Patterns of maternal care seeking behaviours in rural Bangladesh

OBJECTIVE: Seeking care from a basic or comprehensive facility in response to obstetric complications is a key behaviour promoted in safe motherhood programmes. This study examined definitions of care seeking for maternal health complications used by families in rural Bangladesh, and the frequency and determinants of locally-defined care seeking practices. METHODS: We conducted 24 semi-structured qualitative interviews with women who had recently given birth to characterize care seeking behaviours in response to perceived complications. Based on these findings, a quantitative household questionnaire was developed and administered to 1490 women, half of whom reported a 'serious or very serious' complication during their last pregnancy and/or delivery (n=769; 52%), and were included in the quantitative analysis. RESULTS: Informants described three care seeking patterns in qualitative interviews: (i) sending a family member to purchase treatment to administer in the home; (ii) sending for a provider to treat the woman in the home and (iii) taking the woman outside the home to a facility or provider's office. The quantitative survey revealed that most women sought care for 'serious' complications (86%), with 42% seeking multiple sources of care. The majority of women purchased a treatment to administer at home (68%), while 20% brought a provider to the home. Thirty per cent of women were taken to a provider or facility. CONCLUSIONS: Families generally seek care for complications, but care seeking does not correspond to definitions used by maternal health programmes. Local definitions of care seeking must be considered in intervention design so that promotion of care seeking increases for facility-based care for life-threatening emergencies rather than unintentionally increasing the use of home-based treatments of little medical value for prevention of mortality.