the poverty line, the government in Bangladesh spends about 3.35% of its GDP on healthcare which is below the recommended amount of approximately 15%. The inadequacy of funds in the country places the vulnerable in society, especially women and children at high risks of infections and mortality. The United Nations development goal for 2015 is to provide quality maternal health for women by providing better quality life to facilitate this. By improving the Quality of life (QOL) for women in developing countries by empowering them economically, the United Nations aims at assisting them to facilitate their own maternal well beings (Hunt, Mesquita, 2013). In the strategy to achieve millennium development goal in maternal health, the Bangladesh government hopes to improve paternal access to postpartum programs that will enable women as well in reduction of postpartum morbidity and maternal complications. The problem in Bangladesh is faced in the world over in developing nations. The current status put Bangladesh women at the risk of postpartum complications, infections, haemorrhages, pelvic disorders among others. While it is largely recognised that there are cultural and religious barriers to the strategies, there is inadequate information to support its countering and thus complicating the situation even further. To deal with the inequities that are faced in the maternal health sector in this country, it is crucial to have an understanding of defined community needs and the medical positions that put them in risky situations in the first place. The perceptions that people have In terms of pregnancy, giving birth, religious beliefs, gender equality and treatment as well need to be understood, documented and critically evaluated to deal with the issue. According to Gill, Pande and Malhotra (2007, p. 3) provision of economic empowerment to women is the first step towards ensuring that they have empowerment which translates to their health requirements. Economic capabilities and independence leads to awareness in terms of social health, and nutritional requirements. The case is however different in Bangladesh and other developing countries where economic opportunities and capabilities are severely skewed and diminished among many women (Iyenger, 2012. P. 12). In addition to the poor economic status for women, there are cultural barriers that make the situation even direr. This is the case especially for those women that live in impoverished rural regions that are marginalised from development of urban areas in the country. The situation is aggravated by the limitedness of health facilities and the distances that women have to travel when they require obstetric services (Paul & Rumsey, 2002, p. 14). Apart from dealing with the health problems themselves, it may take longer for the situation to be alleviated as research into the needs and approaches that can work in Bangladesh are determined. The there are many issues that need tackling in order to make life bearable in Bangladesh and achieve millennium development goals. The health issue is paramount for everybody in the country. Women and children are the most vulnerable and affected by the maternal health inequity in Bangladesh. Methods In the study, several criteria have been used to induce discussions and view on the inequity of women in Bangladesh and the effect it has had on women maternal health. As mentioned earlier, the World Health Organisation through the United Nations has statistically shown the inequity and its causes in the country. Several researchers and experts have also put across studies to evaluate the differences in the Bangladeshi society and he effects it is having on maternal health in women. A systematic search for literature which supports the review was conducted with the period between 2000 and 2013. The information sought was in relevance to the keywords that were relevant to the study. The information sough used both qualitative and quantitative approaches in coming up with figures that support the inequity claim in Bangladesh. Further, the articles references that were used to create the source literature were also considered as sources of relevant information. The sources were additionally sourced fro m authentic databases that are accepted for academic research and are termed as credible. Government sources from the Bangladesh and relevant statistical bodies were also reviewed. The recurrences in literature and issues have been used to draw meaningful conclusions which have been used to substantiate the claim with tangible evidence. Literature search strategy Table Date Databases Keywords Wave 1 Wave 2 No selected Abstract Full 18/11/2013 Proquest Latrobe Maternal health inequity Bangladesh 15 Reviewed all 5 6 18/11/2013 Google scholar Maternal health in Bangladesh 37 Reviewed all 6 4 18/11/2013 Science direct Maternal health inequity in Bangladesh 5 18/11/2013 United Nations databases Maternal Health statistics in Bangladesh 4 Total 11 Abstract 19 Full Maternal Healthcare in Bangladesh and Gender Equity A review of literature and definitions from various medical sources define maternal mortally as death as a result of pregnancy, giving birth, or death after six weeks due to complications from child birth (Hogan, Foreman, & Naghavi, 2008, p. 2). Women living in Bangladesh who cannot access adequate maternal health are exposed to complications such as urinary inconsistencies, urinary tract infections (UTI) and preeclampsia. Over half of the women who get pregnant in the country are reported to experience these problems. This was according to a study that was carried out in 2001 where over 103,000 women were involved in a two stage sampling study (Koenig, Jamil, & Streatfield, 2007, p. 412). Inequality in Healthcare-use and Health in Rural Bangladesh The apparent problems facing those in the rural areas and slum areas of the country are however, not experienced by the wealthy and wealthier and well up Bangladeshis. Women care and postpartum care is mainly focused in urban areas where access to facilities is better and is also facilitated by better health facilities (Anwar, Sami, & Akhtar, 2008, p. 253 ). Unlike in the urban areas, skilled birth attendants and nurses are not available in rural Bangladesh and a majority of women have to give birth at home which further increases the risk of mortality both for mothers and children. The situation is especially dire for young mothers who have higher possibilities of experiencing complications. Mothers turn to untrained personnel and friends or family members to give maternal care and delivery which is most of the times inefficient and unsafe (Health and Medicine, 2013, p. 2373). Even the basic care from skilled personnel is sometimes not accessible for these women in rural areas hence increasing risk. The number of deaths occurring from maternal complications is higher in rural Bangladesh compared to urban areas. According to Li, Fortney, & Kotelchuck, (2006), more than 80% of maternal deaths are caused by infections which are closely related to hypertension, septic abortions, haemorrhages, and urinary complications and dysfunction. In a bid to curb this, education on basic maternal care in the country has been recommended as a certain way of reducing risks associated with pregnancies, birth and after birth disorders. Inequity in the Use of Maternal Health Services in Bangladesh: an analysis of equity gaps Studies in Bangladesh have continued to show the skewedness of distribution of economic facilities as well as health ones. The poor are the most affected with alarming rates being reported in early 2000 on the number of women that could adequately access maternal healthcare. With a rising population and heavy economic burdens, the Bangladeshi government is struggling heavily to provide health care not only for women but also for the entire population. This is facilitated by the large socio economic gap that exists between the rich and the poor in the country (Borghi, Ensor, Somanathan, Mills, 2006, p. 1458).. The Bangladesh Maternal Health Services conducted a survey in 2001 which showed that slightly more than 10% of all deliveries are done by qualified professionals. Only 8.8% of deliveries in the country take place in adequate health and obstetric facilities. The difference was especially huge when rural areas were compared to urban ones. Urban areas recorded a 26.8 % attendance to pregnant mothers compared to just 8.4% in rural areas. Further, only 3.4% of women in the poorest bracket had access to skilled professional in their delivery. As such the rich to poor indicator in this aspect was rated at 11.6 (Chowdhury, Ronsmans, Japhet , & Anwar, 2006, p. 328). The utilisation of maternal health facilities in Bangladesh is also low. The average at the national level is lower than that of the average poor person in the country. However, the situation has been improved by the provision of free maternal services to those who need them. The government in conjunction with international organisations have tried to reduce inequity in the country. The overall goal has not been achieved in relation to maternal healthcare (Chowdhury, Ronsmans, Japhet , & Anwar, 2006, p. 330) Despite the problems facing Bangladesh both economically and health wise, the country has made significant steps towards realising the health sanity and improving maternal health in the last decade. This has been evidenced by a reduction in maternal mortality ratio in the country which has dropped to 322 from 570 per 100,000 live births. However even with this reduction, more research and studies need to be carried out to enable further milestones to be achieved in the process. An empirical study from secondary information compared from 1993 to 2007 in a demographic and health survey in the country provides further insights to the inequities and improvements that have been made. The increase in access to antenatal care increased from 128% to 60% between the two years. However, a huge chunk of the increase was taken by the rich and those better placed economically in comparison to those in the poor socioeconomic quintiles. This is evidenced by the 31% to 84% ratio that exits in the increase between the two groups. This is further supported by figures which showed that 89% of births in rural Bangladesh occurred at home in 2007 compared to 69% in the rest of the country. Though there has been a decline in the number of births taking place at home, the rural urban gap between the two socioeconomic classes is apparent. The lowest socio economic quintile showed a decline of 2% in home deliveries between 2004 and 2007 compared to a reduction of 12% in the upper quintile in urban areas within the same period of study. Between 2004 and 2007, there was an increase from 36% to 46% in deliveries that were made by professionally qualified personnel. This was also marked by a lower increase in the poor urban areas compared to the rural areas. The reduction in mortality deaths was also slower in the poor quintiles compared to reductions in higher quintiles. Though the general health in maternal aspects is improving overall in Bangladesh, the gap between the poor and the rich is continuing to widen. The rate of improvement is more visible and practical in urban areas where people in the higher socioeconomic quintiles reside ( Sarker & Mridha, 2011, p. 85). The progress in the rural areas where the poorest quintiles are located is slow and can be even termed as insignificant. Therefore, if meaningful change in maternal health in the country is to be achieved, then a lot of restructuring in availing theses to the poor is necessary (Mushtaque, &Chowdhury, 2007, p. 1292). Universal healthcare in Bangladesh Apart from maternal healthcare, there are other competing health issues that make inequities in Bangladesh to widen. The provision of universal healthcare in the country is skewed as well (Pitchforth, Edwin, Graham, Fitzmaurice, 2007, p. 313). To support this claim, a study was carried out in comparison of two villages in the country. One village is located near the capital Dhaka,, is called Kashipur while the other is located in a remote area in Char Lata district. Representative samples from the two villages were taken and comparisons made in terms of universal health care. There were many emerging differences in the study and the power of the people in the two villages in terms of decision making on government health policy programs. There were clear inequalities between the two villages and access to universal health care. When such a situation exists in a community, women and children are at the highest risks of vulnerability and mortality (Joarder, Nahin, Uddin, & Islam, 2011, p. 84). The overall health indices include maternal health as well which was found to be unequal for the two villages. The reason for this is access to socioeconomic amenities that is highly unequal in the country. Proximity to the city makes one village to have a better economic status and hence healthcare compared to one that is in a remote area (Quayyum, Nasreen, Chowdhury, Ensor, 2013, p. 22) . Inequality in healthcare in Bangladesh extends beyond maternal health in women and the population as a whole (Rahman, Parkhurst, Normand, 2003, p.5). The government has invested substantially in the health sector in the country but the efforts are barely enough to sustain the ever-growing populations health often has to compete with other social amenities such as education, social services and economic needs. Apart from the government, there are numerous non profit making organisations spreads all over the country, especially in the rural areas. The aim of all these endeavours is to have an overall improvement of the health sector in the country. The priorities in health in the country are mainly in communicable diseases and women related health. However, as mentioned earlier, there is uneven distribution of the services among different economic strata that are found in the country. The social economic differences that are evident in the country have an apparent effect on women maternal health all over the country with the poor being the most affected by the situation. A survey was conducted in an area covering 120 villages with over 4000 households under scrutiny. The issues that were covered in the survey revolved around morbidity, child delivery, postnatal and antenatal care. The results were indexed from very bad to excellent as provided in the answers by the various participants there was a significant difference in the use and access to formal maternal care between the poor and the rich. A majority of the poor in the survey had bad ratings in terms of accessibility and problems faced during pregnancy, delivery and after giving birth. The survey also found out that social economic status in the country has a significant effect on access and use of healthcare facilities (Ahsan & Hamid, 2011, p. 86). There is socioeconomic inequality in Bangladesh that ultimately causes the huge difference in access to maternal care in the country (Streatfield, Arifeen, 2010, p. 2). Despite the numerous efforts to improve the situation in Bangladesh by providing home based skills in birth and maternal related issues, women in Bangladesh remain illiterate and held up by cultural barriers. The wealthier and elite in society are more educated and have a higher likelihood of accessing maternal healthcare that n the poor. Inadequacy of education and illiteracy hamper efforts of teaching locals about basic maternal healthcare. The odds have been placed at 2.9 in the possibility of an educated woman in Bangladesh to access healthcare than the uneducated ones. The same is replicated in healthcare issues such as caesarean sections where the ratio is at 2.6. In postnatal care the ratio is at 2.5. In an effort to reduce maternal mortality in the country, the government has focused on home based skills to help locals assist in basic care where professional care is unavailable or out of reach. The same programs are offered by some non governmental organisations at a small fee which is sometimes out of reach for those women in the poorest strata. The programs have necessitated training of some local women to become midwives to help in delivering children in order to avoid complications. This further shows the level of inequity in Bangladesh that such efforts have become necessary to facilitate the well being of the poor as well. The services sometimes do not reach the neediest as the birth attendants in the local villages are overstretched and receive meagre or no pay at all for their efforts (Doskoch, 2008, p. 98). Discussion Maternal health care is a critical issue for women not only in Bangladesh but in most poverty ridden developing nations. The numbers in Bangladesh are replicated all over in developing countries. Inequity is a huge problem and it derails any efforts put forward to deal with the situation. Inequity ids not just in maternal health but affects other health problems as well. The rural areas are the most affected by the situation due to lack of economic ability and illiteracy. Another major cause of the inequity is driven by gender imbalances that are evident in developing nations between men and women. Women are considered less equal to men in societies in Bangladesh and the situation is made worse by traditional beliefs, culture and religion. These have strict norms for women that further widen the inequity gap. As a result, women find it difficult to cater for their own maternal needs. When efforts to improve the conditions are made, the effect of inequity still shows clearly. More positive results are received in economically progressive areas as compared to poverty ridden areas where results are low or even negligible. Though there is evidence of improvement in maternal health and economic statuses of the poor, the demand for the services is overstretched and relevant authorities and stakeholders find it difficult to supply the much needed assistance in a conclusive manner. The rift in inequities between the rich the poor seem to be widening as time progresses. The inequities are not only related to maternal health but to universal health as well. Therefore, women in poor economic quintiles will have general poor universal health both personally and for those close to them. This is translated to poor maternal health as well. Hence the main the most pertinent issues in Bangladesh affecting inequity in maternal health are economic, cultural, religious, educational and geographical. Recommendations and further studies The solution to all these problems for women has been geared towards empowering them educationally and economically. When women are economically stable and independent, they take good healthcare of themselves and their children as well. Even though there have been efforts to deal with the problem, it is a case of treating the symptoms while the real issues persist. Dealing with inequality is the key to solving poverty issues in Bangladesh and other aspects such as health will eventually improve. Education is also a major factor that needs to be addressed in order to empower women to take roles in society that will help them deal with problems facing them collectively As mentioned earlier, there is no adequate statistical information to come up with conclusive national statistics of maternal health for women in Bangladesh. Accessible information for the same is based on specific studies that are concentrated on areas that are thought to be most vulnerable. This leaves a huge population unaccounted for in studies. Further research which is inclusive of larger samples is recommended so that the overall statistics in the country can provide a clearer picture which would guide strategic framework for reforms and their implementation Conclusion Women in Bangladesh are at high risk of experiencing maternal complications ether in the neonatal, during delivery and postnatal periods. This is because of the evident inequalities that exist between the poor in the lower economic quintiles and the well to do in the higher quintiles. Most inequalities are evident in the country from a rural and urban perspective. The services in the rural areas are evidently lacking though there have been efforts to improve the satiation. The overall effect is that inequalities are showing eve in the programs as maternal healthcare statistics show significant improvement in the higher quintiles than in the lower ones. Efforts to train locals in rural areas in home based care have had significant effects though the inequalities are still wide between the two economic strata. Apart from equity in terms of economic abilities, there are also the issues of gender equity that affect women health in the predominantly Muslim nation. Discrimination against women is also a factor that has been cited as a cause for their maternal health problems. Women are at times not allowed to access equal education opportunities even in instances where economic factors are favourable. This has in turn resulted to poor health generally other than in the maternal perspective. It has also been realised that those who cannot access appropriate maternal health cannot access healthcare for their children as well as their own in other related health issues. References Ahmed, T., & Jakaria, S, 2009, ‘Reproductive Health Matters’ ,Reproductive Health Matters,, vol. 17, no. 33, pp. 45-50. Ahsan, S, Hamid, S, 2011, Inequality in Healthcare-use and Health in Rural Bangladesh. ASCON, vol. 66, no. 272, pp. 86. Anwar, I., Sami, M., Akhtar, N., Chowdhury, M.E., Salma, U., Rahman, M. & Koblinsky, M. 2008, "Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh", World Health Organization.Bulletin of the World Health Organization, vol. 86, no. 4, pp. 252-9. Baum, F 2008, The New Public Health (3rd Edition), Oxford University Press, Melbourne Bishai, D., Suzuki, E., McQuestion, M., Chakraborty, J. & Koenig, M. 2002, "The role of public health programmes in reducing socioeconomic inequities in childhood immunization coverage", Health policy and planning, vol. 17, no. 4, pp. 412. Borghi, J., Ensor, T., Somanathan, A., Li, C., & Mills, A, 2006, ‘Mobilising financial resources for maternal health’, The Lancet, vol 368, no. 9545, pp. 1457-1465. Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, & Ronsmans C ,2007). Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. Lancet, vol. 370, no. 9595, pp. 1320-1328 Chowdhury, M. E., Ronsmans, C., Japhet , K., & Anwar, I., 2006, Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study. The Lancet, , 28 January–3 February vol. 36, no. 9507, pp. 327-332. Doskoch, P. 2008, "Inequities Remain in Use Of Maternal Health Care Services in Bangladesh", International Family Planning Perspectives, vol. 34, no. 2, pp. 98-99. Gill K, Pande R, & Malhotra, 2007, ‘Women delivery for development’,The Lancet, vol. 370, pp. 1347-1356. "Health and Medicine; New Findings on Health and Medicine Discussed by Researchers at University of Aberdeen", 2013, Health & Medicine Week, , pp. 2373. Islam MA, Chowdhury RI, Chakraborty N, 2004, ‘Factors associated with delivery complications in rural Bangladesh. European Journal of Contraception & Reproductive Health Care, vol. 9, no. 4, pp.203-213. Joarder, T., Nahin, S., Uddin, A., & Islam, A., 2011, ‘Achieving Universal Healthcare: State of Community Empowerment in Bangladesh. ASCON, vol 64 ,no. 157, pp.84. Hogan, M, Foreman, Naghavi, M, Ahn, S, Wang, M, Makela, S, Lopez, A, Lozano, R & Murray, C 2010, ‘Maternal mortality for 181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5’, THE LANCET, vol.375, no.9726, pp.1609-1623. Hunt, P & Mesquita, J.B (n.d), ‘REDUCING MATERNAL MORTALITY: The contribution of the right to the highest attainable standard of health, UNFPA, New York, viewed 18 November 2013 Mushtaque, A. & Chowdhury, R. 2007, "Rethinking interventions for women's health", The Lancet, vol. 370, no. 9595, pp. 1292-3. Paul BK & Rumsey DJ (2002). Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study. Sociology Scientific Medicine, 54, 1755-65. Pitchforth, E., Edwin, v.T., Graham, W. & Fitzmaurice, A. 2007, "Development of a proxy wealth index for women utilizing emergency obstetric care in Bangladesh", Health policy and planning, vol. 22, no. 5, pp. 311-9. Quayyum, Z., Khan, M.N.U., Quayyum, T., Nasreen, H.E., Chowdhury, M. & Ensor, T. 2013, ""Can community level interventions have an impact on equity and utilization of maternal health care" - Evidence from rural Bangladesh", International Journal for Equity in Health, vol. 12, no. 1, pp. 22. Rahman, S. A, Parkhurst, J & Normand, C 2003, ‘Maternal Health Review Bangladesh’, Health Systems Development Programme. RajmoniSingha. (2012). TARGET OF MDG TO DEVELOPMENT OF MATERNAL HEALTH IN BANGLADESH. BANGLADESH RESEARCH PUBLICATIONS JOURNAL, 7(4), 454-460,. Ryan, G & Bernard, H 2003, ‘Techniques to Identify Themes’, Field Methods, vol.15, no.1, pp.85-109. Sarker, B. K., & Mridha, M. K. 2011,' Inequity in the Use of Maternal Health Services in Bangladesh:A Barrier to Achieving Millennium Development Goal 5. ASCON,vol 65, no.181, pp. 85. Streatfield, P.K, El Arifeen, S 2010, ‘Bangladesh: Maternal Mortality and Health Care Survey 2010 Summary of Key Findings and Implications, pp.1-11, UNFPA. Walton, L. M., & Schbley , B.2013 Maternal Healthcare in Bangladesh and Gender Equity: A Review Article. Online J ournal of H ealth Ethics, 9(1). Retrieved from ,http://aquila. usm. edu/ojhe/ vol9/iss1/8 . WHO 2011, Bangladesh: health profile, viewed 18 November 2013 . WHO 2012, Trends in Maternal mortality: 1990-2010, WHO, UNICEF, UNFPA, The World Bank and UN Population Division, Maternal Mortality Estimation Inter-Agency Group,Bangladesh, viewed 18 November 2013 http://whqlibdoc.who.int/publications/2012/9789241503631_eng.pdf World Bank Report (2010). Poverty Assessment for Bangladesh: Creating opportunities and bridging the East-West Divide: Bangladesh Development Series No. 26. World Health Organization (2010). Improving Maternal, newborn and child health in the Southeast Asia Region: Focus on Bangladesh. World Health Organization (2010). World Health Statistics, http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf. Retrieved on September 30, 2012. Read More