Modes of delivery and delivery assistance in rural bangladesh.
OBJECTIVE
This paper employs statistical methods to identify the factors associated with modes of delivery and delivery assistance in rural areas of Bangladesh. The principal objective of this paper is to suggest various policy options on the basis of study findings in order to provide guidelines to improve the overall delivery-related morbidity conditions in Bangladesh.


METHODS
This study analyzes data from a followup study conducted by the Bangladesh Institute of Research for Health and Technologies (BIRPERHT) on maternal morbidity in rural Bangladesh in 1993. A total of 1020 pregnant women were interviewed in the followup component of the study. For the purpose of this study, we selected 993 pregnant women with at least one antenatal followup.


RESULTS
It is observed that the mode of delivery is complicated (assisted or destructive) if the pregnancy is either first or fifth or higher order and if bleeding occurred during the antenatal period. More educated respondents, high-risk pregnancies, pregnancies with past history of anemia and respondents who reported marriage at a relatively higher age receive assistance from trained personnel at a significantly higher proportion. Some of the important findings are: (1) first pregnancy or fifth or higher prior pregnancies and hemorrhage during pregnancy increase the risk of assisted or destructive modes of delivery; and (2) first or fifth or higher prior pregnancies are more likely to seek assistance from trained health personnel; similarly, regular antenatal visits and past history of anemia are also positively associated with seeking assistance from trained personnel. However, still there is a substantial proportion of women who remain at risk of complicated deliveries assisted by untrained personnel, posing a formidable challenge to policymakers.


CONCLUSIONS
The results indicate several policy options: (1) the high-risk group, first or fifth or higher pregnancies, need special care and the existing health management system may be strengthened to create awareness among potential mothers for seeking appropriate measures from the beginning of pregnancy; (2) antenatal followup can be emphasized for high-risk pregnancies, and for respondents with a past history of anemia and other complications, a realistic referral system can be developed; (3) the campaign for increased age at marriage and increased age at first birth needs to focus the health issues more extensively; and (4) education for women needs to be given very high priority in order to bring about a lasting impact on the overall health condition of women.
Islam
Ataharul
A
Professor, Department of Statistics, Dhaka University, Dhaka-1000, Bangladesh.
Rafiqul Islam
Chowdhury
C