After losing her first child to a congenital heart defect, Sabina Yasmin was anxious when she found out about her second pregnancy.

Her doctor's explanation of potential complications led her to consult four other doctors, and all of them confirmed it was a high-risk pregnancy.

Sabina said, "Still grieving the loss of my first child, I faced pregnancy-induced hypertension, gestational diabetes and obesity, which caused placental insufficiency – my baby wasn't getting enough nutrition.

"I had to take routine insulin injections, blood thinners and had expensive dietary requirements and medication, while having to monitor my baby's development through expensive scans every 15-20 days in the first two trimesters, and every week in the last."

She had to undergo numerous costly tests to assess her conditions, while having to be hospitalised a number of times due to low amniotic fluid, often rendering her unable to walk. 

After the 9-month ordeal, Sabina had a baby girl but the challenges persisted as her infant was at risk of hypoglycemia due to high insulin levels.

According to data from 14 medical college hospitals, 38 percent of 1,24,557 obstetric patients in 2023 had high-risk pregnancies like Sabina's.

These hospitals performed deliveries on around 98,000 pregnant women. Of them, 531 died, even though BBS's Bangladesh Sample Vital Statistics-2023, recorded the maternal mortality rate at 136 per 1,00,000 live births.

Dr Raunak Jahan, assistant professor of Shaheed Suhrawardy Medical College and Hospital's gynae and obstetrics department and one of the 25 doctors in the country specialising in feto-maternal medicine, said, "Factors that classify pregnancy as high-risk include chronic health conditions such as uncontrolled hypertension and diabetes, pre-existing hepatic, renal, and cardiac issues, advanced maternal age or teenage pregnancy, multiple gestations, lifestyle factors like smoking and substance abuse, and pregnancy-related complications such as preeclampsia and gestational diabetes.

"Such pregnancies need extra attention to ensure the mother and baby stay healthy. These complications can include high blood pressure, seizures, preterm birth, necessary C-section, bleeding issues, having a baby with a low or high weight, birth defects, issues with the baby's brain development, needing special care in the hospital for the baby or the mother, and even fatalities."

SHORTAGE OF SKILLED PROVIDERS

The rise in high-risk pregnancies adds strain to an already stretched healthcare system, exacerbating the shortage of specialists, especially in rural areas.

With around 3.6 million pregnancies every year, the doctor-patient ratio is currently one doctor for every 2,374 pregnant women, which is far from the ideal situation.

Asma Akter, an expecting mother with a high-risk pregnancy from Gazipur's Kapasia, has been experiencing placenta previa and enduring prolonged bleeding since the start of her third pregnancy.

After seeking help from multiple doctors in her locality, she was finally referred to DMCH.

"I was prescribed bed rest and necessary injections, but I have to travel 65km to visit my doctor."

Dr Raunak said, "Currently, only four medical colleges – RMCH, DMCH, Suhrawardy hospital, and Sir Salimullah hospital -- offer feto-maternal medicine positions to manage high-risk pregnancies, with postings in 10 more medical colleges underway.

"We're yet to develop proper sub-speciality positions in gynaecology and obstetrics, unlike other departments and developed countries where maternal and fetal medicine are already separate sub-specialities."

She said, "In rural areas, families often delay hospital visits until a crisis arises; sometimes, they only seek care after the first trimester when risks have already developed. Though four antenatal visits are recommended, the BSVS-2023 showed only 39 percent of pregnant women undergo four or more such visits.

"Teenage pregnancy, a significant contributing factor of high-risk pregnancy, remains common in rural areas. This is very risky because adolescent mothers' bodies are still developing, and their organs are not fully matured."

The BSVS-23 showed that at least 73 of every 1,000 delivering mothers were teenagers aged 15-19.

Prof Ferdousi Begum Flora, a renowned gynaecologist and former president of the Obstetrics and Gynecological Society of Bangladesh, highlighted issues with the deployment of doctors, noting a bias towards urban areas.

"Why would doctors want to work where there's inadequate space and facilities and no proper educational opportunities for their children? These are reasons they choose not to work in rural areas."

FINANCIAL TOLL

Experts said high-risk pregnancies are also economically taxing.

Specialised tests, frequent monitoring, medications, and potential hospitalisations can lead to excessive medical bills.

Sajida Islam Parul, facing a high-risk pregnancy due to diabetes, thyroid issues, and cystic fibroids, had to borrow over Tk 1.5 lakh from colleagues and relatives.

With monthly medicine costs exceeding Tk 20,000, along with over 150 expensive injections, a special diet, and anticipated Cesarean expenses, she struggled financially.

"I pleaded with the hospital authorities for discounts and even mortgaged my wedding gold ornament for Tk 25,000, which I haven't been able to redeem."

Saudia Afrin had to spend Tk 18 lakh for the preterm delivery of her baby, who required NICU care and other treatment in private facilities.

WAY FORWARD

Dr Raunak suggested implementing overseas training or local workshops for healthcare professionals to address high-risk pregnancies.

She also recommended introducing an app to identify high-risk pregnancies and track appointments, while establishing dedicated high-risk pregnancy units in every government hospital with adequate NICU facilities.

"Additionally, subsidising essential investigations and ultrasounds can also help reduce the financial burden."

She also suggested ensuring pre-pregnancy counselling, conceiving at the right age and management of chronic health issues to prevent high-risk pregnancy.

Dr Ferdousi said government initiatives, including awareness campaigns by community health workers, enhanced access to prenatal care, subsidised services, required policy interventions, and proper research can help tackle the issue.