WHY DID MATERNAL MORTALITY DECLINE IN MATLAB

In 1991, an article on the Maternity Care Program in Matlab, Banglades h, reported a substantial decline in direct obstetric deaths in the in tervention area, but not in the control area. The decline was attribut ed primarily to the posting of midwives at the village level. In this article, data are presented from the same period and area on a variety of intermediate events. They indicate that the decline in deaths was probably due to the combined efforts of community midwives and the phy sicians at the Matlab maternity clinic. Their ability to refer patient s to higher levels of care was important. The data further indicate th at the decline in deaths depended upon the functioning of the governme nt hospital in Chandpur, where cesarean sections and blood transfusion s were available. Midwives might also have made a special contribution by providing early termination of pregnancy, which is legal in Bangla desh.