Advancing People-Centered Maternal and Newborn Health Care through Birth Preparedness and Complication Readiness in Rural Bangladesh

Abstract

Background: 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).