Bangladesh's maternal mortality ratio fell from 574 per 100,000 live births in 1990 to 123 in 2022 — a transformation that public-health scholars sometimes call the Bangladesh Paradox, because it happened on a per-capita budget that should not, by the textbook, have produced this kind of result. Most of the credit belongs to a long, patient investment in midwifery training, community clinics, and skilled birth attendants in remote upazilas.
But that progress has begun to flatten. The most recent BDHS round suggests that the national figure has moved only marginally in the past five years, and the unfinished work is concentrated in three places — the haor basins of Sunamganj, the chars of Kurigram and Gaibandha, and parts of the Chittagong Hill Tracts. In each of these, distance to a functional emergency obstetric facility, not training or supplies, is the binding constraint.
"You can have the best midwife in the country, but if she is on the wrong side of a flooded haor when a haemorrhage starts, you have a problem that no amount of training fixes," said Dr. Hasina Kabir, a maternal-health adviser to the Directorate General of Health Services.
BHRF reporters travelling with a Save the Children mobile team in Sunamganj last month watched a young woman from Tahirpur upazila being transported by boat for nearly three hours before reaching a comprehensive emergency obstetric and newborn care facility in the district town. She and her newborn survived; her own mother, a generation ago, did not.
The next phase of progress, several officials and donors told BHRF, will not be cheaper. Helicopter referrals, water ambulances, and a permanent CEmONC presence at the upazila level are all being discussed for the upcoming five-year plan. The political will to fund them is the open question.
