Dhaka: Access to free-of-charge or subsidised emergency obstetric care is very low in Bangladesh as there is only one public obstetric care facility per 500,000 people in the country, according to an icddr,b survey.

It reveals that one-fifth of all districts in the country do not meet the World Health Organization recommendation of at least five public or private obstetric facilities per 500,000 individuals.

The comprehensive survey of the national health system was carried out by icddr,b scientists and their international colleagues with financial support from the UK Department of International Development, reports UNB.

The study said public-private partnerships and incentive schemes could increase coverage to address key causes of maternal mortality.

Researchers found that there are 577 public facilities, 114 not-for-profit facilities and 1696 private for-profit facilities that offer obstetric care services across Bangladesh. This means that Bangladesh has 8.6 obstetric care facilities per 500,000 individuals, but only two are public (free of charge or subsidised).

Of these, there is one comprehensive emergency obstetric care facility, which offers more technical services like cesarean delivery, but only one basic emergency obstetric care facility per 500,000 individuals, said the report.

Most facilities do not offer basic emergency obstetric care. The provision of drugs to prevent excessive bleeding after child birth - postpartum hemorrhage, which is a leading cause of maternal mortality - was only available in four out of every five facilities, for example.

While assisted vaginal delivery was available, it was not often practiced in the majority of all obstetric healthcare facilities, with most women presumably seeking a private cesarean delivery instead, the researchers say.

They suggest public-private partnerships to increase access to care for low-income women, or performance-based incentive schemes to retain skilled rural health workers and address regional imbalances in healthcare coverage.

Bangladesh may have made great strides in reducing maternal mortality, with a 66 percent decrease between 1990 and 2010, but studies like these demonstrate that access to skilled healthcare is still poor and that this could be hindering further progress.

However, the survey also found that there were at least six private obstetric healthcare facilities per 500,000 individuals. Low-income women may be priced out of these facilities, but the researchers highlight the potential of harnessing public-private partnerships, which could make these services available free-of-charge or at subsidised rates.