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Abstract
BackgroundAlthough many studies have been carried out to learn about maternal care practices in rural areas and urban-slums of Bangladesh, none have focused on ultra poor women. Understanding the context in which women would be willing to accept new practices is essential for developing realistic and relevant behaviour change messages. This study sought to fill in this knowledge gap by exploring maternal care practices among women who participated in a grant-based livelihood programme for the ultra poor. This is expected to assist the designing of the health education messages programme in an effort to improve maternal morbidity and survival towards achieving the UN millennium Development Goal 5.MethodsQualitative method was used to collect data on maternal care practices during pregnancy, delivery, and post-partum period from women in ultra poor households. The sample included both currently pregnant women who have had a previous childbirth, and lactating women, participating in a grant-based livelihood development programme. Rangpur and Kurigram districts in northern Bangladesh were selected for data collection.ResultsWomen usually considered pregnancy as a normal event unless complications arose, and most of them refrained from seeking antenatal care (ANC) except for confirmation of pregnancy, and no prior preparation for childbirth was taken. Financial constraints, coupled with traditional beliefs and rituals, delayed care-seeking in cases where complications arose. Delivery usually took place on the floor in the squatting posture and the attendants did not always follow antiseptic measures such as washing hands before conducting delivery. Following the birth of the baby, attention was mainly focused on the expulsion of the placenta and various maneuvres were adapted to hasten the process, which were sometimes harmful. There were multiple food-related taboos and restrictions, which decreased the consumption of protein during pregnancy and post-partum period. Women usually failed to go to the healthcare providers for illnesses in the post-partum period.ConclusionThis study shows that cultural beliefs and norms have a strong influence on maternal care practices among the ultra poor households, and override the beneficial economic effects from livelihood support intervention. Some of these practices, often compromised by various taboos and beliefs, may become harmful at times. Health behavior education in this livelihood support program can be carefully tailored to local cultural beliefs to achieve better maternal outcomes.
Highlights
Many studies have been carried out to learn about maternal care practices in rural areas and urban-slums of Bangladesh, none have focused on ultra poor women
Pregnancy identification and its subsequent care was seen as a normal event which did not require any additional medical intervention unless significant complications arose during this period
Antenatal care Confirmation of pregnancy was considered by the women as the most important part of antenatal care and eight out of 20 women went to the nearby health facilities for pregnancy tests
Summary
Many studies have been carried out to learn about maternal care practices in rural areas and urban-slums of Bangladesh, none have focused on ultra poor women. To improve the maternal health indicators it is necessary to develop interventions that meet the health needs of extremely poor women These extremely poor households, ultra poor households, have few or no asset base, are highly vulnerable to any shock (e.g., natural disaster, disability of an income-earner or illnesses involving costly care), and mainly depend on seasonal wage-labour for survival. They are characterized by their inability to participate fully in social and economic activities which make them vulnerable to differential treatment of the society [2]. Drawing on the learning and experiences from the first phase (CFPR-I), the fiveyear second phase of this programme (CFPR-II) started in 2007 with an even greater scale and scope [7]
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