Maternal mortality in rural Bangladesh: lessons learned from Gonoshasthaya Kendra Programme villages.

The present study examines the experiences and health care strategies of Gonoshasthaya Kendra (GK) the first NGO to tackle rural health care delivery in Bangladesh in reducing maternal mortality. A close scrutiny of the GK experience shows that reduction in maternal mortality in rural Bangladesh is possible even while keeping the place of delivery at home and at a low cost with the support of trained traditional birth attendants provided (a) they are integrated into the formal rural health delivery system through which they are linked with local-level-government trained health workers for effective supervision and referrals and (b) a system of accountability is institutionalized by which trained 4 traditional birth attendants along with health workers are accountable to their supervisors and the community they serve through village health committees and local government. The GK experience of involving village-level trained paramedics and trained traditional birth attendants in the rendering of maternal and child care services can be replicated by the Government through improving skills of traditional birth attendants in pregnancy management through continuing in-service training and linking them with the existing reproductive health care systems. The finding calls for a fundamental shift in the current nature of public service provision in Bangladesh to make public service providers directly accountable at the local level. Further reduction in maternal mortality is possible in rural Bangladesh through vigorous campaigns against smoking prevention of births to women with four or more children the delay of births to primigravidas prevention and treatment of anaemia and promotion of full doses of tetanus vaccines for pregnant women.