Expectant mothers: Govt struggling to ensure adequate care

Even as pregnancies rise across the country, fewer women are turning to government health facilities, the most accessible and affordable source of care, for help during and after childbirth.

Despite the often-life-threatening risks of pregnancy-related complications, recent data from the Medical Education and Family Welfare Division shows a steady decline in antenatal check-ups, deliveries, contraception use, and postnatal care in public hospitals and clinics.

Healthcare professionals cite shortages of medical staff, essential equipment, available beds and reliable medication as key deterrents, along with limited awareness among expectant mothers.

Meanwhile, the number of deliveries nationwide jumped from 2.79 million in 2023 to 3.03 million in 2024, according to the Directorate General of Health Services. But this surge has not been matched by a rise in the use of public health services, raising urgent concerns about the wellbeing of mothers and newborns.

Government health facilities handled just over six percent (193,755) of total deliveries in 2023–24, slightly down from 194,992 the previous year, according to the Medical Education and Family Welfare Division's report.

WHO now recommends eight antenatal care (ANC) visits during pregnancy, but in Bangladesh, even the older target of four is becoming harder to meet.

In 2023–24, only 5.14 lakh pregnant women received the recommended four ANC check-ups at government facilities -- down from 10.7 lakh in 2019–20. Postnatal care has followed the same trajectory, with only 3.55 lakh women receiving four full check-ups in 2023–24, compared to 5.7 lakh four years ago.

Contraceptive use has also dropped sharply, especially for long-term methods like injectables, IUDs, no-scalpel vasectomy, and tubectomy.

According to the Bangladesh Bureau of Statistics, the national Maternal Mortality Rate (MMR) stands at 136 per 100,000 live births. In rural areas, the figure is even higher at 157 -- still far from the Sustainable Development Goal of reducing MMR to less than 70 by 2030.

Prof Dr Ferdousi Begum Flora, former president of the Obstetrical and Gynaecological Society of Bangladesh, said, "Among every 10 women, at least three never come in for even one ANC visit. We've failed to bring them into the system."

She added that essential drugs are often out of stock where they are most needed. "Magnesium sulphate for treating preeclampsia is sometimes available in Non-Communicable Disease units, but not in maternity wards."

Training and supervision also fall short, with many medical colleges lacking qualified instructors and updated equipment.

Public awareness, she added, is worryingly low. "Pregnancy is as normal as eating rice. But it can be life-threatening too. That's what people need to understand… The government, the health system, the media, and the public, all need to act."

Her concerns are echoed by DGHS data showing over 1,000 maternal deaths reported in the past year, with nearly half in government facilities. More than 1.1 million complicated pregnancy cases were admitted last year alone.

Irfana Lima's harrowing journey reveals how critical gaps can become deadly.

The 30-year-old from Gazipur suffered placenta previa, a condition where the placenta blocks the cervix. She lost her baby and had her uterus removed to save her life.

In her sixth month of pregnancy, she began bleeding heavily and collapsed. Hospitals in her upazila and district refused to admit her, directing her to Dhaka Medical College Hospital. "But DMCH is far, and beds are never guaranteed. I was almost dead," she said.

A private hospital in Uttara finally admitted her. "After 21 days, I returned home. But I was never able to hold my baby, who died before I regained consciousness."

Prof Dr Nasrin Akter of DMCH's Feto-Maternal Medicine Unit said patients frequently arrive with complications such as hypertension, diabetes, thyroid disorders, or placenta previa.

"At least two women per week are near-miss cases needing ICU care, but shortages of ICU beds, anaesthetists, and night-time blood supply severely limit critical care."

She stressed the importance of early screening, stronger referral systems, and emergency transport, especially at the upazila level.

Teenage pregnancies, often due to early marriage, also worsen outcomes, with many young mothers arriving with anaemia or preterm labour.

Dr Raunak Jahan, assistant professor at Shaheed Suhrawardy Medical College Hospital, noted that preeclampsia, caused by high blood pressure, is now the second leading cause of maternal death after postpartum haemorrhage. "It's a multi-organ disorder. Once seizures begin, saving both mother and baby becomes very difficult."

Her unit manages up to 25 high-risk cases daily, yet often lacks access to life-saving drugs like labetalol and magnesium sulphate. "Sometimes we ask patients to buy them or use our own emergency stock."

With only two operation theatres, limited ICU beds, and unreliable blood supply, Dr Jahan said, "Overcrowded, under-resourced wards make respectful maternity care almost impossible."