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Aid Cuts Childbirth Risks in Bangladesh

COMILLA, Bangladesh , Aug 23 2013 (IPS) - Seven months pregnant, 24-year-old Shumi Begum has travelled 220 km from her village with her paternal grandmother to consult a specialist on childbirth.

“We seek treatment here because of the good reputation of the service providers. We have had childbirth in our family in the hands of the same service providers here and for safety reasons I think this centre is still the best choice,” Shumi’s grandmother Hosne-Ara told IPS.

She was waiting at a community maternity centre here in Jafargonj in Comilla district, about 55 km from capital Dhaka.

At the crowded two-storey maternity centre popularly known as Mayer Hashi (smiling mother), a project supervised by EngenderHealth and funded by USAID, Shumi anxiously looks at one of the birth attendants to check if she is next in queue to consult the childbirth specialist known as the family welfare visitor.

In the last decade, the Bangladesh government has invested in a maternal health programme with support from a number of foreign development partners. The health, nutrition, and population programme of Bangladesh has adopted a national strategy for maternal health focusing on emergency obstetric care for reducing maternal mortality, concentrating especially on early detection and appropriate referral of complications, and improvement of quality of care.

A maternal mortality and healthcare survey conducted in 2010 with the help of several development partners found that maternal mortality in Bangladesh fell from 322 deaths per 100,000 live births in 2001 to 194 in 2010 – a 40 percent decline in nine years.

Despite improved safe motherhood services in their hometown, Shumi’s grandmother did not want to take any risk during the expectant mother’s first childbirth.

Regardless of the improved state-owned health facilities, Jafargonj health centre is considered better than other centres. The family welfare visitors at Jafargonj are popular for their efforts to provide risk-free care during childbirth.

The centre is also women-friendly, since most of the attendants pay special attention to the personal needs of the clients. And the long journey to Jafargonj is now less hazardous due to improved road access.

In a career spanning 13 years, Kawser Hasina Pervin, a family welfare visitor at Jafargonj, has twice received awards from the prime minister for her outstanding professional care.

She told IPS that they treat about 20 to 25 patients daily and have seen a rise in the number of expectant mothers visiting the centre in the past five years.

“The obvious reasons are improved care and individual counseling.”

A private clinic would cost her family at least 400 dollars. At a state health centre she would have to spend only on medicines, which would be just 15 to 20 dollars. The problem is that at the government centres, the medicines are often not available.

“Customarily childbirth at home is still preferred by mother-in-laws and grandmothers, but with awareness and increased education of girls this trend is now changing,” Anjali Bala Das, one of the health providers at the centre who makes regular visits to the community, told IPS.

“[After] years of advocacy on safe motherhood, the ice is gradually starting to melt,” said Das, who has worked two decades as a family planning health promoter. “Elderly people have started to recognise the benefits of modern healthcare instead of sticking to the traditional myths.”

Sabrina Begum, 22 had similar views. “My mother-in-law is a very rigid person and she is highly religious. She refuses to have male doctors attending during childbirth, so she always preferred delivery at home.”

Begum’s mother-in-law has now come to the Jafargonj centre to consult health providers for a safer childbirth for her daughter-in-law. This is after she attended several advocacy programmes in her Ganganagar village in Comilla.

In Bangladesh, expectant mothers rarely decide where to give birth. Often malnourishment and early pregnancy lead to complicated delivery. That results in about 12,000 deaths every year.

In its country report in 2011, the United Nations Children’s Fund (UNICEF) stated that though maternal mortality has been reduced in Bangladesh, only half the mothers receive antenatal care from skilled providers. The report said that healthcare correlates with household wealth and educational background.

“We are working with the government to promote safer childbirth by continuously developing skills of professional group of people like the health providers, and community and religious leaders,” Dr Abu Jamil Faisel, country representative of EngenderHealth, told IPS. “The idea is to increase access to quality maternal healthcare services at no cost.”

 
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