Fear of rise in maternal mortality looms large

The Covid-19 pandemic is undoing Bangladesh's achievements in maternal health – like in almost all other sectors, it seems.

Amid worries of contracting the virus during the 66-day lockdown period nationwide, pregnant mothers largely avoided hospitals, which resulted in a significant fall in the institutional delivery rate. Antenatal and postnatal care were also disturbed considerably.

Following the lifting of the lockdown, the institutional delivery rate has recovered but it is still low, which raises concern among experts about a possible increase in the maternal mortality rate.

Before the novel coronavirus broke out in the country, 50% of deliveries were performed at home but the rate rose to as high as 73% during the pandemic, said Abu Jamil Faisal, a public health expert and member of the Public Health Advisory Committee of Covid-19.

Institutional deliveries declined the most in April and May. In the following three months, the scenario changed positively but it will take a long time to return to the previous level of achievement in this sector, he also said.

Normal delivery, active management of the third stage of labour and C-sections – all forms of institutional delivery – were 15%-20% lower in April year-on-year, following the announcement of the lockdown on 26 March, 2020, according to latest research.

The rate, year-on-year, was 10-20% lower in May and 10%-15% lower in June and July, read the analysis titled "Trends in Maternal Health Services in Bangladesh Before, During and After Covid-19 Lockdowns."

However, institutional deliveries did not decline that abruptly in March 2020, it also said.

Population Council, a non-governmental organisation, conducted the research to find out how the lockdown had impacted maternal health in the country.

"The decrease in institutional deliveries will have an impact on maternal mortality. In the case of home births, we see increased postpartum haemorrhages and eclampsia, thanks to the absence of proper antenatal care at home," said Abu Jamil Faisal.

The mark of recovery in the institutional delivery situation is based on Dhaka only but problems still lie in the areas outside the capital, he maintained.

"Now, undertaking local-level plans in association with local-level health providers is required to return to the previous state of achievement. If we plan it from Dhaka, it will not work," he warned.

The maternal mortality ratio in Bangladesh is 196 per 100,000 live births, according to the Bangladesh Maternal Mortality and Health Care Survey 2016 conducted by National Institute of Population Research and Training (NIPORT) and icddr,b.

Haemorrhages and eclampsia account for 54% of all maternal deaths in Bangladesh, the survey reveals.

Noted gynaecologist professor Rowshan Ara told The Business Standard home births are a major reason for maternal mortality.

"Giving birth at home can cause: haemorrhages, eclampsia, interrupted delivery, fistula, infant death, postpartum complications, etc. We have received many such cases due to limited delivery facilities at home during the lockdown."

Now, the situation has improved a bit. But the maternal mortality rate is assumed to have risen slightly. However, Directorate General of Health Services (DGHS) have not released any figures on it yet, she added.

Dr Md Shamsul Haque, line director of DGHS' Maternal Neonatal Child and Adolescent Health, said, during the lockdown, mothers did not come to hospitals and hospital services were also disrupted.

"However, later, we trained all the health workers – including doctors, nurses and midwives – online. They also provided antenatal care to patients over mobile phones," he also said.

Now deliveries in hospitals have increased even though they are lower year-on-year. And, the maternal mortality incidents have reduced compared to the number during the lockdown period, he claimed.

"Although we did not conduct any survey during this time, many mothers might have died because of home birth. Now, the situation has changed and we hope maternal mortalities will not increase," added Shamsul Haque.