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Ensuring better antenatal and post natal care

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Dr. A.M.M. Anisul Awwal, PhD :
Bangladesh has already been identified by all the global economic forums as one of the most rapidly growing economy of the world. Within a short span of 10 years of time, the country has shown tremendous economic growth, and thus, has become a lower middle income county.
Geographically the country is smaller in comparison to many neighboring countries like India and China. But the most significant issue is that the country harbors more than 160 million people in such a smaller reverie land which indicates that the country is the most densely populated country of the world. Here, we have not considered the city countries like Hong Kong and Singapore.
The development of Bangladesh has already become a wonder for many countries of the world and everyone is eager to know the secret strategy of such a quick economic growth and overall development. Starting from education sector to ICT to Health  - all the sectors and sub-sectors are developing keeping a close synchronization with each other so that no imbalance can occur to de-stabilize the sustainability of the developmental pace.         
If we consider the indices of health, nutrition and population, these (indices) will definitely depict appreciable improvement over the past few years. It is now not a wonder to us (but may be for many other countries) that in health sector, with the expansion of service delivery systems up to village levels, millions of valuable lives are being saved every year. Achievement of EPI program, vitamin A administration, ORS and other public health programs and policies brought a revolution in the country which has become a role model for many developing countries.  
There are so many issues (sectors and sub-sectors) that we can concentrate to write with the view to let others know our basic status on that particular issue. Here, in this article, I will try to show some of the important aspects of maternal health and care during pregnancy.
Appropriate care during pregnancy and childbirth are important both for mother and her baby. In the 2014 Bangladesh Demographic and Health Survey (BDHS), women who had given birth in the five years preceding the survey were asked a number of questions about maternal and child health care, and many of the issues are based on the findings of the survey.
Anti natal care (ANC) from a medically trained provider is important to monitor the status of pregnancy and identify the complications associated with it. To be most effective, there should be regular (at least 04 visits) ANC throughout pregnancy. Findings show that more than 70 percent of women with a birth in the three years preceding the survey received ANC at least once from any provider. Majority of the women received care from a medically trained provider, (doctor, nurse, midwife, family welfare visitor, community skilled birth attendant, medical assistant or sub-assistant community medical officer). Comparable data from 2004, 2007 and 2011 BDHS show that while ANC from any provider has increased by 25 percent over the past few years, ANC from a medically trained provider during the same period has increased by more than 10 percent.
The urban-rural differential in antenatal care coverage continues to be large: more than 80 percent of urban women receive antenatal care from a trained provider, compared with only about 55 percent of rural women. ANC from a medically trained provider increases with the mother's education level and wealth status. Coverage of ANC from a trained provider increases from about 30 percent for mothers with no education to about 90 percent for mothers who have completed secondary school.
Findings also show that significant percent of births in Bangladesh are delivered at a health facility. Delivery in NGO facilities are only 2 percent. Delivery in a health facility is considerably lower for women age 35 years or older compared to those who are younger. Facility delivery decreases sharply as birth order increases. On the other hand, the number of women's ANC visits, education level and wealth status have a positive relationship with health facility. The proportion of births delivered at health facilities has been increasing rapidly since 2004, from 12 percent in 2004, 17 percent in 2007, 29 percent in 2011 to more than 35 percent in 2014. Increase since the past four years is mostly due to a sharp increase in delivery at private facilities and a less significant increase in deliveries in public facilities.
More than 35 percent of births in Bangladesh are attended by medically trained personnel. However, more than half of births in Bangladesh are assisted by dais or untrained Traditional Birth Attendants (53 percent), and few percent of deliveries are assisted by relatives and friends. In 2011, 17 percent of births were delivered by caesarean section, which has increased to more than 20 percent. Caesarean section is very high among women in the highest wealth quintile and among women who completed secondary education.
Post natal care (PNC) is considered as one of the efficient indicators of health service delivery both for the mother and the baby. PNC is also a crucial component of safe motherhood and neonatal health. Postnatal check-ups provide an opportunity to assess and treat delivery complications, and to counsel mothers on how to care for themselves and their newborn infant. Even a couple of year ago, a large proportion of maternal and neonatal deaths occur during the first 24 hours of delivery. The trend has changed significantly. In addition, the first two days following delivery are critical for monitoring complications both for mothers and newborn. Data shows that about 30 percent of mothers in Bangladesh receive postnatal care from a medically trained provider within 42 days after delivery. The vast majority of these mothers receive postnatal care within the crucial first two days of delivery. Postnatal check-ups are slightly more common for children than mothers.
Maternal health service delivery has improved significantly over the past 10 years, and data show that ANC, natal care and PNC - the most vital aspects of saving lives of mother and the baby are still not up to the standard. However, to protect and save our mothers and babies, we need to invest more money, strategies, launch new ideas, policies and interventions. The health goal of the nation should be to have a healthy and well nourished mother and a child.
 (PID-Project Article)

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