Eighty-nine percent expectant mothers living in Sunamganj district have to have their deliveries at home with the help of traditional birth attendants due to the existing social barriers to get access to skilled healthcare at hospitals, according to a new study.
The study found that the level of awareness of maternal and child health issues and utilisation of skilled care was very low in Sunamganj while the overall knowledge of danger signs associated with pregnancy and childbirth was also found to be low as less than half of the study respondents received information on birth preparedness.
A baseline study, led by Bidhan Krishna Sarker at icddr,b’s Centre for Reproductive Health, was carried out recently in Sunamganj under Sylhet Division considering the economic, social and cultural factors that prevent women from access to quality maternal and neonatal care.
The Sylhet division has shown the least amount of improvement in recent years in both maternal and child health. Maternal mortality in this region is very high -- 425 deaths per 100,000 live births, compared to the national average of 194. Similarly, infant and under-five child mortality are 67 and 83 per 1,000 live births, compared to a national average of 45 and 56, respectively.
Sunamganj district is one of its remotest areas with very poor communication linkages with the rest of the country.
The study reveals that about two-thirds of the women did not receive any postpartum care, a period that begins immediately after the birth of a child and extending for about six weeks. In case of complications during or after birth, more than half of the women responded that they consulted a village doctor, rather than a trained physician.
However, lack of access to skilled healthcare was not the main reason for using traditional birth attendants and village doctors. The unskilled healthcare providers are much less expensive and do not require travel, and they also tend to be well known to the community and viewed as a trusted resource, the study says.
On the other hand, perceptions of poor quality of treatment and of poor communication at government hospitals and private clinics discourage villagers from using these more formal health services.
The study also found that many families have religious objections to taking pregnant women to hospitals for delivery as it is considered a ‘sin’ and violates the modesty of a pregnant woman to be treated by strangers, especially men.
Women also lack decision-making power when it comes to their pregnancy and health care options.
These decisions are usually deferred to the husband or mother-in-law who often opt for traditional healthcare providers such as birth attendants and village doctors.
Aiming to address these multiple barriers to quality care, the researchers of the study recommend introduction of a community-based skilled birth attendant programme; training of existing traditional
birth attendants and village doctors to recognise danger signs for both the mother and child and to make timely referrals; and development of strong referral collaboration between the range of providers.
