Adolescents weigh in on maternal and neonatal health
By Michael Osmond
ISLAMPUR, Bangladesh, July 2010: Rice paddies abound. Brick kilns mark the landscape. It is harvest time, and women beat rice against road. And it is hot. Men and bricks bake in the heat.
In a concrete building near the centre of town, a group of grade eight and nine students are generating some heat of their own. They are taking part in a high school debate programme as part of a joint UN-Government of Bangladesh Maternal and Neonatal Health Initiative (MNHI).
Every day in Bangladesh, 320 newborn babies, and 32 women die during childbirth. About 1,000 people have packed the building to hear these adolescents debate exactly what the causes of this high mortality rate might be. According to the team of four boys from Islampur Nekjahen Pilot High School, the main problem lies in the delivery of health services – the lack of skilled staff, inadequate health care facilities and policy failings.
The opposing girls from JJKM Girls High School and College agree that services need improving, but argue that people must change their attitudes to maternal and neonatal care to foster and create change. According to 13-year-old Nasirt Aditoi Yeana, “hospital improvements are important. And it is very important that there are enough trained doctors. But the most important thing is knowledge. Mothers and families need to know more, so they can make better use of the health services”.
Shabur Abir Rahmen is a feisty 14-year-old, from Islampur Nekjahen Pilot High School. He and classmate Subad Rafsan al Shafatul Islam cite a lack of skilled service providers as the single most pressing issue. Shabur tells me that “ignorance does contribute to the deaths of mothers and babies here, but corruption is a problem. Doctors are leaving the (public) hospitals during work hours in order to attend a private practice. It makes me very angry”.
Subad expands. “Physicians are not interested in working at public hospitals, because they earn more money through private practice. They encourage patients to visit private practices too, but they are very expensive for poor people”.
Shabur agrees that poverty is an issue. “Even visiting public hospitals can be expensive. Many people cannot afford extra costs, like transport to hospital. And it is difficult for some women who live so far away”.
According to Babul Adhikary, from Development Organisation of the Rural Poor (DORP) – the NGO overseeing the debate programme in Jamalpur District – the debates are particularly effective because the participants themselves learn so much about maternal and neonatal health. “But there is a knock-on effect. They will tell their parents about this. They will share the message with their friends. And because these boys and girls are already well-educated, they are very effective in educating others about the importance of maternal and neonatal health”.
Nasirt says that the debate is of special importance to her – “I will be a mother too one day”, she says, “and this will help teach me to take proper care of my own children”.
All the adolescents involved in the debate agree that they will discuss these issues with their families, friends, and members of their community. Shabur’s eldest sister is 18, and studying at university. But Shabur plans to talk to her so she is prepared when she is ready to have children. “I will help make sure she visits a doctor and is properly looked after. In that way, not just my sister, but her children too will receive proper care”.
Maysha Mehnanaz is a classmate and friend of Nasirt. “These issues about the health of mothers and children are not things I have talked about before. My family does not discuss it”, she says. But “seeing this debate is like training for me. Now I feel like I can talk to my family and friends. I will share this story”.
In the end, the girls are judged to have won this debate, and Nasirt claimed the prize as best debater on the day. While the girls and boys may have been on opposite sides today, everybody agrees that improving health care for mothers and infants is a priority for Bangladesh. And everybody agrees that these students, and others just like them all across Bangladesh, are doing their bit for mothers and babies all over the country.