Why this project?

In Bangladesh, 12,000 women die from problems related to pregnancy and childbirth every year. That is more than 30 women a day. There are various reasons for this. An important cause is the high percentage of teenage pregnancies (under 20 years). 28% of girls between 15-19 years are mothers of at least 1 child. In this age category, the mortality rate is twice as high in women of older age. Another important cause is that 85% of the women deliver their baby at home without expert guidance. They are assisted by female family members and untrained traditional midwives. Professional help is often too expensive or unavailable. In case complications occur, hospitals are often far away and inaccessible.

Infant mortality is also high in Bangladesh. To compare; in the Netherlands there are 3.6 deaths per 1,000 live births every year. In Bangladesh, there are 45.7 deaths per 1,000 live births. 70% of these causalities occur in the first week after birth, meaning that 99 thousand children a year do not get older than six days. What are the causes? First of all, the condition of the mother. An undernourished pregnant woman has a much higher risk of premature delivery and an underweight baby. Secondly, 80% of new-born babies do not receive professional care after birth. 20% die of breathing problems just after childbirth, 52% of the deaths are caused by an infection that would be relatively easy to prevent. In addition, complications in pregnancy and childbirth lead to an increased percentage of children with physical or mental disabilities.

Instead of being discouraged, these figures prompted partner organization Chandradip Development Society (CDS) to initiate this all-round health programme in the Bakarganj municipality, where close to none health services were available, even to Bangladeshi standards. In the past 10 years, a lot of work has been done, and various care activities have been initiated and implemented from day to day. CDS has opted for an integrated approach, in which they not only reach mothers and children, but also try to involve the family and community that are near to mother and child.

Project focus

The activities of the mother & child care project of CDS can be divided into three components:

1. Information and awareness

Not only (prospective) mothers are informed about a healthy pregnancy and childbirth, so are the family members close to the pregnant woman and other members of the community: husbands, mothers-in-law, but also youths (girls and boys), religious leaders, and village elders. These consultations can be privately organized, but CDS also sets up monthly village meetings. During these outreach activities, information on pregnancy and childbirth related issues is provided. Information is provided about a healthy diet, the importance of preventive health check-ups, and of professional support during childbirth. Additionally, the pro’s and con’s of giving birth in the hospital, when this is medically necessary, what the costs are etc. In traditional families, the men and older women of the family usually decide whether a young mother is to deliver at home or in a hospital. Cultural sensitive issues are also discussed, such as birth control, teenage pregnancy, and domestic violence. In addition, attention is paid to health rights, and how the community can organize itself to address their needs with the government.

2. Care around pregnancy and delivery

From the beginning of the pregnancy, women are monitored every two weeks. If necessary, nutritional supplements are provided. Where necessary, a pregnant woman is referred to a doctor. Traditional midwives receive extra training, with special attention given to the identification of complications and situations where it is necessary to refer to professional medical assistance.

3. Care for babies up to 6 months

Traditional midwives are trained on the care of the newborn baby, immediately after childbirth. Much emphasis is placed on hygiene, breathing, nutrition (breastfeeding), and observation of the general health condition of the baby. The first six days after the delivery, home visits are made to assist mother and child during these first critical days. When necessary, it is advised to call in professional medical assistance. After the first six days, a two-weekly health check-up is offered. The weight and growth of the baby is monitored, and a start is made with the vaccination program. This intensified care program runs until the baby is six months old.

Organization

The program requires a well-designed organizational and logistics structure. The project administration is accommodated at the small clinic, set up in the working area. The clinic is the project centre, open on a daily basis for consultations and medicine dispensary. From there, trained health workers go out to visit the surrounding villages where they hold a ‘clinic on location’. At each village, CDS has formed a Care Committee consisting of nine local authoritative women. These women work on a voluntary basis. The female members of the Care Committee monitor the daily routine and have a signalling function. During the bi-weekly visits of the CDS team, they provide the CDS health workers with information about who is pregnant, who delivered, etc. The Care Committee also takes responsibility to motivate women to attend the pre-natal and post-natal check-ups.  On average, around fifty women and children visit each ‘clinic on location’. Women and new-borns receive a preventive health check and simple treated if necessary. In case medical assistance is required, they will be referred to a doctor. In case women cannot come to the clinic, a home visit is made.

 

After ten years, the program has achieved positive results. In the area where CDS is active, the number of infant mortality during the first week after delivery has dropped to 26 out of every 1,000 live births. Maternal mortality (number of women who die during childbirth, out of every 100,000 live births) also decreased. CDS is the first to say that these results are not due to the efforts of the Mother and Child project only. In addition to their activities, the clean water and sanitation program has also an important positive impact, as well as the organization’s informal education program for children who do not have access to mainstream education. Another important success factor is the social imbedding of CDS. The organization aligns with several national networks to lobby for better education and health facilities with the government. It is this integrated approach that ensures that the health situation of women and children is gradually improving.