Bangladesh, recognized as having one of the most successful family planning programs in the developing world(CPR 54%), continues to have high maternal mortality (4.5-8.5 deaths/thousand live births). Only 5% of women with pregnancy complications present to medical facilities. To address unmet need for Emergency Obstetric Care(EOC) services, CARE-Bangladesh implemented a project to assess the effectiveness of a community mobilization intervention to increase EOC service utilization.
The project, working in rural areas for two years, addresses the “3 delays” to emergency obstetric care (delay in seeking care; delay in reaching facilities; delay in receiving competent care). Project components include: promotion of birth planning, establishment of community support systems, improvement of health service quality(QOC).
The utilization rate of EOC services in the intervention area increased from 14% to 39.5% (compared to control of 4-18%). Knowledge of pregnancy danger signs is 63% among women, 39% among husbands, and 55% among other decision-makers in the intervention area. In comparison, baseline and non-intervention areas knowledge was close to 0%. Fifty percent of families in the intervention area have made plans to prepare for an obstetric emergency (savings and transportation), double the percentage in the comparison areas. Almost 45% of families in the intervention areas reported having access to the community support system(CSS) versus the non-intervention area where no families reported access. Specific improvement of QOC, (improved cleanliness, privacy, security, inter-personal communication), was observed.
These approaches were found effective in increasing EOC service utilization and in creating a supportive community environment to resolve maternal health problems.
Learning Objectives: List reasons for maternal mortality in Bangladesh. Discuss components of a community-based response and implications for replicating project success.
Keywords: Access to Care, Maternal Health
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