The Contribution of the Matlab Safe Motherhood Programme to Perinatal Mortality in Bangladesh

Current knowledge on mortality rates for stillbirths, early and late neonatal deaths and perinatal deaths in South Asia is dependent on statistically modelled estimates. There is very little information on the contribution of intrapartum complications and preterm births to stillbirths and mortality in the first month of life in rural Bangladesh. First, I systematically reviewed studies and performed a meta-analysis to obtain reliable estimates for the above mentioned mortality rates in South Asia. Second, I examined the association between the presence of a programme increasing professional birth attendance, facility delivery and emergency care access and reductions in mortality levels in a retrospective cohort in Matlab, Bangladesh. Third, I examined the determinants of preterm birth and whether this programme was associated with preterm prevalence reduction. Fourth, I explored the contributions of intrapartum complications and preterm births to perinatal deaths in this cohort. The systematic review found that perinatal mortality levels were high in Afghanistan, Bangladesh, India, Nepal and Pakistan and low in Sri Lanka and Maldives. Stillbirths were underreported. The cohort study found that the presence of the Matlab Safe Motherhood Programme was strongly associated with greatly reduced stillbirths and very early (Day 0-2) neonatal deaths. This programme did not contribute to the neonatal mortality decline after Day 3 or to preterm birth trends. Preterm birth accounted for a third of stillbirths and deaths in the neonatal period. Against expectations, only two intrapartum complications (haemorrhage and multiple pregnancy) was associated with increased odds of perinatal mortality. Dystocia and hypertensive diseases of pregnancy showed no effect. Stillbirth and very early neonatal death reduction in Bangladesh can be achieved by improving access to facilities and emergency care. Focused antenatal care for women might possibly reduce preterm births but further research is needed to understand how the prevalence of preterm birth can be reduced.