Emergency obstetric care : needs of poor women in Bangladesh
Background: Ensuring that all women have access to emergency obstetric care (EmOC) in the event of a complication is vital. One well-accepted conceptual model suggests that the three main areas of delay facing women in accessing EmOC are: (1) deciding to seek care; (2) reaching an appropriate health facility; and (3) receiving treatment once at a health facility. This study explores whether poorer women are disadvantaged in receiving treatment once at a health facility. Methods: The mixed-method study is based in a large teaching hospital in Bangladesh. The poverty status of obstetrics patients is assessed and a case note review is conducted for women staying in the hospital longer than 24 hours. Treatment and time waited are then analysed by poverty status. A sub-group of women are followed-up for more indepth interviews after discharge. These interviews explore the experience of women and relatives in using EmOC. Observation and staff interviews are also conducted within the hospital. Findings: Compared to the wider population, the poorest women are not utilising EmOC. Women face considerable costs in receiving treatment but there did not appear to be differences in treatment received by different poverty groups. The main costs were for drugs, blood and other medical supplies. Most families had to sell assets or borrow money to meet these costs. The doctors operated a 'poor fund', which could provide help for the poorest women in immediately life threatening situations. The government funded welfare organization did not operate well in emergency cases. Conclusions: As the provision of EmOC increases, efforts must ensure equitable uptake among women of all socioeconomic status. Sustainable support mechanisms are needed within hospitals as well as community-based programmes promoting uptake of care. Better maternity services and strengthening the role of trained midwives may be important in improving the uptake of EmOC.