238428 Barriers to Effective Emergency Obstetric Care in Bangladesh: Insights from Verbal Autopsy Data

Wednesday, November 2, 2011

Ízge Tunšalp, MD MPH , Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Michelle J. Hindin, PhD , Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Shams El Arifeen, Dr , Child Health Unit, Public Health Science Division, ICDDR,B, Dhaka, Bangladesh
Kim Streatfield, PhD , Health & Demographic Surveillance, ICDDR, B: Centre for Health and Population Research, Dhaka, Bangladesh
Cynthia Stanton , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Michael Koenig, PhD , Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Verbal autopsies represent an increasingly deployed approach for ascertaining causes of maternal death in developing countries. To date, they have been less utilized for understanding the familial and health service factors that contribute to such deaths. Using data from a nationally representative survey of women in Bangladesh (2001), this paper examines 186 case narratives. Among 186 maternal deaths, the most prominent causes of death were hemorrhage (n=54), and eclampsia (n=42), accounting for more than one-half of all the maternal deaths. The data reveal the importance of delays in obtaining treatment, as well as the serious constraints of access, quality, and costs of maternal health care. These issues likely influence many Bangladeshi couples' maternal health care decisions. The paper also illustrates the largely untapped potential of the verbal autopsy approach for elucidating the specific factors, which must be addressed, to reduce maternal mortality levels in low resource settings such as Bangladesh.

Learning Areas:
Public health or related research

Learning Objectives:
1) To identify the causes of maternal mortality in a nationally representative survey by using verbal autopsy methodology. 2) To analyze the delays and the familial and health sector factors contributing to these deaths. 3) To demonstrate the importance of access, quality and cost constraints in seeking and receiving care in a developing country setting.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because as a physician and a public health researcher I have worked on various research projects focusing on maternal morbidity and mortality in Sub-Saharan Africa and South East Asia.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.