Afsana K, Rashid S F
Reprod Health Matters. 2001 Nov;9(18):79-89. doi: 10.1016/s0968-8080(01)90094-1.
Despite initiatives and interventions undertaken at national and international levels, maternal health is still neglected in Bangladesh, and the maternal mortality ratio remains one of the highest in the world. In order to improve rural women's access to maternity care, in 1996 the Bangladesh Rural Advancement Committee (BRAC) instituted services for birthing women in 21 health facilities in each Thana. This paper reports on research conducted three years later, based on interviews with women who gave birth in one BRAC Health Centre (BHC) and women who gave birth at home, interviews with staff of the BHC and observation of provider-patient relations. Acceptance of delivery in a health facility by rural women is still minimal. Most women only attended the BHC due to complications, yet the BHC was unable to handle most complications and referred women to the district hospital, where they received poor quality care. Cost, fear of hospitals and the stigma of an 'abnormal' birth were also important constraints. Female paramedics who attended normal deliveries were praised for being caring, but made women deliver lying down, did not always use aseptic procedures and were too busy to give information, making birth a passive experience. Recommendations to provide comprehensive emergency obstetric care at the BHC and upgrade staff skills, introduce rural health insurance and others have already begun to be implemented.
尽管在国家和国际层面采取了诸多举措和干预措施，但孟加拉国的孕产妇健康仍被忽视，孕产妇死亡率依然位居世界前列。为改善农村妇女获得孕产妇护理的机会，1996年孟加拉国农村发展委员会（BRAC）在每个县的21个卫生设施中为分娩妇女提供服务。本文报告了三年后开展的一项研究，该研究基于对在一个BRAC健康中心（BHC）分娩的妇女和在家分娩的妇女的访谈、对BHC工作人员的访谈以及对医患关系的观察。农村妇女对在卫生设施分娩的接受度仍然很低。大多数妇女只是因为出现并发症才前往BHC，但BHC无法处理大多数并发症，于是将妇女转诊至地区医院，而她们在那里得到的护理质量很差。费用、对医院的恐惧以及“异常”分娩的耻辱感也是重要的制约因素。参与正常分娩护理的女性医护人员因富有爱心而受到称赞，但她们让产妇躺着分娩，并非总是采用无菌操作，而且太忙而无法提供信息，使得分娩成为一种被动的经历。关于在BHC提供全面的紧急产科护理以及提升工作人员技能、引入农村医疗保险等建议已经开始实施。
