Introduction
deaths
COMPLICATIONS
The Sustainable Development Goal-3 aimed to scale down the maternal mortality ratio to below 70 deaths per one hundred thousand live births by 2030 [Institutional delivery is one of the key tools to ensure safe delivery under trained medical practitioners and tackle any delivery-related complications efficiently reducing maternal deaths and thus help to reach the SDG target. According to a joint report by the World Health Organization and UNICEF, around 83% of deliveries were conducted by skilled providers worldwide during the 2014–2020 period [A non-randomized controlled study conducted by Solomon Shiferaw et al. in Ethiopia featured an increase of 14.7% in facility delivery compared to the control group due to implementing mHealth services using both voice calls and text messages [Bangladesh targets to drop down Maternal Mortality Ratio (MMR) to 121 deaths per one hundred thousand live births by 2022 and below 70 deaths per one hundred thousand live births by 2030 [However, the effect of e-registration tracking and mHealth counseling in both voice calls and text messages as a package on institutional delivery in the Bangladesh country context is yet unknown. Although the study conducted in Ethiopia showed positive results in increasing the facility delivery using both text messages and voice calls, the cultural, social, and geographical variations present between the Ethiopian and the Bangladeshi population beg the importance of a separate study to be conducted in the Bangladesh country context [In Bangladesh, paper-based registers are used mostly in the health system to keep a record of health-related data of the care-receivers. The Directorate General of Family Planning (DGFP) of the Ministry of Health and Family Welfare (MoHFW) of Bangladesh uses Family Welfare Assistant (FWA) registers to keep track of pregnant mothers at the community level. Each FWA is assigned to one or more than one adjacent union who visits houses to conduct population registration, eligible couple registration, and pregnant mother registration quarterly. The data were stored in the paper-based registers previously, and union-level data were compiled monthly to produce sub-district-level reports. The field activity and data validity were checked by the Family Planning Inspectors (FPI)s. However, carrying a large register during home visits, input data in the field, and monthly compilation of the huge dataset manually was cumbersome, time-consuming, and prone to human error. To address the problems, the digitalization of the FWA register of 39 districts to an e-Register system was a step forward to initiating e-registration in Bangladesh taken by the Directorate General of Family Planning in accordance with the rest of the world [The Management Information System (MIS) unit, DGFP will start e-Registration in Chandpur Sadar, Kachua, and Faridganj sub-districts of Chandpur district with the technical assistance of Maternal and Child Health Division of icddr,b under the Safe Motherhood Promotion- Operations Research on Safe Motherhood and Newborn Survival (SMPNS) Project. The project aims to reduce maternal and newborn mortality by developing and evaluating intervention packages at the project implementation sites. Strengthening pregnancy registration is one of the key mandates of this project, and assisting DGFP in the roll-out of the eMIS registration system in Chandpur district was done to achieve the mandate. The project has employed midwives in the Chandpur District Hospital, Kachua Upazila Health Complex, and Faridganj Upazila Health Complex who will send text messages and make voice calls to counsel the registered pregnant mothers for institutional delivery. Therefore, we plan to conduct a two-arm, non-randomized controlled cluster trial to evaluate the joint effort of the DGFP eMIS tracking system and mHealth counseling done by the midwives in overcoming the challenge and improving institutional deliveries in the hazard-prone areas of Southern Bangladesh. We expect that e-Registration and mHealth intervention will provide policy-relevant lessons on scaling up this package to improve the facility deliveries in hazard-prone areas in Southern Bangladesh.