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Summary Background Few studies have examined injury-related deaths among women in Bangladesh. We did a case-finding study to identify causes and the impact of intentional and unintentional injury-related deaths among women aged 10–50 years in Bangladesh. Methods Between 1996 and 1997, health care and other service providers at 4751 health facilities throughout Bangladesh were interviewed about their knowledge of deaths among women aged 10–50 years. In addition, at all public facilities providing inpatient service, medical records of women who died during the study period were reviewed. The reported circumstances surrounding each death were carefully reviewed to attribute the most likely cause of death. Findings 28 998 deaths among women aged 10–50 years were identified in our study, and, of these, 6610 (23%) were thought to be caused by intentional or unintentional injuries. About half (3317) of the injury deaths were attributable to suicide, 352 (5%) to homicide, 1100 (17%) to accidental injuries, and the intent was unknown for 1841 (28%) deaths. The unadjusted rate of suicides were higher in the Khulna administrative division (27·0 per 100 000) than the other four administrative divisions of Bangladesh (range 3·5–11·3 per 100 000). Poisoning (n=3971) was the commonest cause of injury-related death—60% of all injury deaths (6610) and 14% of all deaths (28 998). Other common causes of injury deaths in order of frequency were hanging or suffocation, road traffic accidents, burns, drowning, physical assault, firearm or sharp instrument injury, and snake or animal bite. Interpretation Intentional and unintentional injuries are a major cause of death among women aged 10–50 years in Bangladesh. Strategies to reduce injury-related deaths among women need to be devised.

A national survey of health-care providers in Bangladesh identified 298 women who died from pregnancy-related tetanus. Immunising all girls with tetanus toxoid and providing safe menstrual regulation services would prevent such deaths.This letter discusses pregnancy-related tetanus mortality in Bangladesh. A national survey of health care providers identified 298 women from 5 urban infectious disease hospitals who had died from pregnancy-related tetanus after an induced abortion or during the postpartum period. In response to the problem, the Bangladesh government has provided a tetanus toxoid vaccination program for pregnant women to prevent neonatal and postpartum tetanus and has begun training health workers to perform menstrual regulation procedures. Considering the contribution of traditional abortion practices to tetanus death in Bangladesh, a proposal on maternal tetanus prevention policies would be most effective if it included safe menstrual regulation services and provision of tetanus toxoid immunization to all girls before they reach reproductive age (i.e., at age 12).

Health-workers in 795 health centres in Bangladesh were interviewed about complications arising from induced abortion in rural Bangladesh. 1590 cases of complications from abortion were reported. Dais (traditional birth attendants) and traditional practitioners were the larger groups of operators (42.1% and 18.1%, respectively). Menstrual regulation or dilatation and curettage (the medically approved procedures) were used 9.1% of the time. Nearly half the complicated abortions were induced by inserting a foreign object, such as a stick or root (sometimes treated with an herb), into the uterus and leaving it until either abortion or complications ensued. 498 abortion-related deaths were reported. The proportion of complicated abortions resulting in death was lowest for medically approved procedures (4.9%) and highest for vigorous physical activity (100%) and abdominal pressure (66.7%), although the last two together accounted for only 2.3% of abortion procedures. Women who died after abortion were more likely than were women who survived to be further along in their pregnancies. An extrapolation from these results gives a figure of 780000 abortions in Bangladesh in 1978 and 7800 deaths that year from abortion complications. Many of these deaths might have been prevented if a means of safe, affordable termination of unwanted pregnancy had been available.Induced abortion, although illegal, is common in Bangladesh. A number of health workers were interviewed in 1978-79 in 795 health centers to investigate the magnitude of the problem in rural areas. There were 1590 reported cases of complicated abortions, of which 498, i.e. 31.3% were fatal. 42.1% of abortions were performed by traditional birth attendants, and 18.1% by traditional practitioners; a very small number was performed by husbands, or by the women themselves. Medically approved procedures for abortion, such as dilatation and curettage and menstrual regulation, were used only in 9.1% of cases. Most abortions were caused by inserting a foreign object, such as a stick, into the uterus. Abortion complications after medically approved procedures were only 4.9%. Fatal cases were more likely to occur in advanced pregnancies. It is estimated that in 1978 there were 780,000 abortions in Bangladesh, resulting in 7800 deaths.