Postpartum health in a Dhaka slum

Abstract

This study examines the health, nutritional status, and health care seeking behaviour of a community based sample of 122 postpartum women from an urban slum in Dhaka, Bangladesh. It describes a physically impoverished environment in which malnutrition is serious, and non-trivial morbid episodes as a consequence of childbirth are very common. Malnutrition was found to be widespread: about one-quarter of the study mothers were short in stature, measuring 145 cm or less in height; over two-thirds of the women weighed <45 kg; and a similar proportion had a BMI of <20. Based on mid-upper arm circumference, an overwhelming majority (96%) suffered from some degree of malnutrition. During the first 6 weeks postpartum over three-quarters of the women reported a non-trivial illness. The frequency of reported illnesses was significantly associated with both increasing age and parity. Despite severe poverty, most of the women reporting illnesses (71%) received some form of health care from a wide range of western and traditional health care providers, with Traditional Birth Attendants (TBAs) and unqualified western care providers being the most frequently utilised. This study highlights the plight of these women in a precarious environment and shows how their health is compromised by cultural and political constraints. We conclude that while the burden of postpartum morbidity is very high, the incorporation of traditional practitioners and unqualified western care providers into maternal health training programs, together with efforts to empower women, could be effective in improving the health status of mothers in this marginalised and fragmented community. To achieve this outcome, a clearly articulated and integrated approach to development in slum communities is required.