Community Delay in Decision Making and Transferring Complicated Mothers at Facilities Caused Maternal Deaths: A Qualitative Study in Rural Bangladesh

Background: Community delay is one of the major determinants of maternal mortality. Community delays include delay in decision making to seek care and delay in reaching the appropriate facility during maternal complication. Bangladesh is facing challenges to overcome the factors to reduce the community delays. The study explored the factors influencing community delays lead to maternal deaths and the challenges to overcome the delays during maternal complications.

Methods: A qualitative study has been conducted in two districts of Bangladesh. Five Focus Group Discussions (FGDs) and twenty In-Depth Interviews (IDIs) were conducted in rural communities of the two districts.

Results: Community people perceived that the maternal death is due to fate but not for any delay in seeking care or attending a health facility. The cause of community delays is mainly due to dependency on unskilled provider, poverty, lake of knowledge and practices on birth preparedness, danger signs and importance of skilled care in obstetric complications. Community people are unaware of the communication and transport necessary to reach facility. They were not interested to go to facility apprehending more chance of operative delivery at facilities, ill behavior of health care providers and expensive treatment at facility. During complications, the community people first approached the traditional birth attendant (TBA) for treatment and then to village doctors (quacks) when failed with TBA. Lastly, having no alternative, they took decision to go a facility that already made a delay. After taking the decision, a good time required to manage money and vehicle for transportation. The transportation to a facility (the second delay) was further delayed due to poor quality of vehicle and also road and communication.

Conclusions: The study revealed that lack of awareness on danger signs of pregnancy, importance of early seeking skill care, going to facility in right time, and lack of preparedness for emergencies, money and transport had influenced causation of maternal death at community level. Early decision-making capacity of rural people and availability of transportation to the facility would reduce maternal mortality at community.

Author(s): Abdullah ASM, Hossain MS, Rahman F, Halim A and Biswas A

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