Non-Certified Providers Provide Initial Care for Pregnancy-Related Complications in Rural Bangladesh

In rural Bangladesh, non-certified providers such as village doctors and untrained birth attendants are the first-line providers for women with severe obstetric complications, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Decisions on care-seeking for obstetric emergencies were largely made by husbands and in-laws. The study, published in the January 3 edition of BioMed Central Pregnancy and Childbirth, analyzed the factors associated with health care decision making during obstetric emergencies.

For the study, researchers collected data using the pregnancy surveillance infrastructure from the JiVitA-3 community trial in northwest rural Bangladesh. The Johns Hopkins researchers conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications to document barriers to timely receipt of medical care. Although the women surveyed recognized the severity of their complications, this recognition did not translate to prompt seeking of medical care. According to the study, women attributed delays in seeking medical care to the reluctance of their husbands and other decision makers to seek prompt care. They also complained of the tremendous pain endured before their male relatives decided it was necessary to seek medical care. When families did decide to seek care, women first visited non-certified treatment providers, citing established relationships, lower cost of treatment compared to certified providers, and close proximity as reasons for this choice.

“Interventions to improve timely seeking of medical care for obstetric complications may need to more effectively and appropriately target husbands and family members with messaging on care seeking,” said Alain Labrique, PhD, assistant professor in the Bloomberg School’s Department of International Health and corresponding author of this study. “The use of mobile phones holds potential for decreasing delays to receiving hospital care by increasing access to information and facilitating coordination of finances and logistics for emergency medical care.”

“Accounts of Severe Acute Obstetric Complications in Rural Bangladesh” was written by Shegufta S Sikder, Alain Labrique, Barkat Ullah, Hasmot Ali, Mahbubur Rashid, Sucheta Mehra, Nusrat Jahan, Abu A Shamim, Keith P West and Parul Christian.

Financial support for the research was provided by the Bill & Melinda Gates Foundation to the Center for Human Nutrition in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Original trial support came from the U.S. Agency for International Development, with additional support from the Sight and Life Research Institute. Partial support for this data analysis was provided by the Johns Hopkins Bloomberg School of Public Health through a Global Field Experience Fund, a Framework Award in Global Health (Center for Global Health), and a Delta Omega Scholarship (Delta Omega Honor Society).

Media contact: Tim Parsons, director of Public Affairs, at 410-955-7619 or tmparson@jhsph.edu.