Ubaidur Rob

Using Vouchers to Increase Access to Maternal Healthcare in Bangladesh

The maternal mortality ratio (322) is comparatively high in Bangladesh. The utilization of maternity care provided by trained professionals during and after delivery is alarmingly low, primarily due to lack of knowledge and money. The overall objective of this operations research project was to test the feasibility and effectiveness of introducing financial support (voucher scheme) for poor rural women to improve utilization of antenatal care (ANC), delivery and postnatal check-up (PNC) from trained service providers. A pretest-posttest design was utilized. A total of 436 women were interviewed before and 414 after the intervention to evaluate the impact of interventions. In-depth interviews were conducted with users and non-users of vouchers. Findings show that institutional deliveries have increased from 2% to 18%. Utilization of ANC from trained providers has increased from 42% to 89%. Similarly, utilization of PNC from trained providers has increased from 10% to 60%.

Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison.

Out-of-pocket expenses incurred by women for availing maternal healthcare services at public and private health facilities in Bangladesh were examined using a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal healthcare. The survey was conducted in 2010 among 3,300 women who gave birth in the previous 12 months from the start of data collection. Information on costs incurred to receive antenatal, delivery, and postnatal care services was collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal healthcare services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, transportation, and other associated costs incurred for receiving maternal healthcare services. On average, women paid US

Inequalities in maternal health care utilization in rural Bangladesh.

3.60 out-of-pocket expenses for receiving antenatal care at public health facilities and US

Premarital Sex among Urban Adolescents in Bangladesh

12.40 at private health facilities. Similarly, women paid one and half times more for normal (US

Distance, Transportation Cost, and Mode of Transport in the Utilization of Facility-Based Maternity Services: Evidence from Rural Bangladesh

42.30) and cesarean deliveries (US

Lessons learned from health sector reform: a four-country comparison.

136.20) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between public and private health facilities. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized. At the same time, effective demand generation strategies are necessary to encourage women to utilize health facilities.

Reproductive and sexual health education for adolescents in Bangladesh: Parents view and opinion.

The article examines the inequalities in utilization of maternal health care in rural areas of Bangladesh. It also attempts to identify the expenditure pattern for these services. Findings suggest that large disparities in the maternal health care utilization exist between the poorest and the richest population in Bangladesh. Two in three women in the highest wealth group receive antenatal care from qualified doctors as opposed to one in five women in the lowest wealth group. Almost all the deliveries occur at home among the lowest wealth group, whereas 16% of deliveries occur at health facilities among the highest wealth group. Wealth is also associated with the seeking of care for delivery-related complications. The practice of seeking services during post-natal period is not common and it varies positively with economic condition. Family savings is found to be the dominant source of paying the maternal health care services among the women in the highest wealth group. Cost has been found to be the most commonly cited reason for not seeking care for delivery complications. Eighty-four percent of women in the lowest wealth group compared to 13% of women in the highest wealth group did not seek treatment for delivery complications due to cost. Lack of perceived need of antenatal care (ANC) and postnatal care is the most pressing reason for not seeking these services. The study findings contain a number of implications for policy purposes that could be useful in devising ways to increase the utilization of maternal health care services.

Male involvement in the bangladesh family planning and reproductive health program.

This article presents the results of a study conducted in Bangladesh to examine the reproductive and sexual health behavior of adolescents. It is observed that adolescents are not aware of their reproductive health (RH) needs. More than two-thirds of the girls reported that they usually discuss RH issues with their mothers. Findings suggest that approximately 5 percent of the unmarried adolescents had premarital sexual exposure and 98 percent of them were males. Half of the sexually active unmarried adolescents had sex in the last six months. Adolescents are engaged in risky sexual behavior without protection. Almost 95 percent of the adolescents heard about contraceptive methods and 85.4 percent had heard about RTI/STDs. It is observed that approximately 39 percent of male adolescents had sex with commercial sex workers and 56 percent of them did not use a condom.

Development of population policy in Bangladesh.

Although the maternal mortality ratio in Bangladesh has decreased, significant underutilization of facilities continues to be a persistent challenge to policy makers. Women face long distances and significant transportation cost to deliver at health facilities. This study identifies the distance traveled to utilize facilities, associated transportation cost, and transport mode used for maternal healthcare services. A total of 3,300 mothers aged 18–49 years, who had given birth in the year before the survey, were interviewed from 22 sub-districts in 2010. Findings suggest that facility-based maternal healthcare service utilization was very poor. Only 53% of women received antenatal care, 20% used delivery care. and 10% used postnatal care from health centers. Median distance traveled for antenatal and postnatal check-ups was 2 kilometers but 4 kilometers for complication management care and delivery. Most women used non-motorized rickshaw or van to reach a health facility. On average, women spent Taka 100 (US

Effect of a maternal health voucher scheme on out-of-pocket expenditure and use of delivery care services in rural Bangladesh: a prospective controlled study

1.40) as transportation cost for antenatal care, Taka 432 (US