Child and Maternal Mortality
in Islamic Countries
72
Bangladesh has slightly reduced inequity in MNCH care in the recent period, but substantial
inequity still exists. The rate of ANC was 56.3% among urban women, but only 24.1% among
rural women in 1994 (32% difference); in 2014, 89.3% of women received any ANC in urban
areas, compared to 74.6% in rural area (14.7% difference). However, the differences in SBA and
facility delivery rates remained almost similar between the urban and rural areas during the
period. In 1993-94, 39.6% of women delivered under a skilled birth attendant in urban areas
compared to 10.7%of women in rural areas. Although the SBA rate has increased in both groups
(60.5%and 35.9%, respectively), the gap has not narrowed. Similarly, the rate of facility delivery
remained almost double in urban areas (57.4%) than in rural areas (30.7%).
Any ANC visit, ANC4+ visits, SBA, and facility delivery rates have increased in all socioeconomic
status and education groups, but the level of inequity in all indicators remained unchanged in
the last three decades. Another paradoxical concern is high rates of c-section among the richest
quintile (51.4%) and higher educated (54.8%) groups of women. Alarmingly, 73% of deliveries
in private facilities are conducted by cesarean section. In public facilities, 37% of deliveries are
performed by c-section, which is also exceedingly high.
The recent BDHS surveys collected data on postnatal care visits for mothers and newborns. The
trends analysis shows that the overall postnatal care within 2 days from any health providers
has increased from 32.9% to 58.2% for mothers, and 39.3% to 52.6% for newborns between
2011 and 2014. However, postnatal care from trained providers has increased marginally from
32.6% to 37.4% for mothers and 30.4% to 32.1% for newborns between 2011 and 2014.
Bangladesh has achieved remarkable success in increasing contraceptive prevalence rates. The
CPR has reached to 58.9% and mCPR to 51.0% in 2014. Unmet need for contraception has
reduced almost half from 20.3% in 1994 to 11.3% in 2014 and demand satisfied has been
increased from 62.8% to 81.9% during the period (the post-2015 agenda is to achieve at least
75% demand for family planning with modern methods49). Inequity in contraceptive use by
socioeconomic status, education level, and urban-rural residence is low. Contraceptive use has
increased in all segments of the population.
Figure 3.19 shows the trends of vaccination coverage from 1994 to 2014. BCG vaccination has
increased from 86% in 1994 to 98% in 2014. DPT1 has increased from 85% to 97%, DPT2 from
79% to 95%, and DPT3 from 67% to 91%. Measles vaccination has increased from 70% to 86%.
Polio3 has increased to almost 92% in 2014 from 68% in 1994. The use of all recommended
doses has increased from 59% to 84%.
Although inequity in vaccination coverage has decreased, the use of vaccination remained
comparatively lower in the lowest wealth quintile group.