Delivering health and saving lives

Jan 9, 2014

Remote areas report show disproportionately higher rates of maternal death than urban areas . Photo: UNDP Bangladesh

Halima Begum wailed through the night as she clutched her pregnant stomach. She was in labour and in pain. Miles away from the nearest hospital, things took a turn for the worse as she fainted from pain.

Chameli Khatun, 42, a local midwife, heard that Halima had fainted and rushed to her house with the ‘Midwife Kits’ she got from the Upazila Parishad. A few hours later Halima’s baby was delivered but without Chameli, things could have been a lot worse.

Halima knows, only two years ago she lost her baby during childbirth.   

Saving lives 

Halima was lucky. She had the help of a trained midwife like Chameli which saved her from a potentially life-threatening birth at home.

Halima’s situation was dire, as all the public and private hospitals and clinics are located on other side of the river and crossing the mighty river Jamuna, which at some points is nine to 10 kilometres wide would be extremely hazardous, especially at night.
Waiting for more than three hours to get a boat to cross the river to reach at Upazila Sadar Medical Hospital on a cold November night, the labouring Halima gave birth to a dead child halfway across the river in 2012. When she reached the hospital, the doctors, after two hours of frantic efforts, somehow managed to save her life, but not the unborn baby.

But now this time around, Halima had the courageous Chameli, a trained midwife, who not only saved her life but that of her baby as well. Chameli was trained by a programme supported by the Upazila Governance Project (UZGP).

Life-saving training

The Kazipur Upazila Parishad under Sirajganj district, one of the 14 pilot districts of UZGP, with financial support from the Upazila Governance Project (UZGP), provided a 12-day intensive training to the community midwives aimed at improving maternal services, lower maternal mortality rates and empower women in the area.

A total of 70 midwives, divided into two batches, took part in the training held at Rahaishuriber Aminadoulatzaman Manobsheba Hospital in Natuarpara Union Parishad. Through the 60 sessions in 12-day intensive training, the participating midwives learned not only about the post, during and life-saving antenatal and delivery, but also about family planning, monitoring the pregnancy from conception to the postnatal period and beyond. They also gained knowledge about comprehensive sexual reproductive health services, including family planning counselling and services, and post-abortion etc.

The UNDP and UNCDF-supported UZGP also provided all the participating midwives ‘Midwife Kit’ that contains essential equipment and supplies that can be used during the delivery at their community.

“It was between life and death for me. At the time of the delivery the bleeding was too much and I felt dizzy and weak and had a headache. I was in panic that I would lose my life” said, Bulbuli, 25, who gave a healthy baby girl recently. “The danger of giving birth was real to me. I would have died if the midwife was not there,” she added.

The Kazipur Upazila Parishad provided the training to the community midwives under a scheme titled “Training to the Community Midwives” taken under Upazila Fiscal Facility (UFF) grants provided by UZGP. The UZGP, during its first year in 2013, it provided a total of BDT 50 lakh to Kazipur Upazila to implement 16 schemes focusing on Millennium Development Goals (MDGs) and pro-poor issues including education, health, poverty alleviation and women empowerment. 

Out of money given the Kazipur Upazila Parishad allocated BDT 5.20 lakh for the “Midwifery Training” to the community midwives which started yielding tremendous results--saving the lives of mothers and children.

“Though Bangladesh has achieved considerable progress in maternal and child mortality, still there are some pockets like chars, hilly areas, coastal belts and other environmentally vulnerable areas where the poor structurally disadvantaged in getting access to basic services prominently education and health. And Kazipur Upazila, where seven out of 12 Union Parishads are char area, is one of them,” said Mr. Tozammel Haque Bakul Sarkar, Chairman of Kazipur UZP, justifying the scheme.

“Medical services are very weak and access to, and utilization of, mother and children’s health services remains limited here. The scheme to train the midwives means a lot to the pregnant mothers here as it is saving their lives and their babies,” he added.

Remote areas report show disproportionately higher rates of maternal death than urban areas since they lack infrastructure and distances to services centres are far. According to UZP sources, the maternal mortality rate (MMR) of Kazipur Upazila Parishas was 276 deaths per 100,000 live births in 2013 whereas the country MMR rate was 194.
No woman should die giving life.

Coming down from dais after receiving the certificate for attending the 12-day midwifery training, Rabeya Khatun of Natuarpara Union Parishad, said, “Now I am more confident to help other women deliver their children safely. I will also teach them hygienic practices.”

“We will definitely won’t let women die while they are giving life,” Nurunnahar Begum, another midwife, who took the training in first batch, said, confidently. 

Lauding the UZGP for providing financial support to the scheme, Mr. Shafiul Islam, Upazila Nirbahi Officer (UNO) of Kazipur UZP, said, “It’s a great help to us in fulfilling our mission to reduce maternal and child mortality. Kazipur UZP is one of pockets that is still lagging behind the country in achieving these two important goals.

The UZGP, during its first year in 2013, has already disbursed first tranche of its fiscal grants amounting BDT 17.5 m to seven UZPs under seven pilot districts for implementing 89 pro-poor and MDG-focused schemes. The grants are being used by the UZPs as additional financial resources, which complements its Annual Development Plan (ADP) grant received from national budget for implementing the schemes.

From second year, all 14 pilot UZPs of the project, will get the grants.
The Upazila Governance Project (UZGP) has been commissioned as part of the overall programme framework of UNDP and UNCDF support to the Government of Bangladesh to make the UZPs more effective, functional and service-oriented local government institutions. It is being supported by the European Union (EU), the Swiss Agency for Development and Cooperation (SDC) and implemented by the Local Government Division (LGD).

Ms. Shaila Khan, Assistant Country Director and Head, Local Governance Cluster, UNDP Bangladesh, said, “In a country like Bangladesh, where women, especially in remote areas, can’t really access medical facilities because they lack women health workers, a midwife can save a woman’s life. And for the inhabitants of a char area, where communication is difficult the midwives seem to them are god-sent.”

Mr. Shah Kamal, Additional Secretary (Admin), LGD and National Project Director (NPD), UZGP said, “This is unacceptable that women and their babies continue to die in the 21st century because of lack of access to midwives and other midwifery-skilled health workers. As part of our global commitment to meet this important MDG-5—reducing maternal mortality rate---we, the UZGP, will continue the support to the UZP to train midwives so that no women would die for giving life.”