The Acceptability, Effectiveness and Cost of Strategies Designed to Improve Access to Basic Obstetric Care in Rural Bangladesh

 Funded by: USAID

The government of Bangladesh is committed to the success of ESP, which ranks safe motherhood high in its reproductive health component priorities. In Bangladesh, over 90% of deliveries are still taking place at home without any skilled assistance. Accordingly, the government has adopted a strategy to train existing paramedics to ensure basic obstetric care to the majority of women. However, the scope of work and minimum skills required of these paramedics have not been clearly defined, nor has a policy been formulated as to whether these paramedics should conduct deliveries at home or in a health facility to reach the majority of women.

Using a variety of quantitative and qualitative methods, this study aims to evaluate the acceptability, effectiveness and cost of home and facility-based strategies to ensure access to basic obstetric care at the community level. The study is being conducted in Matlab and includes the following components:

a)    The effectiveness of different delivery strategies will be assessed by describing their uptake in different annual periods between 1987 and 2001 in the MCH-FP area.

b)   The impact of different delivery strategies on met need for obstetric care and on perinatal, neonatal and maternal mortality will be assessed in a cohort of women who gave birth between 1987 and 2001 in the MCH/FP area.

c)   The acceptability of services will be assessed using a variety of qualitative methods including interviews with key informants, health providers (midwives and traditional birth attendants) and users and non-users of basic obstetric care offered by trained midwives, as well as through observations.

d)   The cost of services will be determined through record reviews, interviews with providers and observations of births.

e)   The validation of the link between processes of care and perinatal, maternal and neonatal mortality will be assessed in a cohort of women who gave birth between 1976 and 2001 in the MCH/FP and Comparison areas of Matlab.