Maternal morbidity and mortality among indigenous people in Bangladesh : a study of the Mru community

Abstract

Maternal health of indigenous people is poorer than the non-indigenous people across the world which is also true in the Bangladesh context. However, little research has been done among indigenous people in Bangladesh. As a result, the present study was conducted among the Mru indigenous people to comprehend their maternal health status and the factors associated with it. The study was carried out in three upazilas (administrative sub-districts) namely Alikadam, Lama and Thanchi of the Bandarban district and a part of CHT, the south-eastern part of Bangladesh where most of the Mru people live. In this research, a mixed method approach, combining both qualitative and quantitative methods, was employed. A total of 374 currently married women having at least one child aged less than five years old or women having at least one delivery experience were interviewed purposively from three upazilas. On the other hand, a total of 26 in-depth interviews were conducted among people from different stratas of the Mru community from those three upazilas. Finally, the collected data was presented using uni-variate, bi-variate and multivariate analyses. The study showed that maternal health was poor among the Mru women and less than one-third of the Mru women had access to health care services which might be one of the key reasons for their poor health. Their access to maternal health care services was beyond geographical, linguistic, cultural and economic reach. By and large, the major problems and complications Mru women faced during their pregnancy, delivery and after delivery were headache, blurry vision, high blood pressure, cough or fever, excess vomiting tendency, morning sickness, excessive hemorrhage, obstructed labour, prolonged labour, eclampsia, premature rupture of membrane, anemia, post-partum hemorrhage, perineal tears and swelling of the legs and body. The study also revealed that one out of every nine women visited for antenatal care while only one out of sixteen women visited for postnatal care in the Mru society. More than half of the respondents reported that they did not receive any antenatal or postnatal care due to the long distance to the service center as well as lack of transportation facilities. The study also demonstrated that delivery care and current use of contraception were also low among the Mru mothers as compared to xiii Bengali mothers. Almost all deliveries were home-based deliveries assisted by traditional midwives. About forty per cent of the respondents have heard of family planning methods and only one-fourth of them were current users of contraceptives. The factors associated with low antenatal and postnatal cares and contraception use were age, mothers’ education and occupation, husbands’ education and occupation, religion, place of residence, place of service provided in the locality, distance of the service centers and exposure to mass media of radio, television and newspaper. Maternal mortality also seemed to be higher in the community due to the delivery practices done by the traditional midwives. Traditional beliefs and practices after delivery were also responsible for their high deaths rate. This high maternal morbidity and mortality rate in the Mru society was interwoven with multiple factors that could be classified into three major aspects. First, socio- economic and cultural factors were functioning through their effect on the Mru mothers. Secondly, spatial factors which include geographic settings and proximity and road infrastructure was one of the significant constraints to access to health care services resulting in poor health. Finally, clinical factors that consist of every aspect of obstetric knowledge and education of both women and midwives and availability of care were totally absent in the society. This maternal morbidity and mortality was somewhat consistent with the historic experiences of western countries in seventeenth and eighteenth century. The present study is concluded with urgent requests for implementation of special health care strategies. For instance, the development of obstetric care and maternal health programs, replacement of existing traditional midwives by well-trained midwives, community-based collaborative strategy and most importantly to train the young Mru girls as midwives, particularly those that are bilingual and educated. Along with this significant strategy, socioeconomic development, Mru language- based maternal health education and family planning programs with a special emphasis on awareness through mass media may have a significant influence on maternal health status of the Mru community.