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Johns Hopkins University
Background Death and illness related to pregnancy and childbirth are significant health problems in developing countries. The World Health Organization estimates that 529,000 women die from complications related to pregnancy and childbirth each year, with 99% of these deaths in developing countries. An additional 300 million women suffer from illness and long-term disability related to childbearing. The vast majority of maternal mortality and morbidity is avoidable through timely use of obstetric care. Use of skilled care remains low in developing countries, especially in South Asia where home-based birth is the norm. Safe motherhood programs focus on improving recognition of life-threatening complications and subsequent care seeking behaviors. Objective This research examined maternal morbidity in Bangladesh by exploring women’s perceptions of complications and care seeking behaviors. Methods This study utilized three methodologies: a literature review and both qualitative and quantitative methods. The literature review compared methods of morbidity measurement in Bangladesh and India. The qualitative study included 24 in-depth interviews on women’s perceptions of complications and care seeking behaviors. Bivariate and multivariate analyses were used to explore associations between socio-demographic/reproductive factors and care seeking behaviors. Results The literature review revealed a variety of measurement methods as well as a wide range in the proportion of women reporting complications. The qualitative and quantitative studies demonstrated high levels of self-reported maternal morbidity in rural Bangladesh, although few women sought skilled care even for complications perceived to be “serious.” Among women who did seek care, traditional providers or pharmacy shops were the preferred locations. Factors associated with seeking skilled care included primiparity, antenatal care visits, previous pregnancy loss, and higher wealth status. Knowledge of danger signs was significantly associated with seeking skilled care but was moderated by the number of antenatal care visits. Conclusion These findings have important implications for safe motherhood programs and future research. We suggested guidelines for definition and measurement of community-based reports of maternal morbidities. We also suggested recommendations for safe motherhood programs, including the necessity of formative research, combining qualitative and quantitative methods to capture perceived “severity” and care seeking processes. Additional research into the mechanisms that translate knowledge into seeking skilled care is needed.