Availability of and Accessibility to Primary Health Care Services for Women Living in Poverty: The Bangladesh Case

Abstract

Poor women, in both rural and urban areas in the northern region of Bangladesh, suffer from high maternal mortality rates (MMR), and compared to other regions, this group also has a low proportion of births assisted by skilled attendants. This thesis critically examines the availability of and accessibility to primary, particularly maternal, healthcare services, provided by government and non-government organisations in Bangladesh. The broader purpose of this thesis is to probe the gap between the national MMR in Bangladesh and the target set by the 5th Millennium Development Goal (MDG). It also explores ways of reducing the gap, especially given that the country's MMR is very high compared to other South Asian countries. The study is significant because it has gone beyond the bio-medical approach (with the focus on human patho-physiology and emphasis on cure over prevention) and develops a bio-social approach to improve maternal health. The latter encompasses strategies to reduce high MMR from sociological and public health perspectives. The study used both primary and secondary data to meet its objectives. Triangulation of methods (questionnaire interviews of service users and providers, focus group discussions [FGD] and direct observations) were employed to collect primary data. A large number (160) of mothers who delivered at least one baby during the last ten years and the heads of relevant health centres were interviewed. Eight FGDs were conducted during the research. An assortment of articles, reports, theses and books were consulted in complementing and substantiating the arguments in this study.