Bangladesh Maternal Mortality and Health

Care Survey 2016: Summary

Background

In Bangladesh, the fourth Health, Population, and Nutrition Sector

Programme (4th HPNSP) for 2017-2022 aims at a maternal
mortality ratio (MMR) target of 121 per 100,000 live births by 2022.
The 2016 Bangladesh Maternal Mortality and Health Care Survey
(BMMS 2016) assesses the recent progress in maternal health and
establishes the baseline for HPNSP and Sustainable Development
Goals (SDGs).

Between BMMS 2001 and BMMS 2010, MMR declined

significantly: from 322 to 194 maternal deaths per 100,000 live
births. This was remarkable progress, linked to fertility reduction;
increased access to maternal health care; increased use of maternal
health services in the antenatal, delivery, and postpartum periods;
and socioeconomic improvements.

Key Findings of BMMS 2016

MMR has stalle d between 201 0 and 2016, although
Bangladeshi wome n are increasingly se e king mate rnal care
from health facilities.
• The MMR in Bangladesh declined between 2001 and 2010 but
has now stalled. The MMR estimate from the BMMS 2016 is
196 maternal deaths per 100,000 live births, almost identical to
the estimate of BMMS 2010.
• In 2016, 50 percent of births were attended by medically trained
personnel, compared to 27 percent in 2010. This increase is
driven by rapid rise in facility births. The percentage of births in
health facilities increased from 23 percent in BMMS 2010 to 47
percent in BMMS 2016. Medically-trained attendance for home
deliveries has consistently been around three to four percent
during 2001-2016.
• The private sector accounted for most of the increase in facility
deliveries. Between BMMS 2010 and 2016, the percentage
of deliveries in private facilities jumped from 11 percent to 29
percent, while deliveries in public facilities increased from 10
percent to 14 percent. In the public sector, 13 percent (out of
14 percent) of the births take place in upazila and higher-level
facilities. NGO facilities now account for 4 percent of births, up
from 2 percent in BMMS 2010.
• Delivery by C-section increased dramatically, from 12 percent
in 2010 to 31 percent in 2016. In private facilities, C-sections
accounted for 83 percent of deliveries, compared to 35 percent
in public facilities and 39 percent in facilities run by NGOs.
• The percentage of women receiving the complete continuum of
maternity care (antenatal care, delivery care, and postnatal care
from medically trained providers) has increased significantly
from five percent in 2001, to 19 percent in 2010, and to 43
percent in 2016.
• Seeking facility-based care for reported maternal complications
has increased from 29 percent to 46 percent between 2010 and
2016.
• It had been assumed that increased utilization of health facilities
for maternal health care would further lower the MMR. But
MMR appears to have stalled between BMMS 2010 and
BMMS 2016.
Stalling of MMR: Possible Explanations
Bangladesh is not the only country that has experienced
increased utilization of maternal services with no impact
on MMR.
• There is international precedence for a stall in MMR decline in
low- and middle-income countries, even with increased care in
facilities.
• An analysis of 37 countries in sub-Saharan Africa (SSA) and
South and Southeast Asia (SSEA) found a weak association
between the MMR and the percentage of deliveries occurring in
a health facility.
• These data suggest that increasing facility delivery is important
but not sufficient to lower MMR
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