Assignment | Maternal and Neonatal Mortality

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