Reaching poor mothers with quality maternal health care: Bangladesh experience

The maternal mortality ratio is comparatively high in Bangladesh. Though it has declined from more than 600 in 1980 to 322 in 2004, it is still one of the highest in the world. Studies suggest that utilization of ANC and PNC can reduce maternal mortality or morbidity significantly. However, the utilization of maternity care provided by trained professionals during and after delivery is alarmingly low in Bangladesh. Several special programs have been introduced to provide subsidized health care services to the poor people in Bangladesh. Financial assistance to poor women to avail pregnancy related services has been tested in this operations research project. The overall objective of the study is to test the feasibility and effectiveness of voucher scheme for poor rural women to improve utilization of ANC, delivery and PNC from trained service providers. A quasi-experimental pretest – posttest design has been utilized. The duration of intervention was 9 months. During the intervention period, 674 pregnant poor women received vouchers from the project staff. A total 436 women were interviewed before and after the intervention to evaluate the impact of intervention. In-depth interviews were conducted with voucher users and non-users. Findings suggest that institutional deliveries have increased from 2.5 percent to 20 percent in three months. Utilization of antenatal care from trained providers has increased from 50 percent to 72 percent. Similarly, number of women attending postnatal care services also has increased from 36 percent to 59 percent.