How to improve maternal health for marginalised women: A case study of Women's Health & Rights Advocacy Partnership in Patharghata, Bangladesh

Anja M. Nielsen & Julia W. Dallerup

Studenteropgave: Speciale


Maternal mortality in Bangladesh is amongst that highest in the world. Several projects have been set up to address this situation, among them the Women’s Health & Rights Advocacy Partnership (WHRAP). A non-governmental organisation, Naripokkho, is responsible for the implementation of WHRAP in Bangladesh. Naripokkho’s strategy has an underlying assumption that creating accountability among the duty-bearers in the health system will improve the health facilities, which will result in more women utilising the facilities for pregnancy and delivery and hereby improve the women’s maternal health. This report examines whether this assumption is valid with the women’s choice of action. In addition we examine whether WHRAP can contribute to a improvement in maternal health, and if it can, how this can be achieved. The analysis is based on a case study of the implementation of WHRAP in Patharghata upazila in Bangladesh. The case study focuses on the women’s understanding and utilisation of the health facilities. Giddens’ theory of structuration is used to analyse how change can be brought about and what influences an agent’s choice of action. To understand maternal health in a developing country we use Labonté & Laverack’s definition of health promotion and A. Sen’s definition of development. WHRAP has been successful in increasing the accountability among the duty-bearers and improving the quality of health services. However, the empirical data shows that WHRAP’s assumption - that increased accountability leads to increased utilisation of health facilities - is only partly correct. Facilities for maternal health can generally seen be divided into those relating to pregnancy and those relating to delivery. There are barriers to utilisation of all facilities on the supply-side and the demand-side. As a result of WHRAP’s assumption, the project focuses only on reducing the barriers on the supply side. The main barriers to utilisation of facilities for pregnancy are on the supply side. The project has reduced some of these supply-side barriers (and some demand-side barriers indirectly), which has resulted in increased utilisation of facilities for pregnancy. Thus in this case the assumption is valid. There are significant demand side barriers to utilisation of facilities for delivery. These include issues relating to the marginalised women’s understanding of health. Thus in this case the assumption is not valid. We conclude that increased accountability does lead to increased utilisation of health services facilities for pregnancy but not for delivery. As complications linked with pregnancy or delivery can rapidly become life-threatening, increasing the utilisation of health service facilities for delivery is central to bringing about an actual improvement in the maternal health of marginalised women. In order to achieve this, the project would need to augment its focus on the supply-side barriers to utilisation with efforts to lower the demand-side barriers that take into account the women’s understanding of health.

UddannelserInternationale Udviklingsstudier, (Bachelor/kandidatuddannelse) Kandidat
Udgivelsesdato1 maj 2010
VejledereKirsten Bransholm Pedersen


  • advocacy
  • maternal health