Bangladesh Maternal Mortality and Health Care Survey 2010 Bangladesh Maternal Mortality and Health Care Survey 2010 National Institute of Population Research and Training (NIPORT) MEASURE Evaluation, UNC-CH, USA icddr,b Funded by: Government of the People’s Republic of Bangladesh US Agency for International Development (USAID), Bangladesh Australian Agency for International Development (AusAID) United Nations Population Fund (UNFPA), Bangladesh December 2012 MEASURE Evaluation is funded by the U.S. Agency for International Development (USAID) through cooperative agree- ment GPO-A-00-08-00003-00 and is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with Futures Group, ICF International, John Snow, Inc., Management Sciences for Health, and Tulane University. The opinions expressed are those of the authors and do not necessarily reflect the views of USAID or the U.S. government. TR-12-87 (December 2012). Data collection and data processing agencies: Associates for Community and Population Research (ACPR) 3/10 Block A, Lalmatia, Dhaka-1207, Bangladesh Mitra and Associates 2/17 Iqbal Road, Mohammadpur, Dhaka-1207, Bangladesh Special acknowledgement: Dr. Kanta Jamil, Monitoring and Evaluation Advisor, Office of Population, Health, Nutrition and Education, USAID, Bangladesh for technical assistance at all steps of survey implementation, data analysis, and report generation. Cover Photo: Courtesy of Photoshare SNL, Save the Children (USA) The 2010 Bangladesh Maternal Mortality and Health Care Survey is undertaken under the Line Director (Train- ing Research and Development) of the Health, Nutrition and Population Sector Program (HNPSP). The survey is funded by the Government of the People’s Republic of Bangladesh, USAID Bangladesh, AusAID, and UNFPA. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the Government of the People’s Republic of Bangladesh or other funding agencies. Additional information about the Bangladesh Maternal Mortality and Health Care Survey may be obtained from the National Institute of Population Research and Training (NIPORT), Azimpur, Dhaka-1205, Bangladesh. Suggested citation: National Institute of Population Research and Training (NIPORT), MEASURE Evaluation, and icddr,b. 2012. Bangladesh Maternal Mortality and Health Care Survey 2010. Dhaka, Bangladesh: NIPORT, MEASURE Evaluation, and icddr,b. CONTENTS SUMMARY OF KEY FINDINGS AND IMPLICATIONS ..............................................................................xix CHAPTER 1 INTRODUCTION 1.1 SAFE MOTHERHOOD InitiatiVES IN BANGLADESH ............................................................................3 1.1.1 Emergency Obstetric Care Programs/Interventions ..................................................................................3 1.1.2 Government of Bangladesh – UN Joint MNHI ..........................................................................................4 1.1.3 Demand Side Financing (DSF) Maternal Health Voucher Scheme .........................................................4 1.1.4 Community Skilled Birth Attendant (CSBA) Program .............................................................................4 1.2 ORGANIZATION of THE 2010 BMMS ...........................................................................................................5 1.2.1 Survey Objectives and Implementing Organizations ................................................................................5 Objectives ......................................................................................................................................................5 Implementation ............................................................................................................................................5 1.2.2 Survey Design ..................................................................................................................................................5 1.2.3 Questionnaires ................................................................................................................................................6 1.2.4 Training and Fieldwork ..................................................................................................................................7 1.2.5 Data Processing ...............................................................................................................................................7 1.2.6 Response Rate ..................................................................................................................................................7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 HOUSEHOLD Population ..........................................................................................................................11 2.1.1 Demographic Characteristics of Households............................................................................................11 2.1.2 Marital Status .................................................................................................................................................13 2.1.3 Household Composition ..............................................................................................................................14 2.1.4 Education .......................................................................................................................................................15 2.2 HOUSING Characteristics .......................................................................................................................18 2.2.1 Household Possessions .................................................................................................................................19 2.3 Characteristics of SURVEY Respondents ....................................................................................21 2.3.1 Background Characteristics ........................................................................................................................21 2.3.2 Educational Level of Survey Respondents .................................................................................................23 2.3.3 Exposure to Mass Media ..............................................................................................................................25 CHAPTER 3 ADULT FEMALE MORTALITY: LEVELS AND CAUSES 3.1 Measures of Maternal MORTALITY ...................................................................................................29 3.1.1 Measuring Maternal Mortality ....................................................................................................................29 3.1.2 Maternal Mortality Measures in the BMMS .............................................................................................30 3.2 Maternal MORTALITY IN BANGLADESH: LEVELS AND Causes .................................................32 3.2.1 Estimates from Household Deaths .............................................................................................................32 Contents iii Pregnancy-Related Mortality....................................................................................................................32 Maternal Mortality .....................................................................................................................................33 Maternal Mortality Ratios by Background Characteristics ..................................................................35 Maternal Deaths by Cause of Death ........................................................................................................37 3.2.2 Estimates of Pregnancy-Related Mortality from Sibling Histories ........................................................38 3.2.3 Distribution of Maternal Deaths by Timing Relative to Delivery ..........................................................38 3.2.4 Summary of Estimates of Pregnancy-Related and Maternal Mortality, 1996 to 2010 .........................40 3.3 OVerall Adult MORTALITY ......................................................................................................................40 3.3.1 Adult Mortality Estimates from Household Deaths .................................................................................40 Mortality Levels and Patterns ...................................................................................................................41 Causes of Non-maternal Deaths ..............................................................................................................42 3.3.2 Adult Mortality Estimates from Sibling Histories ....................................................................................46 Mortality Levels and Trends .....................................................................................................................46 CHAPTER 4 MATERNITY CARE 4.1 Antenatal CARE .............................................................................................................................................49 4.1.1 Source of Antenatal Care .............................................................................................................................50 4.1.2 Number and Initial Timing of Antenatal Care .........................................................................................52 4.1.3 Reasons for Not Seeking Antenatal Care ...................................................................................................53