Impact of health behaviour on maternal health in Bangladesh

Content

INTRODUCTION

MATERNAL HEALTH

HEALTH BEHAVIOUR

Education and Freedom

Poverty

Income and social class

Occupation

Culture

Religion

Access and Utilisation of Maternal Health in Bangladesh

GOVERNMENT INTERVENTIONS

CONCLUSION

REFERENCES

INTRODUCTION

The essay will talk about maternal health and health behaviour in Bangladesh. It will also critically explore the actual fact in Bangladesh, how maternal health is influenced by their health behaviour based on social, cultural and religious framework. Moreover, it will also highlight governmental strategy for improving maternal health what will be outstanding achievement of “Millennium Development Goal (MDG) 5” in Bangladesh.

Maternal health is the prime concern of public health in Bangladesh. After that, Bangladesh is highly motivated for achieving “Millennium Development Goal (MDG) 5” for improving maternal health and reducing maternal mortality rate by 75% between the period of 1990 and 2015. However, Bangladesh government is working hard with partnership organisations for achieving MDG goal, while Bangladesh is on track for fulfilling target of MDG 4 and 5 (UN, 2013). Bangladesh government are promoting safe maternity practice and reducing maternal mortality. Already, government has been expanded and promoted existing health services implementing with new policy and services performing EOC (essential obstetric care) services accessible to all women particularly pregnant mothers and adolescent (Anwar et al., 2004)

Moreover, Bangladesh is highly populated developing country in the world with a maternal mortality ratio of 170/100,000 live births (WHO, 2015). Particularly, prenatal and postnatal care is very poor in Bangladesh because of malnutrition. Maximum pregnant mothers are not literate and living with poverty so they are in greater risk during their pregnancy and child birth (BBS, 2013). Walton, Brown and Schbley (2012) stated that in Bangladesh, maternal mortality and morbidity rate is the second highest in the world. There are several influential factors for instances: indigenous health behaviour and traditional lifestyle are remarkable based on social, cultural and religious belief. In Bangladesh, around 20,000 mothers are dying each year during pregnancy period, while 69% (obstetric causes), 14% (injury and violence) and rest 17% deaths indirect causes (Ministry of Health and Family Welfare (MOHFW), 2008).

Almost 99% maternal deaths occur in developing countries, whereas higher than half of the deaths are occurring in sub-Saharan Africa and rest one third occur in South Asia, while rare in developed countries (WHO, 2015). In 2013, maternal mortality ratio was 230 per 100 000 live births in developing countries, while only 16 per 100 000 live births in developed countries. Moreover, the probable number of maternal mortality is only 1 in 3700 in developed countries, while 1 in 160 in developing countries. In 2013, total 289000 women died during their pregnancy period in the world, while almost 800 women are dying only for simple complications during their pregnancy and child birth periods (WHO, 2015).

Royal College of Nursing (2002) stated that determinants of health are the cumulative conditions where people born, grow up, live and work what include accommodation, education, economic status and living environment and health system, while these is variable changed by social and political circumstance.

Moreover, World Health Organisation (WHO, 2015) defined that determinants of health generally depends on particular circumstances include: social and economic status, physical status, and person’s individual status (behaviours and characteristics). However, individual’s health is absolutely depends on the following factors: Income, education, occupation, social class, gender, race or ethnicity, culture, and religion what play substantial effects on maternal health (Solar and Irwin, 2007).

MATERNAL HEALTH

According to World Health Organisation (WHO) (2014) defined that maternal health is the women’s health condition during their whole pregnancy cycle (prenatal, childbirth and postnatal period). Maternal health of any particular country is measured by several parameters for instances: nutritional status (BMI-body mass index), epidemiological report like maternal mortality and morbidity rate and prenatal and postpartum care, contraceptive prevalence rate (CPR), coverage of tetanus toxoid (TT) vaccination, percentage of live bath.

Moreover, maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. In Bangladesh, in minor cases women experience better in their maternity though maximum women are suffering, ill-health and even death. The major direct causes of maternal morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour (WHO, 2008).

In addition, in Bangladesh leading cause of maternal mortality is obstetric what leads about 69% maternal death (MOHFW, 2008). Graham et al. (2008) claimed that a woman could be died due to direct or indirect obstetric cause over than 41 days but below one year after pregnancy termination, while direct pregnancy-related death could be defined as: death of women during pregnancy period or termination of pregnancy (not more than 42 days) or other causes is called direct pregnancy death.

In Bangladesh, rural areas due to cultural and religious barrier and lack of education rural women and particularly in slum areas women are accessing maternal health care service as result maternal health situation still in questionable! Most common causes of maternal mortality include postpartum haemorrhage, eclampsia. In addition, domestic violence is also remarkable factors of maternal mortality. In addition, demotic violence (including physical abuse, deprived food, education, care, mental torture) is the remarkable reason what leads about 14% maternal deaths during their pregnancy period(MOHFW, 2015). According to Bangladesh Bureau of statistics (BBS) (2013) reported that in rural Bangladesh, about 22.4% women are victims of physical tortures (beatings), 27% mental torture and rest 34% of verbal abuse where particular young women are more vulnerable under this violence.

Bangladesh is the second highest maternal mortality rate in the world. However, Bangladesh recently, attained considerable improvement of maternal health and reduced maternal mortality rate by expanding promotional health program achieving MDG 5.

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Basically two targets have to fulfil for achieving MDG 5 for instance: reduction of maternal mortality rate by 75% between 1990 and 2015 and accomplishment of universal reproductive health access by 2015 what about to reach (figure 1 and table 1). After implementing government new initiation for achieving MDG 5, maternal mortality rate substantially reduced in 2013 what was 170 per 100 000 live births. In 2001, Maternal Mortality Ratio (MMR) was about 320 per 100 000 live births, while 1990 rate was 570/100,000 live births what almost 44% reduction. Though, that period maximum maternal death occurred at home and Neonatal mortality rate (NMR) was also high as 37 per 1000 live births in 2007 (WHO, 2015).

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Maternal morbidity is also unacceptable like mortality ratio. Actual rate of morbidity data is impossible as limited number of data is available from Bangladesh demographic health survey. However, mortality and nutritional status is high among women rather than men so it predictable as morbidity rate is also high.

In Bangladesh, girls are more prone affecting iron deficiency anaemia (IDA). Particularly, in rural areas women are more susceptible as the prevalence of IDA about 50 to 90% of pregnant women where 13% women are higher risk making complications during their last pregnancy period (Moran et al., 2009). Moreover, the remarkable complications were abdominal pain (about 25.31%), inflammation of leg or some part of the body (23.33%), IDA (19.94%), urine infections (16.76%), eclampsia (1.99%) and haemorrhage (3.51%). One is every 21 mothers’ life is in risk during their pregnancy period (UNICEF, 2009).

Rahman, Parkhurst and Normand (2003) reported that in Bangladesh, about four million women conceive baby yearly but among them about 600,000 women are predictable facing complications during their pregnancy life. About 9 million women developed permanent complications during their pregnancy for instances: fistulae, inability to control urination and painful intercourse what excluded from their family and husband (MOHFW 2008). During pregnancy complications only 21.9% received medical care. Kamal (2012) stated that about 48% women did not receive any medical care during their bleeding. Maximum cases women did not take any care where 61% oedema, 56% vomiting, 35% fever and 19% for high blood pressure. It proved that, in Bangladesh maternal outcomes was so poor, while women were facing complications but they did not seek any care due to their traditional thought and health behaviour.

In addition, according to report only 7.9% child was born in hospital and 5% delivery complications sought out under medical care (Rahman, Parkhurst and Normand, 2003). NIPORT (2001) also reported that only few number of mothers access maternal care through their whole maternity cycle (figure 2).

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