Maternal Health Services and Maternal Mortality Survey 2001
Mitra and Associates, National Institute of Population Research and Training (NIPORT), ICDDR,B: Centre for Health and Population Research Dhaka, Bangladesh, Associates for Community and Population Research (ACPR)
Maternal Health Services and Maternal Mortality Survey 2001
Other Household Health Survey [hh/hea]
The 2001 Bangladesh Maternal Health Services and Maternal Mortality Survey (BMMS) is the first nationally representative sample survey designed to provide information on the level of maternal mortality, causes of maternal and nonmaternal deaths, and perception, experience, and utilization of maternal health care in Bangladesh.
The Bangladesh Maternal Health Services and Maternal Mortality Survey (BMMS) is intended to serve as a source of maternal health and maternal death data for policymakers and the research community.
In general, the objectives of the BMMS are to:
• Collect data at the national level, which will facilitate an assessment of the level of maternal mortality in Bangladesh;
• Identify specific causes of maternal and nonmaternal deaths to adult women;
• Collect data on women’s perception of and experience with antenatal, maternity, and emergency obstetrical care;
• Measure indicators of utilization of maternal health services in Bangladesh.
Kind of Data
Sample survey data [ssd]
The 2001 Bangladesh Maternal Health Services and Maternal Mortality Survey includes the follwoing topics:
- Background Characteristics
- Maternal Mortality (Sisterhood)
- Pre and Postnatal Care
- Selection of People
- Background Information
- General Information about Events Preceding Death
- Descriptive Report of Illness and Events That Led to The Death
- General Illness Leading to Death
- For Death During Pregnancy Prior to Onset of Labor or Within 1Year of Abortion/ Miscarriage
- For Deaths During Labor, Delivery of After Delivery
- General Care Seeking
Producers and sponsors
Mitra and Associates
National Institute of Population Research and Training (NIPORT)
ICDDR,B: Centre for Health and Population Research Dhaka, Bangladesh
Associates for Community and Population Research (ACPR)
Johns Hopkins University
United State Agency for International Development
Administratively, Bangladesh is divided into six divisions. Each division is divided into districts (zilas), and then thanas or upazilas. Each urban area in a thana or upazila is divided into wards, and each ward is divided into mohallas; each rural area in a thana or upazila is divided into union parishadas, and each union is divided into mouzas.
Smaller subdivisions called enumeration areas (EAs) were created for the 1991 census based on the number of dwellings units. However, experience with the 1999-2000 Bangladesh Demographic and Health Survey (BDHS) showed that EA maps and sketch maps were not easily accessible. For this reason, EAs were not considered suitable as primary sampling units for the 2001 BMMS survey. Also, it was not feasible to obtain a computer file of the census information with the codes for the different subdivisions and their corresponding basic household or population information. However, the complete basic census information is available in published reports, from the division level down to the mouza level, but not at the EA level. Consequently, it was decided to make use of the published census reports and to use wards and unions as the primary sampling units. The second stage of sampling for urban areas involved selecting two mohallas in each ward, while for rural areas, two mouzas were selected in each selected union (with a few exceptions of one mouza or one mohalla per union or per ward, respectively). The third stage involved selecting households. In summary, in each division, the list of wards constituted the initial sample frame for urban areas and the list of unions was the sample frame for rural areas. A total of 808 primary sampling units were selected: 134 urban and 674 rural.
The field organizations (ACPR and Mitra and Associates) conducted a household listing operation in all of the sample points from November 2000 to April 2001. To obtain an accurate estimate of the maternal mortality rate at the national level (as well as to achieve other objectives of the survey), a stratified national sample of 104,323 households was systematically selected from a total of 1,616 clusters.
All ever-married women age 13-49 were eligible to be interviewed. It was expected that the sample would yield interviews with more than 100,000 ever-married women.
Note: See sample implementation table in APPENDIX D of the report which is presented in this documentation.
A total of 104,323 households were selected for the sample, of which 99,202 were successfully interviewed. The shortfall is primarily due to dwellings being vacant or the inhabitants being gone for an extended period at the time of the survey. Of the 100,379 households occupied, 99 percent were successfully interviewed. In these households, 106,789 women were identified as eligible for the individual interview (i.e., ever-married women age 13-49), and interviews were completed for 103,796, or 97 percent. The principal reason for nonresponse among eligible women was the failure to find them at home, despite repeated visits to the household. The refusal rate was low.
See summarized response rate by residence in Table 1.2 which is presented in the final report.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
Training and Fieldwork
The BMMS questionnaires were pretested in November 2000. Pretest teams from both ACPR and Mitra and Associates were trained jointly at NIPORT. After training, the teams conducted interviews at various locations in the field under the observation of staff from the two field organizations and members of the technical task force. Before the pretest, the verbal autopsy methodology was validated in a field trial in Matlab, Bangladesh, during October-November 2000. ACPR was responsible for recruiting a field trial team and conducting fieldwork, with assistance from ICDDR,B, to pretest the methodology in a sample of households with a disproportionate number of maternal deaths as reported by the Demographic Surveillance System. Based on observations in the field and suggestions made by the pretest and field trial teams, the technical task force revised the wording of the questionnaires and adjusted the translations.
In December 2000, candidates for field staff positions for the main survey were recruited. Recruitment criteria included educational attainment, maturity, experience with other surveys, and a firm commitment to spend one month in training and at least five months in the field. Training for the main survey was conducted at two different sites by each field organization from December 3 to January 7, 2001. Initially, training consisted of lectures on how to complete the questionnaires, with mock interviews between participants to gain practice in asking questions. Toward the end of the training course, the participants spent several days carrying out practice interviews in places close to Dhaka. Trainees whose performance was considered superior were selected as supervisors and field editors.
Fieldwork for the BMMS was carried out by 50 interviewing teams (23 teams from ACPR and 27 teams from Mitra and Associates) in five phases. Each team consisted of a male supervisor, a female field editor, and four female interviewers. During fieldwork, emphasis was placed on the quality of data. ACPR and Mitra and Associates also fielded quality control teams to check on the fieldwork. Feedback was given to teams after each phase to improve on the quality of data collection. In addition, staff from USAID, NIPORT, and ORC Macro monitored the fieldwork by visiting teams in the field. Fieldwork started on January 9, 2001 and was completed in the second week of June 2001.
Three questionnaires were used for the BMMS: a Household Questionnaire, a Women’s Questionnaire (for ever-married women age 13-49), and a Verbal Autopsy Questionnaire (for deaths of women age 13-49).
The Household Questionnaire consisted of a schedule for listing all household members. For each listed person, the survey collected basic information such as age, sex, marital status, and education. Information was also collected on household characteristics such as type of housing, source of water, and availability of electricity. The Household Questionnaire asked about any deaths of household members in the three years preceding the survey. The information on age, sex, and marital status of household members was used to identify eligible respondents for the Women’s Questionnaire. The information about female adult deaths identified deaths for which the Verbal Autopsy Questionnaire was used.
The Women’s Questionnaire was administered to all ever-married women age 13-49 who were listed in the Household Questionnaire. These women were asked questions on the following topics:
• Background characteristics (age, education, religion, etc.),
• Reproductive history,
• Use of family planning methods,
• Information about siblings (to calculate the maternal mortality rate),
• Knowledge of maternal health problems,
• Antenatal, delivery, and postnatal care,
• Experience with and treatment of maternal health problems during pregnancy, delivery, and after delivery,
• Treatment-seeking behavior.
The Verbal Autopsy Questionnaire was used to collect information on causes of death for all female adult (age 13-49) deaths in the household in the three years preceding the survey. The questionnaire was both structured (precoded questions) and nonstructured (open-ended questions) in nature, and was answered by the most knowledgeable member of the household.
During the design of the questionnaires, input was sought from various organizations that were expecting to use the data. ORC Macro designed the questionnaires with assistance from JHU, ICDDR,B, and USAID. After preparation of the questionnaires in English, they were translated into Bengali. Then back-translations were done by people other than the initial translators, to verify the accuracy of the translations.
All questionnaires for the BMMS were returned to Dhaka for data processing at ACPR and Mitra and Associates. Data entry personnel were trained in Dhaka in February 2001 by ORC Macro data processing personnel. The processing operation consisted of office editing, coding of open-ended questions, data entry, and resolving inconsistencies found by the computer edit programs. The data were processed on microcomputers working in double shifts. The ISSA (Integrated System for Survey Analysis) program developed by MEASURE DHS+ was used during all stages of data entry and processing. Data processing commenced in mid-February 2001 and was completed by the end of August 2001.
Estimates of Sampling Error
Sampling error tables are presented in Appendix E of the final report.
Data Quality Tables
- Household age distribution
- Age distribution of eligible and interviewed women
- Completeness of reporting
- Births by western calendar years
- Reporting of age at death in days
- Reporting of age at death in months
Note: See these tables in APPENDIX C of the report which is presented in this documentation.
Data and Data Related Resources
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National Institute of Population Research and Training (NIPORT), ORC Macro, Johns Hopkins University and ICDDR,B. Bangladesh Maternal Health Services and Maternal Mortality Survey 2001. Dataset downloaded from www.measuredhs.com on [date].
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