Post-Partum Excessive Bleeding among Bangladeshi Women; Determinants, Perceptions, Recognition, Responses

Abstract

The study assessed post-partum blood loss among women in two areas of Bangladesh and explored community perceptions, recognition, and response. A cross-sectional survey among 840 women was conducted in two sites to estimate excessive blood loss in the study population. In-depth interviews were conducted among a sub-sample of women (n=34), husbands (n=15), mothers-in-law (15), and Traditional Birth Attendants (TBAs) (11). Two Focus Group Discussions (FGD) were held with TBAs and village health care providers. Among post-partum haemorrhage (PPH) cases, approximately 60% perceived blood loss as excessive. Multi-parity, Absence of Antenatal Care (ANC), delayed placental delivery, previous PPH, hypertension, and blood loss during current pregnancy were significantly associated with PPH. Community members are unable to recognize excessive bleeding in absence of means for assessment and misconceptions that exist among decision makers in the family and the community delay decisions to seek formal health care. Community members, including TBAs, should be equipped and trained with appropriate assessment tools that can be supplied in the delivery kits. Behavioral change and communication activities should be developed and implemented to increase timely recognition of PPH at the household level, increase utilization of health facilities, and encourage the transport of urgent cases to emergency care.