Background: Although safe motherhood strategies recommend that women seek timely care from health facilities
for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We
sought to describe and compare availability and readiness to provide EmOC among public and private health
facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also
described aspects of financial and geographic access to healthcare and key constraints to EmOC provision.
Methods: Using data from a large population-based community trial, we identified and surveyed the 14 health
facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by
women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and
record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision
was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores
were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities
were described. Textual analysis was used to identify key constraints.
Results: The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public
facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed
private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low
scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics
was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities
located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the
main barrier to EmOC provision in public facilities.
Conclusions: Although EmOC availability and readiness was higher among the surveyed seven most commonly
visited private clinics, public facilities appeared to be more affordable for C-section and more geographically accessible.
Strategies to retain anesthesiologists and surgeons, such as non-financial incentives, are needed to improve EmOC
provision in the public sector. Centralized blood banks are recommended to streamline safe blood acquisition for
obstetric surgeries.