Socio Demographic Determinants of Delivery Practice in Rural Women of Bangladesh

Background: Every year, world wide, 200 million women become pregnant. The development of urban areas allowed women to receive more care and treatment. However, in rural areas such measures are not available to every woman. Data on delivery practice of rural woman may help the social and public health planners and decision makers to minimize and prevent maternal mortality and morbidity ensuring safe motherhood. Objective: The aim of the study was to observe the delivery practice of rural women of Bangladesh. Materials and method: A cross-sectional study was conducted and data were collected from Dhamrai upazila, Dhaka, Bangladesh in April 2008. Total 159 women of reproductive age group at least having one child were selected purposively to elicit information on various demographic, socioeconomic, cultural and selected programmatic variables including maternal health care and delivery practices. Results: Among the respondents about 55% were literate. Majority (80%) of the respondents delivered at home and most of the them (71%) felt that home delivery was comfortable where as about 29% of the respondents were compelled to deliver at home due to family decision and financial constraint. Among the deliveries about 82% occurred normally and 18.2% were by cesarean section. A considerable percentage of deliveries (49%) were attended by traditional birth attendants. Blade was used for cutting umbilical cord in majority of the cases (74%) who delivered at home. Most of the respondents (90%) took ante natal check up and about 74% were vaccinated by tetanus toxoid. Conclusion: The results of the study suggest that a lot of work is still to do for the policy makers and health planners to target, plan, develop and deliver maternal health services to the rural women of Bangladesh.


Introduction
Although most pregnancies end with the birth of a live baby, on many occasions, childbirth is a time of pain, fear, suffering, and even death.Pregnancy and childbirth related complications are among the leading causes of maternal mortality in Bangladesh. 1 The health and family planning program of Bangladesh has made remarkable progress in the last two decades as evident from the decline in fertility rate, infant and child mortality rates.However, the maternal mortality ratio (MMR) is still high (1.94 per 1000 live births). 2 In any community, mothers and children constitute a priority group.In developing countries they comprise approximately 70% of population.Mothers and children not only constitute a large group, but they are also a vulnerable or special risk group. 3Maternal mortality is one of the most important health challenges the world is facing today.More than 20 million women experience ill health as a result of pregnancy each year.The risk of a woman dying as a result of complication related to pregnancy in developing countries can be as much as 100 times that of women in Western Europe or North America. 4ough the safe mother hood initiative has been priority in recent years, maternal morbidity and mortality still remain a major public health issue in most developing countries.Child birth is a time of transition and social celebration in many societies.Women's progression from birth to child bearing is influenced by economy, religion, kinship system and the complexity of communications and medical technology. 5In some societies, there is a continuum between traditional and modern care, with some households operating at the traditional end, others at the modern end, with the majority somewhere in between. 6Women are most in need of skilled care during delivery and immediate post partum period, when roughly seventy five percent of all maternal death occurs.Traditional birth attendants, whether trained or untrained can neither predict nor cope with serious complications.Public hospital, private hospital and maternity clinic provide modern delivery care. 7esearch consistently shows that high cost is an important constraint to service utilization particularly for the poor. 8

Materials and method
This cross sectional study was conducted in April, 2008 to get information on various demographic, socioeconomic variables, including delivery practices among 159 married rural women of reproductive age group at least having one child, who were selected purposively residing in Dhamrai upazila in Dhaka district.A pre designed questionnaire containing the combination of closed ended and open ended questions was applied to get data.Data was collected by face to face interview by going door to door in the village.Data processing and analyses were done using SPSS (Statistical Package for Social Sciences) version 17.The results were expressed as proportions.Verbal consent was taken from all the study subjects.

Results
Out of 159 respondents, 71(44.6%)were between 21-25 years of age, 87(54.7%)were literate and 90(56.6%)were housewife.Regarding their husbands' occupation, majority (40.3%) were service holder followed by 26.4% being garments worker.Highest percentage of the respondents' (46.5%) monthly family income was up to Tk. 10,000 and 64% of the respondents lived in nuclear family.Regarding age of the marriage of the respondents, 42.1% was up to 21-25 years which is same with their age of first pregnancy.Variables Proportion (%)

Discussion
A cross sectional study was carried out among 159 married rural women at least having one child.The aim of the study was to address the socio-demographic variables related to delivery practice among the Bangladeshi rural women.The study revealed that literacy rate of the respondents was about 55% of whom 57(35.9%)had primary level of education.This is little bit higher than that of previous national literacy rate of female which was 48.8%. 9 Among the respondents, 143(89.9%)took ANC in last pregnancy which was much higher than that of previous study done by Bangladesh Demographic and Health survey where ANC coverage was 15.4%. 10 This difference may be due to that this study was conducted in a selected rural area and the location is close to the capital city.
Regarding the place of delivery it was evident that the practice of home deliveries was higher than that of hospital deliveries (80.5% vs. 19.5%).In a similar study conducted among the urban women of Nepal showed that planned home deliveries were 58.3%, which was much less than present study. 11Majority of the respondents (71.1%) felt that home delivery was comfortable and 28.9% were compelled to deliver at home due to family decision, financial constraint and other causes.In a similar study conducted among the urban women of Nepal shows that 25.7% home delivery was conducted due to comfort and 21.4% due to convenience and 18% due to lack of transport . 11 The result of the study showed that a considerable percentage of deliveries (49.2%) were attended by traditional birth attendants.Various studies had been undertaken on pregnant women in the world and Bangladesh, but the information on delivery practice among the rural women at the community level is still inadequate.In our study, we were interested to examine the current behavior of rural women regarding delivery and child birth from the perspective of the women themselves and their families.It can be recommended that, more emphasis should be given at MCH based health care at the grass root level to facilitate safe and comfortable delivery practice, trained traditional birth attendants should be developed to prevent pregnancy complications and female education about pregnancy, safe delivery, place of delivery, vaccination should be promoted.
population Research and Training.Bangladesh demographic and health survey 2011.Dhaka: National Institute of population Research and training, 2011.NIPORT, ORC Macro, JHU and ICDDR,B: Bangladesh Maternal Health Services and Maternal Mortality Survey 2001.