Advancing People-Centered Maternal and Newborn Health Care through Birth Preparedness and Complication Readiness in Rural Bangladesh
Keywords:People-centered care, maternal health, newborn health, birth preparedness and complication readiness, male involvement, community participation.
AbstractBackground: In Bangladesh, women and newborns continue to face elevated risks around the time of pregnancy, birth and postpartum. Applying a people-centered approach to maternal and newborn (MNH) services is a priority in such contexts to increase appropriate use of services and improve the health of women and newborns. In 2009, Enfants du Monde and PARI Development Trust began supporting the Ministry of Health at local level to implement birth preparedness and complication readiness (BPCR) for improving MNH in Netrokona district, Bangladesh. Objective: To assess the contribution of the BPCR intervention in advancing people-centered MNH care in Netrokona district, Bangladesh. Methods:We conducted 15 in-depth interviews (IDIs), one focus group discussion (FGD) and four group discussions with different stakeholders. In addition, a household survey was conducted with 725 women (intervention n=444, control n=281) and 317 of their husbands (intervention n=178, control n=139) at baseline and with 737 women (intervention n=442, control n=295) and 732 husbands at endline.Results: The BPCR intervention was co-designed through a consultative process with national and local stakeholders, ensuring the reflection of local context. Training health care providers to improve their counseling skills allowed them to apply effective BPCR counseling during ANC visits and be responsive to women’s situations and individual needs. In addition, discussion on BPCR in households and courtyard meetings provoked families’ and communities’ engagement in MNH. Consequently. there was significant increase across most indicators related to BPCR practice among women and husbands’ involvement between baseline and endline.Discussion: The BPCR intervention was successful in advancing people-centered MNH care by empowering women and increasing the engagement of men, families and communities in MNH care. Our study findings are coherent with the findings of studies conducted in similar settings. Conclusions: Carefully co-designed BPCR interventions should be further expanded within Bangladesh and beyond in order to advance people-centered care and progress toward the Sustainable Development Goals (SDGs).
WHO. Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization,, 2015.
NIPORT, Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh, and Rockville, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and ICF International, 2016. .
WHO. People-Centered Health Care: A Policy Framework 2007. Geneva: World Health Organization, 2014.
Mezzich JE, Snaedal J, Van Weel C, Heath I. Toward person‐centered medicine: from disease to patient to person. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2010;77(3):304-6.
United Nations Development Programme. Sustainable Development Goals 2017 [updated 2017; cited 2017 27 June ]. Available from: http://www.undp.org/content/undp/en/home/sustainable-development-goals.html.
WHO. WHO global strategy on people-centred and integrated health services: interim report. Geneva: World Health Organization, 2015.
Haque MA, Dash SK, Chowdhury MAB. Maternal health care seeking behavior: the case of Haor (wetland) in Bangladesh. BMC public health. 2016;16(1):592.
Ahmed R, Hassan S. Hard-to-Reach Areas: Providing Water Supply and Sanitation Services to All. 2012.
Development Wheel. Final Report on Essential Services of Haor Areas and Way Forward [updated 2017; cited 2017 July 17]. Available from: http://dewbd.org/dew/index.php/publications/reports.
Bangladesh Bureau of Statistics. District Statistics 2011 Netrokona.
WHO. Working with individuals, families and communities to improve maternal and newborn health. Geneva: World Health Organization, 2010.
WHO. WHO recommendations on health promotion interventions for maternal and newborn health. Geneva: World Health Organization, 2015.
Miltenburg AS, Roggeveen Y, Shields L, van Elteren M, van Roosmalen J, Stekelenburg J, et al. Impact of birth preparedness and complication readiness interventions on birth with a skilled attendant: a systematic review. PloS one. 2015;10(11):e0143382.
Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, et al. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reproductive Health. 2016;13(1):79.
Sheferaw ED, Bazant E, Gibson H, Fenta HB, Ayalew F, Belay TB, et al. Respectful maternity care in Ethiopian public health facilities. Reproductive Health. 2017;14(1):60.
Warren CE, Njue R, Ndwiga C, Abuya T. Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions. BMC Pregnancy and Childbirth. 2017;17(1):102.
Ishola F, Owolabi O, Filippi V. Disrespect and abuse of women during childbirth in Nigeria: A systematic review. PloS one. 2017;12(3):e0174084.
Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Medicine. 2015;12(6):e1001847.
Molina RL, Patel SJ, Scott J, Schantz-Dunn J, Nour NM. Striving for Respectful Maternity Care Everywhere. Maternal and Child Health Journal. 2016;20(9):1769-73.
McMahon SA, George AS, Chebet JJ, Mosha IH, Mpembeni RN, Winch PJ. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy and Childbirth. 2014;14(1):268.
The White Ribbon Alliance. Respectful Maternity Care 2013 [updated 2013; cited 2017 7 July]. Available from: http://whiteribbonalliance.org/campaigns2/respectful-maternity-care/.
Pasha O, Goldenberg RL, McClure EM, Saleem S, Goudar SS, Althabe F, et al. Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial). BMC Pregnancy and Childbirth. 2010;10(1):82.
Midhet F, Becker S. Impact of community-based interventions on maternal and neonatal health indicators: Results from a community randomized trial in rural Balochistan, Pakistan. Reproductive Health. 2010;7(1):30.
Mullany BC, Becker S, Hindin M. The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial. Health Education Research. 2006;22(2):166-76.
Nyandieka LN, Njeru MK, Ng’ang’a Z, Echoka E, Kombe Y. Male involvement in maternal health planning key to utilization of skilled birth services in Malindi subcounty, Kenya. Advances in Public Health. 2016;2016.
Chhabra S. Birth Preparedness and Complications Readiness for Safe Birth, Safe Womanhood and Safe Childhood. Women’s Health. 2016;1(4):555568.
Mukhopadhyay DK, Mukhopadhyay S, Bhattacharjee S, Nayak S, Biswas AK, Biswas AB. Status of birth preparedness and complication readiness in Uttar Dinajpur District, West Bengal. Indian Journal of Public Health. 2013;57(3):147.