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UTILIZATION OF POSTNATAL CARE SERVICES AMONG RURAL MOTHERS IN BANGLADESH

UTILIZATION OF POSTNATAL CARE SERVICES AMONG RURAL MOTHERS IN BANGLADESH. Forhana Rahman Noor Md. Moshiur Rahman COHEA 2012 Jakarta, Indonesia 12 December 2012. Introduction. Population : about 153 million Density: 1,099/sq km Per capita income - US$ 848

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UTILIZATION OF POSTNATAL CARE SERVICES AMONG RURAL MOTHERS IN BANGLADESH

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  1. UTILIZATION OF POSTNATAL CARE SERVICES AMONG RURAL MOTHERS IN BANGLADESH • ForhanaRahmanNoor • Md. MoshiurRahman • COHEA 2012 • Jakarta, Indonesia • 12 December 2012

  2. Introduction • Population: about 153 million • Density: 1,099/sq km • Per capita income - US$ 848 • Below the poverty line - 63 million (40%) • More than 80% people live in rural areas • MMR: 194/100,000 live births • Births attended by skilled person: 25% • CPR: 56% • Growth rate: 1.4 • TFR: 2.4 • Life expectancy at birth: 66.7

  3. Background • Globally, each year, more than 350,000 women die from pregnancy or delivery-related causes and the vast majority of these deaths occur in developing countries. • The burden of maternal complications and deaths is mainly highest in the first few days of delivery. • In Bangladesh, about 20 mothers are dying every day; most of them are dying right after delivery, which caused half of the maternal mortality in Bangladesh. • Thus, postnatal interventions can contribute to change the maternal mortality scenario significantly in Bangladesh. Source: BMMS 2010, BDHS 2007

  4. Objective • To explore prevalence and factors associated with non-utilization of postnatal care (PNC) services in rural Bangladesh.

  5. Methodology • The study used information from the baseline survey of a mult-country project called Output Based Aid (OBA), under Demand Side Financing (DSF) scheme for maternal health care services. • It was a cross-sectional survey of women 18-49 years of age who had delivered her child in the year preceding the survey. • Baseline survey was conducted during May-July 2010 to collect information on service utilization along with other indicators. • A total of 3300 women were interviewed using a structured questionnaire. • Non-utilization of postnatal care services is considered as the dependent variable. Some socio-demographic factors and some selected service related factors were considered as independent variables.

  6. Methodology • Both bi-variate and multivariate analysis were used to identify factors associated with non-utilization of postnatal care services. • For bi-variate analysis, chi-square test of association was performed to examine relationship between the dependent and each of the independent variables. • As a part of analysis, multi-co-linearity among independent variables was examined. • In the multivariate technique, binary logistic regression was used to examine strength of the relationship between the dependent and independent variables in order to identify those variables that have a significant relationship with the dependent variable.

  7. Result • More than 80 percent of women were aged below 30 years and 87 percent of them were Muslim. • Nearly all women were currently married and reported their occupation as housewife. The most common occupations of their husbands were agriculture, business, and day labor. • The educational status of women reflected that about one-fourth of the women never attended school and 14 percent of women completed primary education. • About four out of ten respondents’ educational status was below secondary and only seven percent respondents completed secondary or higher than secondary education. • Regarding exposure to mass media, four out of ten respondents watch television and only two percent read newspaper at least once a week

  8. Result • The average number of family members was about six. • The average number of living children was slightly higher than two and about 49 percent were male children. • Results revealed that about 72% of women received first, 54% second and 39% third ANC check-up either at a facility or at home. • Almost one third (28%) of total pregnant women did not seek any ANC services. • Findings suggest that home deliveries are still common in Bangladesh where only 20% of deliveries were conducted at health facilities. Among facility based deliveries, about half of the deliveries required caesarean.

  9. Result Background Characteristics of Respondents

  10. Utilization of postnatal care (PNC) • Only one-fifth of the respondents reported having a postnatal check-up during their last pregnancy. But half of them visited health facility and half received PNC check-up at their residence. Utilization of postnatal care by the respondent after their last pregnancy

  11. Bi-variate Results • Findings suggest that some socio-demographic factors (age, education, number of living children, wealth index and exposure to mass media) and some selected service related factors were strongly associated with non-utilization of postnatal care services.

  12. Bi-variate Results

  13. Bi-variate Results NB: *=p<0.05, **=p<0.01, ***=p<0.001

  14. Multivariate Results • Logistic regression analysis was used to examine the odds of non-utilization of postnatal care for each of the risk factors controlling for the others. • In the logistic regression model, four independent variables (antenatal check up, type of delivery, complication raised during delivery, and pregnancy intention) were identified as factors potentially associated with non-utilization of PNC.

  15. Multivariate Results

  16. Barriers of non-utilization of postnatal care • Women, who did not seek care for their health problems during postnatal period, were asked the reason why not. Their main reasons were not necessary to have postnatal care services facility followed by economic factor. Perceived barriers of non-utilization of postnatal care by the respondent

  17. Conclusion and Recommendations • In rural Bangladesh, lack of education and poverty are the main obstacles for seeking treatment. • Usually, mothers receive delivery or postnatal care services at health facilities when they face any life-threatening complications. • The study confirmed a highly significant associations between some services related factors of pregnancy and delivery healthcare and the utilization of postnatal care services.

  18. Conclusion and Recommendations • The finding suggests that a strong need to improve the access to maternal health care services which could increase community awareness about the importance of delivery at healthcare services. • This is an important message to health-policy makers. Also there is a dire need for promotional programs of maternal services which include postnatal care services like in the DSF scheme. • With the right types of interventions, maternal health-related MDG may not be very difficult to achieve.

  19. Thank You!

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