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Support for mothers in the Chittagong Hill Tracts

© UNICEF/2010/S.Noorani
25 year-old Sumati (left) has been trained as a Community Mobilizer. to help improve maternal and child health in her local community. Sumati has been providing guidance to young mother, Chaity, since she was four months pregnant.

By Naimul Haq and Jessie Mawson

Chhangyai Tripura Para, Bandarban, 21 July, 2010 : Twenty-two year-old Chaity Tripura is a picture of serenity as she stands outside her two-room home, cradling her one month-old daughter in the warm afternoon air.

As her husband, Johon, watches on, Chaity sings softly and pulls aside a thin layer of cloth, allowing the sunlight to bathe her baby’s skin. “I was very lucky to deliver my child in a hospital,’’ says the young mother.

Chaity and Johon live in the remote village of Chhangyai Tripura Para, some eight kilometers from Bandarban city centre. Populated largely by indigenous people, Bandarban makes up part of the Chittagong Hill Tract region of Bangladesh and is characterised by dense green forests and unforgiving hills. While beautiful, the geographical isolation of this area makes delivering health services a challenge.

Recognising the risks

 “My hands and legs swelled up in the weeks before my daughter’s birth and I frequently fainted”, says softly spoken Chaity.

Chaity’s in-laws grew so concerned about her condition that they eventually took her to the district hospital in a ten-seater vehicle known as chander gaari. “I spent about 4000 taka (US$ 57.00) to rent the vehicle and buy some medicines,” says 25 year-old Johon who works growing fruits and spices. “When my wife got pregnant, I was advised by our councillor to save money for the delivery, so I had been saving in a piggy bank”.

On arrival at hospital, Chaity was admitted immediately and, three hours later, she gave birth to a healthy baby girl.

Making informed choices

Like Chaity, many mothers and families now realise that maternal and infant deaths can be prevented if early action is taken. This is thanks in part to a programme called ‘Maternal, Neonatal and Child Survival Interventions’ which has been operating in the Hill Tract districts since late 2008.

Funded by UNICEF and implemented by the Government of Bangladesh, “the programme is designed to empower families to make informed choices about maternal and child healthcare issues,” says Aung Chano Marma, District Coordinator of UNICEF’s partner in the field.

Information is disseminated via a network of Community Mobilizers (CMs) who track down newly married couples and register pregnant women and children under five. CMs provide couples with counselling to build awareness around maternal and child health-related issues, help identify danger signs during pregnancy, and emphasize the need for proper nutrition.

© UNICEF/2010/S.Noorani
Chaity (22) who received guidance from the UNICEF-supported ‘Maternal, Neonatal and Child Survival Interventions’ programme, holds her baby girl in the remote village of Chhangyai Tripura Para, Chittagong Hill Tracts, Bangladesh.

Changing attitudes

In order to achieve their aims, CMs must address many traditional beliefs about pregnancy and childbirth still prevalent in Hill Tract communities.

“It’s a challenge to build awareness in tribal areas where literacy rates are some of the lowest in Bangladesh,” says Sumati, a CM who has been advising Chaity since she was four months pregnant. “Unfortunately, traditional beliefs still prevent many families from seeking modern healthcare during pregnancy and childbirth”.

 “When ideas have been handed down from generation to generation it’s hard to melt the ice, so it often takes repeated attempts to convince people, particularly the elderly, that changing practices will benefit them.”

Promoting a culture of care

To bring about a change in attitudes and practices, CMs work not only with families and individuals, but with entire communities. To this end, CMs work in conjunction with Community Support Groups (CSGs). “Our goal is to take an integrated approach”, explains Ufo Sway Marma, a member of the CSG in the village of Kuhalong. “If necessary, we arrange loans for poor families to ensure that pregnant women and newborns do not suffer”.

CSG members are advocates for skilled care before, during and after childbirth. Accordingly, they discourage home delivery for complicated pregnancies, arrange to have expecting mothers checked by trained nurses or physicians at community clinics, and link new mothers with immunisation centres to ensure newborns receive vaccinations.

The work of CMs and CSGs in Hill Tract communities certainly seems to be paying off. Once-defiant Hill Tract elder, 65 year-old Muihla Marma, now agrees that her expecting daughter-in-law should deliver her second child in hospital.

This project is funded by AusAID

• Photo Essay: Improving the Health of Mothers and Newborns
• Factsheet: Maternal and Neonatal Health in Bangladesh



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