In developed nations home births, or “natural births,” are a growing trend among middle-class moms-to-be who choose not to give birth in a hospital. However, in many areas of developing nations, poor rural women have no choice but to give birth at home, often with adverse medical consequences. Researchers at the Bloomberg School of Public Health (JHSPH) found that more than one quarter of all women in rural Bangladesh experienced complications during pregnancy and/or childbirth.
In rural Bangladesh today, approximately three quarters of all women give birth at home without the assistance of trained health professionals or skilled birth attendants. As a result, the majority of complications during pregnancy occur at home. Such complications include sepsis, pregnancy-induced convulsions or comas, hemorrhage and obstructed labor.
In a recent study, JHSPH researchers explored the associations between biological, socioeconomic and psychosocial factors and recorded pregnancy-related complications using data from a representative, rural location in Bangladesh. The researchers aimed to identify methods to decrease maternal morbidity in the country. The study was published in the journal Biomed Central Pregnancy & Childbirth on Oct. 4.
In order to perform the study, the researchers followed over 42,000 rural Bangladeshi women throughout their pregnancies and postpartum periods and assessed the women’s symptoms and nutritional statuses. The study took place between 2007 and 2011. Every week, trained female workers visited women enrolled in the study to determine pregnancy outcomes. Women who had a live birth or stillbirth were asked whether they experienced a series of complications during labor and delivery.
The study was conducted as part of a broader randomized controlled trial called JiVitA. JiVitA is a long-term maternal and child health and nutrition research project site located in northwestern rural Bangladesh and managed by JHSPH. JiVitA’s study area was chosen as representative of typical rural communities in Bangladesh based on population density, rural agrarian characteristics and economic and public health indicators.
Fifteen previous studies conducted between 2000 and 2010 in Bangladesh, India and Nepal found that between 12 percent and 75 percent of women reported at least one complication in their most recent pregnancy. These studies showed a U-shaped relationship between a woman’s age and risk of complication: Women younger than 18 years and women older than 35 years are at an increased risk of pregnancy-related complications compared to women between 18 and 35 years of age. These studies found that women who had previously never been pregnant are at an increased risk of complications, especially obstructed labor. Furthermore, these studies found that malnutrition is associated with increased risk of pregnancy-related complications and maternal deaths.
The researchers found that the results of their study were consistent with the proportions of self-reported complications presented in the previous studies done in South Asia. For biological factors, they found that first-time pregnancy and history of pregnancy complications increased the risk of all reported pregnancy complications.
Additionally, maternal malnutrition, defined as a maternal mid-upper arm circumference of less than 21.5 centimeters, was associated with an increased risk of reported hemorrhage or sepsis. Previous studies have shown that malnutrition during pregnancy is associated with weakened immune responses to infection and pregnancy-induced anemia.
For psychosocial factors, the researchers found that reports of neither partner wanting the pregnancy were associated with increased risk of pregnancy-related complications. Previous studies suggest that pregnancy wantedness may denote the importance placed on the pregnancy and so may subsequently determine the care and attention the woman receives throughout pregnancy. Additionally, lack of pregnancy wantedness is associated with decreased prenatal visits by healthcare professionals.
This study has key implications for future research and policy changes. The researchers suggest that further investigation into the risk factors for pregnancy complications in rural communities may help elucidate the specific ways in which such risk factors impact the development of pregnancy complications. They suggest that policies aimed at increasing availability of contraception, reducing early marriages and preventing maternal malnutrition may decrease the risk of pregnancy-related complications in rural Bangladesh.
Finally, the researchers emphasize that it is crucial to continue addressing the heavy burden of pregnancy complications that still occur at home in rural communities across South Asia.
