Shahrazad Rahman
Strategy Consultant, UK
This independent review assesses the current state of maternal healthcare in Bangladesh, drawing on recent evidence of progress alongside persistent structural challenges. While Bangladesh has achieved a notable 79% reduction in maternal mortality between 2000 and 2023, the maternal mortality ratio (MMR) remains at 196 per 100,000 live births, which is nearly three times the Sustainable Development Goal (SDG) target of fewer than 70 by 2030. This indicates that, despite substantial gains, systemic weaknesses continue to undermine outcomes.
The evidence points to a dual narrative of progress and persistent inequity. Maternal mortality remains a leading cause of death among women of reproductive age, with approximately 7,660 preventable deaths annually. The principal causes are hemorrhage (31%) and eclampsia (23%), which are all widely recognised as manageable with timely, skilled care, suggesting that mortality is less a function of clinical complexity and more a failure of service delivery systems. A critical constraint is the availability and distribution of skilled healthcare providers. Only 41% of the required maternal health workforce is currently in place, leaving a significant gap in skilled birth attendance. This is reflected in care-seeking patterns: 71% of births occur at home, with only 4% attended by trained personnel. These figures highlight a structural reliance on informal care, particularly in rural and low-income populations.
Geographic and socio-economic disparities further compound these challenges. Rural maternal mortality (204 per 100,000 live births) exceeds urban rates (147), while women in the poorest quintile face significantly higher risks than those in the wealthiest.
Access to quality antenatal care (ANC) is similarly unequal, with only 7% of the poorest women receiving adequate care compared to 37% of the richest. These inequities appear to be widening, indicating that improvements have not been equitably distributed.
The review also identifies critical failures in emergency response systems. Nearly half of maternal deaths occur within 24 hours of childbirth, with 19% occurring at home and a further 19% during transit to facilities. This highlights deficiencies in timely referral, transportation, and facility readiness. Notably, fewer than 1% of facilities meet essential delivery standards, and only 5% provide comprehensive emergency obstetric care.
The findings suggest that policy commitments have not translated into consistent service quality at the point of care. Significant gaps exist in basic infrastructure, including blood transfusion services (available in only 4% of facilities) and essential medications such as magnesium sulphate (14%). These deficiencies undermine the effectiveness of facility-based care even when access is achieved.
In conclusion, Bangladesh’s maternal healthcare system faces a delivery challenge rather than a knowledge deficit. The required interventions which strengthen the midwifery workforce, improve facility readiness, establish effective referral systems, and address inequities are well understood. However, implementation remains uneven. Without targeted action to address these systemic failures, further reductions in maternal mortality are unlikely to meet national or global targets.
