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Women pay high Price for ignorance

© UNICEF Bangladesh/ 2009/ Arifa S Sharmin
Jasmine, 16, is recovering from a ruptured uterus when the traditional birth attendant was unable to stop the bleeding.
By: Arifa S. Sharmin

Humayra Akhter is 19 years old and seven months pregnant. She has not visited a doctor or health care center during her pregnancy because her in-laws consider it “shameful” to visit a male doctor.

Humayra lives with her in-laws in Mahjer para, Cox’s Bazaar, south east Bangladesh. They live less than a kilometer from the Cox’s Bazaar district hospital. Her husband Ashek is a rikshaw puller.

Many of the women in Humayra’s neighborhood believe that visiting a doctor during pregnancy is not socially acceptable. None of them have ever visited a doctor during their pregnancies or at child birth.

A major tourist destination in Bangladesh, Cox’s Bazaar is comparatively more conservative than other parts of the country. Among 464 families who live in Mahjer para, more than half are extremely poor. Due to social prejudice and ignorance, a significant number of women are still indifferent about visiting health care centers to receive ante-natal care, delivery and post-natal care, increasing the risks of maternal mortality and child morbidity.      

Because of these social norms, women put their lives at risk. Jasmine, 16, is recovering in hospital and was lucky to survive after a difficult delivery at home. Jasmine’s sunken eyes and ashen face show the struggle she endured the last few days.

“She was admitted to hospital with a ruptured uterus and non–stop bleeding. As a teenage mother she was already at risk but her family did not realize it. They used a unskilled traditional birth attendant who was not able to handle her delivery properly,” Dr. Munwar Sultan said.

From an upper middle class family, Jasmine was married at 15 years of age. She lived with her in-laws only half a kilometer from the Cox’s Bazaar District Hospital.  Her husband works in Saudi Arabia. Following the traditional rule imposed by her mother-in-law, Jasmine was assisted by a birth attendant to deliver her child at home. However, she was rushed to hospital in a critical state because the birth attendant could not control the bleeding.

Bangladesh has one of the world’s highest rates of adolescent motherhood. Up to 12,000 women die from pregnancy or childbirth complications every year in Bangladesh. Adolescent maternal mortality is double the national figure.

This is not surprising, considering most Bangladeshi women deliver at home without skilled birth attendants. The low status of women, poor quality and low uptake of services all add to this problem.

Women friendly hospitals

To address this situation, UNICEF has developed a ‘women friendly hospital’ initiative. A sign at the entrance of the Cox’s Bazaar District Hospital indicates that the facility is part of this initiative.

Under this gender-sensitive approach to health care, introduced in 2007 and supported by UNICEF, women and newborn children receive priority services and support from trained nurses and doctors, women’s privacy is ensured, and hospital staff received training to sensitize them to the needs of pregnant women.

“The aim of the initiative is to promote safe motherhood while addressing social taboos and encouraging more women to come to the hospital” said UNICEF maternal health specialist Dr. Monira Parveen.

The number of deliveries at the hospital has increased from 300 in 2006 to 878 in 2008 and the number of women patients has increased by more than 200 per cent over the same period. This demand is reflected in hospital budgeting for maternal and neonatal care services.

The biggest challenge for the hospital and the Bangladeshi health care system remains a short supply of women doctors. Dr. Munawar Sultan is the only female doctor out of 40 at the Cox’s Bazaar District Hospital. She performs between five and six caesarean sections every day.

A long way to go

Although the women friendly hospital initiative has increased the number of women patients coming to the hospital, the women who receive the service often pay a high price, in the form of social prejudices and ignorance about maternal health care.

To change this widespread attitude, Mukti, a local NGO, is working to create awareness about safe motherhood and delivery in Cox’s Bazaar.

“We visit households to identify pregnant mothers and we encourage them to go to hospital or ensure delivery by a skilled birth attendant at home. In most cases, family members prefer the second option, especially in-laws who believe that visiting a doctor during pregnancy or delivery is ‘shameful’,” said Mukti Monitoring Officer Saffia Kahtun.

Combating social prejudice and raising awareness of the importance of safe motherhood are still major hurdles that Bangladesh will need to overcome to meet Millennium Development Goals.



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