title: Maternal mortality in Bangladesh: a Countdown to 2015 country case study.
abstract: BACKGROUND
  Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.
  
  
  METHODS
  We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regression.
  
  
  RESULTS
  The MMR fell from 322 deaths per 100,000 livebirths (95% CI 253-391) in 1998-2001 to 194 deaths per 100,000 livebirths (149-238) in 2007-10, an annual rate of decrease of 5·6%. This decrease rate is slightly higher than that required (5·5%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal death.
  
  
  CONCLUSIONS
  The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This finding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in Bangladesh.
  
  
  BACKGROUND
  United States Agency for International Development, UK Department for International Development, Bill & Melinda Gates Foundation.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh. Electronic address: shams@icddrb.org.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Harvard Center for Population and Development Studies, Cambridge, MA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hill
authors.affiliation: MEASURE Evaluation, The University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Karar Zunaid
authors.initials: KZ
authors.lastname: Ahsan
authors.affiliation: USAID, Dhaka, Bangladesh.
authors.forename: Kanta
authors.initials: K
authors.lastname: Jamil
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Quamrun
authors.initials: Q
authors.lastname: Nahar
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Peter Kim
authors.initials: PK
authors.lastname: Streatfield
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003270:Contraceptive Agents; D005260:Female; D005298:Fertility / Q000502:physiology; D006268:Health Facilities / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D018570:Risk Assessment
chemical_list: D003270:Contraceptive Agents