Maternal mortality and access to basic and emergency obstetric care in rural Bangladesh

Greet Dieltiens, Institute of Tropical Medicine
Carine Ronsmans, London School of Hygiene and Tropical Medicine

Progress in safe motherhood has been hampered by the lack of rigorous evidence on the effectiveness of different safe motherhood strategies. Maternal mortality and morbidity are notoriously difficult to measure and most investigations into the success of safe motherhood programmes have relied on the use of process indicators, even though the links between processes of care and levels of maternal mortality have not been firmly established. This paper examines the link between maternal mortality and various process indicators using unique data from a large 25-year cohort in a rural area in Bangladesh covered by an extensive safe motherhood programme. Through linking processes of care and maternal mortality we also gain novel insights into the role of skilled attendance at delivery and access to emergency obstetric care in the decline in maternal mortality. A novel low-cost and easy-to-use indicator for assessing the met need for life-saving obstetric surgery was also included.