Maternal Mortality and Last Mile Challenges: Improved Perspective for Leapfrogging

Abstract

AbstractBackgroundReducing maternal mortality to zero is one of the 3 targeted agendas of the International Conference of Population and Development (ICPD). Though global improvements in align with SDGs commitment have witnessed comparative development but in the case of reaching zero agenda there are still much more improvements to make.ObjectivesUnderstanding the bottom-level reality with field experiences while also paying attention to the policy voices to understand the last mile stumbling blocks.MethodsReality check along with expert opinions working at the field level and beneficiary consultations were the primary components for this study. Three specific modalities (i) field-level consultations with the stakeholders, (ii) facility inspection and (iii) roundtable discussion were the specific tools used for this study.ResultsFindings show that in Bangladesh, substantial inequities exist both in the use of facility-based maternal healthcare with scarce and the absence of competent birth attendants for home births. Moreover, socio-cultural norms and the socioeconomic status of the families contribute to maternal deaths. The poor family setting, the hospital referral system, and the familial understanding of the overall maternal healthcare are largely responsible for maternal deaths.ConclusionAll these issues related to maternal deaths need proper attention to leap forward to overcome the last mile challenges. Determined focus on defining and identifying the last mile population, breaking the pedagogical limitations and institutional barriers with an additional focus on the last mile research to reach the underserved population is imperative to reach the last mile.ProblemImproving maternal health is one of three ICPD 3 zeroes priority, and a nested target in the third goal of the Sustainable Development Goals (SDGs). Alarmingly, maternal mortality is the third highest cause of death among women aged 15 to 49 in Bangladesh contributing to stalling the progress ahead in achieving SDGs.What is Already KnownThe business as usual and contextual factors including poverty, distance to health facilities, lack of information, inadequate services, cultural practices, education coupled with governance and macro-structural factors, private sector infrastructure investment and health finance are greatly responsible for maternal mortality to overcome last mile challenge.What this Paper AddsThis study identifies barriers that limit the availability and access to quality maternal health services at all levels of the health system focusing the grass root maternal services. Underlines the prevailing inadequate and absence of services delivery and suggests necessary steps to address the last mile challenges towards ending preventable maternal deaths,