Socioeconomic determinants of maternal and newborn health in Netrakona district, Bangladesh

Despite notable progress since 1990, Bangladesh still suffers some of the highest rates of maternal and neonatal mortality in the world. Actions have been taken at various levels of the health system to address risks faced by mothers and newborns; however, many of the factors that make motherhood precarious lie outside the reach of health services. In order to guide maternal and newborn health (MNH) programming, Ministry of Health, PARI, Enfants du Monde and other actors conducted a situation analysis followed by a baseline study in Netrakona district, a disadvantaged region located near the Himalayan border. These analyses, utilizing quantitative data gathered through surveys and qualitative data gathered during focus group discussions and semi-structured interviews with community members, healthcare providers and community decision makers, successfully identified many socioeconomic factors contributing to poor MNH. Notably, girls often marry early due to economic necessity of the family, with the consequence of early childbearing. Low status restricts women's decision making ability and they are often reliant on their husbands, generally uninformed as to maternal issues, to make the decisions related to pregnancy, birth and the postpartum period. Additionally, women's low status dictates that they eat after the men and only what is left, leading to nutritional deficiencies during pregnancy. A precarious economic situation frequently prevents women from being able to afford transportation and health services for routine or emergency care. These findings suggest that poverty reduction efforts and actions that raise the status of women are crucial to improving MNH in Netrakona district.