Assignment | Maternal and Neonatal Mortality

I have already prepare the assignment but it needs more work to do. 5 pages with single space excluding appendixes

Name: Syed Rahman
Professor: Caroline Kuo
Course: THE IMPRINT OF TIME, SPACE AND PLACE IN OUR
BODIES: UNDERSTANDING HEALTH DISPARITIES
Date: 20/08/2019
Title: Why Maternal and Newborn Health Disparities in Bangladesh?

Introduction
The maternal and neonatal mortality rate is very high in Bangladesh. There is a high
health disparity rate observed in maternal in Bangladesh. According to the 2019 statistics, the
current population of Bangladesh is 160.9 million, in which the maternal mortality rate is 176
deaths per 100,000 live births and the neonatal mortality rate is 23 deaths per 1000 live births , as
estimated by UNICEF and WHO. The leading issues which have been observed to increase the
maternal mortality rates are reduced access to healthcare facilities and services, infection and
sepsis, premature or still births, trauma, undiagnosed medical complications and pregnancy
complications. The issues which increase the neonatal mortality rates, which can cause
increased health complications in mothers, leading to increase in the maternal mortality rate
include still or premature births, congenital anomalies, birth asphyxia, sepsis and more.
Statistics further suggested that out of 8600 babies born every day, 2904 babies die before
finishing their first month. This has been observed to mainly occur due to the high pregnancy
rate of young women falling in the age range of 18-24 years, majority of which have poor access
to healthcare facilities as well as lack awareness on different significant medical concerns related
to pregnancy, due to their socio-economic status and geographical location.
Health Disparities in a Demographic Context
Health Disparities between the Regions
Even though several measures have been taken to solve public health concerns, health
disparities can still be observed across the different geographical regions within Bangladesh. The
lack of adequate studies and researches on the health disparities based on the geographical
regions of Bangladesh, limits the development of effective health policies, future studies and
planning and management of the issue. A high health disparity among maternal and neonatal
population of Bangladesh, varying from region to region has been observed. Studies have shown
that the effective adoption of strategies for the improvement of maternal and neonatal health is
lowest in Sylhet and highest in Rangpur and Khulna. According to the paper by Anwar et al.
2015, the regions which are statistically found to be economically stable, employed better
maternal and neonatal healthcare management strategies and in turn exhibited lower mortality
rates. According to Islam et al, 2015, the regions with increased mortality rates employed
ineffective healthcare policies, which in turn led to the poor quality of healthcare services and
also poor management of issues concerning pregnancy and the health of child and mother. It was
mainly observed that the government healthcare facilities lacked the proper implementation of
the medical procedures as well as hygiene, leading to several cases of contraction of nosocomial
infections by the newborns and the mothers. Thus, resulting in the increase of the mortality rates
of newborns and mothers.
Health Disparities between Rich and Poor
Studies highlighted the difference in the healthcare services provided by government and
private healthcare facilities in Bangladesh. In Bangladesh, the healthcare system heavily relies on

the public sectors for the financing the healthcare facilities especially delivery settings, post-
operative care services and nursing homes. The private facilities, having improved healthcare
facilities and trained professionals for successful deliveries and proper management of any
pregnancy complications, were found to be highly expensive for the poor or middle-class
population of Bangladesh. The standard and affordable treatment provided in the public
healthcare setting, that is, government services lack the effective implementation of health
hygiene strategies as well as trained professionals to help in the delivery process. Thus, as
mentioned by Pickett and Wilkinson, 2015, there is a great existing health disparity between the
rich and the poor. Even though the private healthcare facilities have been proven to be more
efficient, when compared to the readily available government services, the entire healthcare
system of the country suffers from the lack of healthcare policies which can help in keeping a
check on the quality and standard of services provided. Thus as suggested by Truesdale and
Jencks, 2016, health disparity between the rich and the poor in the context of the mortality rate of
maternal and newborn is very high.
Health Disparities between the Urban and the Rural
The health disparities between urban and rural areas are evident. The quality of
healthcare provided in the rural area is lower in standards in comparison to the urban areas. The
technology and machinery available in the urban areas are not frequently available in the rural
area. As mentioned by Darkwa et al., 2015, there are many reasons, which lead to the health
disparities between urban and rural areas. For example, doctors and nurses are reluctant to work
in rural areas. Thus, leading to the shortage of trained professionals and staffs, resulting in the
availability of low standard of treatment in healthcare facilities. The healthcare settings in rural
areas fail to provide treatment for chronic diseases and terminal diseases. One of the main
limiting factors is the lack of literacy among the rural population, which facilitate the influence
of wrong beliefs regarding pregnancies, and also in many cases prevent them to visit healthcare
facilities for proper guidance during their trimesters. This often results in the lack of proper
nutrition of both the mothers and the newborns, as well as prevents the detection of underlying
health issues, which later cause complications in the pregnancy. Their lack of knowledge even
limits them form visiting healthcare facilities during the time of delivery. Thus, in such areas, an
increased dependency on the midwives for birth can be observed, who are comparatively
inefficient and undertrained when compared to the healthcare professionals in the hospitals.
Thus, this further increases the chance of an increase in the mortality rates of mothers and
newborns. As suggested by Uddin et al., 2016, the vaccination coverage in rural areas is low, due
to their lack of awareness of its importance, despite the availability of free vaccinations, making
the newborns vulnerable to diseases like mumps, and hepatitis.
Reasons for Maternal and Neonatal health disparities in Bangladesh
There are many reasons, which contributed to the health disparities among maternal and
newborn care in Bangladesh, including the difference in healthcare policies of different states of
Bangladesh. However, these can also include broader issues like the unequal distribution of
resources, especially in the healthcare sector, among the different socio-economic groups of the
country’s population. In the context of different regions of Bangladesh, as noted by Khan et al.,
2017, inconsistencies among the fund allocated by the individual state governments for their

healthcare services, add to the overall issue of healthcare disparity in Bangladesh. During
delivery and after delivery, both mother and newborn are vulnerable towards the infection or
other diseases. The mother is frail after delivery and needs high-quality care and proper rests.
Thus, states allocating high resources for their healthcare sector have been estimated to exhibit
higher quality of maternal and newborn medical care. For example in Khulna and Rangpur the
recorded usage of modern treatment facilities in cases of assistance during pregnancies was high,
compared to regions like Sylhet and Chittagong, leading to reduction in the mortality rates of
newborns and mothers compared to the latter. In the context of rural areas, health literacy is very
poor among the rural population. As mentioned by Das et al., 2017, people in rural areas, due to
the lack of literacy, fail to understand the significance of primary treatment provided to them.
Thus, the lack of health literacy in the rural population has been seen to be one of the major
limiting factors in respect to the improvement in the implementation of healthcare services in
Bangladesh. The poor health literacy put the life of maternal and newborn at risk. Studies have
shown that rural mothers often tend to neglect attending follow-ups after their delivery or birth of
their child, and even attending regular health check-ups during their pregnancy. This is mainly
due to their lack of knowledge on the significance of the modern treatment procedures
concerning pregnancy and child birth. They have been found to prefer undergoing their delivery
procedure at their homes with the help of undertrained midwives instead of going to the hospital.
Most of the time, fear of surgery at the time of delivery in hospital settings prevent rural mothers
to prefer delivery in a hospital setting. Although nowadays government-certified midwives are
available, yet delivery, which has complications when attempted at home, can risk the lives of
the mother and the child as basic CPR equipment is lacking in childbirth at home. In the context
of socio-economic disparities, most of the poor people are dependent on the government
hospitals for the treatment despite the severity of the condition of mother or newborn. The sub-
standard treatment available at the government hospitals increases complications during or after
child birth, leading to the increase in the maternal and neonatal mortality rates. The separation
from mother to newborn increases the vulnerability of newborn towards the infections at the
hospital wards in and in turn raising the possibility of increase the mortality rate.
Milestones to Eliminate Health Disparities
Insured Accessibility and Health Equality among Rich and Poor, and Urban and Rural
Despite the several achievements in the aspect of health disparities in Bangladesh, in
recent times, the prevalence of contradictory conditions is alarming. Contradicting conditions
like home births remain predominant, in accordance to statistics only 25% of the women opted
for healthcare facilities for their deliveries between 2008 to 2011 (Olsen & Clausen, 2012). The
Lancet, Bangladesh series, highlighted the ‘Bangladesh paradox’, which showed a pattern of co-
existence of improved health outcomes alongside the unequal distribution of resources within the
different socio-economic groups of the country’s population. The lack of education and
awareness among the female population of the rural areas in Bangladesh facilitates the
employment of traditional and ineffective medical services and under trained practitioners like
midwives (Werner, 2019). According to the Bangladesh Demographic and Health Survey 2014,
highlighted that the estimated statistics of delivery by trained professionals have surged from
16% in 2004 to 42 % in 2014 (Bangladesh Demographic And Health Survey, 2014). However,
still a greater portion of the population fail to seek help and guidance from trained professionals
and proper healthcare facilities causing a hike in the occurrence of pregnancy related deaths of

women in the country. About 5000 pregnancy related deaths of women, 76000 neonatal deaths
and more than 80 stillbirths have been estimated to take place each year mainly in the rural areas
of Bangladesh, ranking the country in the list of top ten nations with highest mortality rates. The
healthcare issues and mortality rates were mainly noted to be high in the rural population of the
country, with low socio-economic status. Thus, to help solve the increase in the healthcare
discrepancies between the rural and the urban population with different socio-economic statuses,
the government of Bangladesh has initiated the Microcredit project. This movement, with the
association of the World Bank, was developed to help in providing extension of microloans to
the poverty stricken population of Bangladesh, who lack collateral or steady employment. This
movement thus, helped in breaking many barriers to public services like government healthcare
facilities as well as accessibility of modern medicines and treatments, to the socio-economically
disadvantaged population. The movement’s focus on microcredit and micro insurance helped the
rural population seek medical help or guidance from trained professionals and increased their
access to basic healthcare services. Thus, this government initiative has also helped in reducing
issues like nutrition related mortalities in infants, and discrepancies in post-pregnancy care,
improving the overall health of the mother and infant population, by decreasing the gap between
the availability of resources in the different socio-economic groups.
Insured that, Symmetries of Medical Equipment, Doctors and Nurses among the Region
Bangladesh is one of those countries facing healthcare crisis. There is an acute shortage
of healthcare professionals noticed in this country which made it challenging and difficult for the
country to access and ensure healthcare of a population of about 150 million (Iqbal, Hanifi,
Wahed & Bhuiya, 2010). Health disparities between different social groups were identified as a
result of inequalities among these groups in terms of region, geography, culture, ethnicity,
gender, education, rich poor and other related aspects. Studies have suggested that health
inequalities are progressively increasing due to certain factors like socioeconomic status,
resources, geographical area (Karim, Tripura, Gani & Chowdhury, 2006). It is evident that
doctors and nurses are very reluctant and unwilling to visit the rural and remote regions. There is
also a lack of equipment and resources required in the healthcare setting of rural areas. There is
an increasing need for the nurses and doctors to encourage them for working in those settings by
either offering them good salaries or incentives and prevent health disparities between different
social groups by assisting them with the needs and proper treatment through different approaches
including supplying the resources and installing technologies such as Electronic Heath Records
(HER) to promote and improve the quality of the healthcare system in such areas (Gnanlet et al.,
2019).
Insured to Practices and Law-Enforcement of Medical Malpractice among the Region
Medical Malpractice can cause a huge trouble to human health and even lead to death.
Medical malpractices are the most common cause of death in individuals. Every healthcare
professionals must maintain their professional, moral and legal responsibility towards their
patients and must maintain the highest standards of professional conduct by aligning with the
regulations, standards and considering ethical issues. Introduction of laws and regulation is
therefore essential in order to prevent medical misconduct or medical malpractice. It has been
reported in a study that due to absenteeism of such effective law in countries like Bangladesh,
the situation in this regard has seen to be deteriorating progressively with time. Thus, there is an
urgent requirement of introducing such laws and bringing them into effect. Sometimes,

allegations are made by the family or relatives against the doctors reporting medial error such as
prescribing wrong medicines or wrong dose of medicines, poor equipment or resource
unavailability, unable to follow up the patient of maternal unit in emergency situations and other
related mistakes, being the cause of death of the patients. Medical negligence laws are enacted
with the aim to protect the patients from such medical errors that can have detrimental effect on
their health and to impose penalty and punishment for the healthcare professionals violating the
laws while doing their professional duty (Akter, 2013).
Conclusion
The paper concludes that, despite the reduced maternal and neonatal mortality rate of
Bangladesh, several incidences like increased dependence on under trained midwives, instances
of medical malpractice in hospitals, as well as reluctance of professionals to work in rural
settings as well as the lack of awareness of rural people about the importance of assistance of
proper delivery systems, is still prevalent in the country. The paper also highlights that
Bangladesh has been actively implementing methods like microcredit and micro insurance,
training midwives and providing other healthcare resources to help reduce the health disparities
based on socio-economic and geographical locations.

References
Akter, K. (2015). A Contextual Analysis of the Medical Negligence in Bangladesh: Laws and
Practices. Northern University Journal Of Law, 4, 67-81. doi: 10.3329/nujl.v4i0.25942
Anwar, Iqbal, et al. "Trends and inequities in use of maternal health care services in Bangladesh,
1991-2011." PloS one10.3 (2015): e0120309.
Bangladesh Demographic and Health Survey. (2014). Bangladesh Demographic And Health
Survey 2014. Retrieved 12 August 2019, from
https://dhsprogram.com/pubs/pdf/FR311/FR311.pdf
Darkwa, Emmanuel Kwame, et al. "A qualitative study of factors influencing retention of
doctors and nurses at rural healthcare facilities in Bangladesh." BMC health services
research 15.1 (2015): 344.
Das, Susmita, et al. "Health literacy in a community with low levels of education: findings from
Chakaria, a rural area of Bangladesh." BMC public health 17.1 (2017): 203.
Gnanlet, A., Choi, M., & Davoudpour, S. (2019). Impediments to the Implementation of
Healthcare Information Technology: A Systematic Literature Review. Journal of Supply
Chain and Operations Management, 17(1), 136.
Islam, Farzana, et al. "Perceptions of health care providers and patients on quality of care in
maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a
mixed-method study." BMC health services research 15.1 (2015): 237.
Karim, F., Tripura, A., Gani, M., & Chowdhury, A. (2006). Poverty status and health equity:
Evidence from rural Bangladesh. Public Health, 120(3), 193-205. doi:
10.1016/j.puhe.2005.08.016
Khan, Jahangir AM, Sayem Ahmed, and Timothy G. Evans. "Catastrophic healthcare
expenditure and poverty related to out-of-pocket payments for healthcare in Bangladesh
—an estimation of financial risk protection of universal health coverage." Health policy
and planning 32.8 (2017): 1102-1110.
Lane, Haylee, et al. "Equity in healthcare resource allocation decision making: a systematic
review." Social Science & Medicine 175 (2017): 11-27.
Mahmood, S., Iqbal, M., Hanifi, S., Wahed, T., & Bhuiya, A. (2010). Are 'Village Doctors' in
Bangladesh a curse or a blessing?. BMC International Health And Human Rights, 10(1).
doi: 10.1186/1472-698x-10-18
Olsen, O., & Clausen, J. (2012). Planned hospital birth versus planned home birth. Cochrane
Database Of Systematic Reviews. doi: 10.1002/14651858.cd000352.pub2
Pickett, Kate E., and Richard G. Wilkinson. "Income inequality and health: a causal
review." Social science & medicine 128 (2015): 316-326.

Truesdale, Beth C., and Christopher Jencks. "The health effects of income inequality: averages
and disparities." Annual Review of Public Health 37 (2016): 413-430.
Uddin, Md Jasim, et al. "Use of mobile phones for improving vaccination coverage among
children living in rural hard-to-reach areas and urban streets of
Bangladesh." Vaccine 34.2 (2016): 276-283.
UNICEF DATA, Bangladesh (BGD) - Demographics, Health & Infant Mortality - UNICEF
DATA, 2019, viewed on 28 July 2019 <https://data.unicef.org/country/bgd/>
Werner, W. (2019). Micro-insurance in Bangladesh: Risk Protection for the Poor?. Retrieved 12
August 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928102/
World Health Organization, Success Factors for Women’s and Children’s Health, 2019, viewed
on 28 July 2019
<https://www.who.int/pmnch/knowledge/publications/bangladesh_country_report.pdf>