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Caring community sparks hope for expecting mothers and newborns

© UNICEF/BANA2012-00818/Ahsan Khan
(Left) Lipi Bordhon, and (right) Rita Rani Boidda, Health Promoters working under the IMCI, MNCS programme supported by UNICEF, conduct a community meeting in Majidpur village, Jagannathpur Upazila in Sunamganj.

By Julhas Alam

Majidpur, Sunamgonj, Bangladesh, 11 June 2012: Thirty-one-year-old Lipi Bardhon explains elegantly how the once-reluctant people in her neighborhood are increasingly becoming caring about women, especially towards pregnant women. Lipi works as a health worker and visits door-to door to raise awareness on maternal and child health.

After years of constant effort, this conservative society, dominated by men and traditional beliefs, is gradually shifting to a positive direction. "Once I used to think that I made the difficult choice by becoming a health worker. They used to look at us with suspicion. Simply, we were unwelcome, unwarranted," says Lipi, a widow with two sons.

 "I had to work hard to break social barriers," she says."Pregnancy was a secret affair. Pregnant mothers or their kin used to suppress everything when it came to the pregnancy of a woman," she continues, "but now they are increasingly becoming open and friendly."

Many husbands were reluctant to allow their wives to go outside or mothers-in-laws used to bar their in-laws from visiting doctors as they were influenced by deep-seated superstitions or social stigma. In the beginning, when the project was initiated to reduce maternal and neonatal deaths in 2009, it was difficult for a health worker like Lipi to reach pregnant mothers.

The Maternal, Neonatal and Child Survival (MNCS) projecthas an impact in changingthe prevailing social perceptions, and a paradigm shift is clearly visiblein this remote, low-lying locality of more than 11,000 people.

Lipi says that engagement of rural opinion makers in the MNCS project, worked as an important factor to make people aware about the necessity of taking pregnant women to doctors, providing them with good diet and allowing adequate rest. 

Affirmative community action:

A group of 16 people - men and women - from various sections of society were sitting in a circle at the Majidpur Community Health Clinic premises. They meet at least oncea month to discuss the situation of the pregnant women in the community and devise ways of providing better support to the pregnant women.

Mannan is the vice chair of the Community Clinic Committee that works to create awareness among the local people about the need for providing better healthcare to the pregnant women. Mannan and his other committee colleagues monitor work of the health workers who visit the pregnant women to sensitize them about "five signs of danger" during pregnancy and about the need for better childcare.

© UNICEF/BANA2012-00851/Ahsan Khan
Lipi Bordhon, Community Health Facilitator, CHF, conducts a community meeting in Majidpur village, Jagannathpur Upazila in Sunamganj on 1 June 2012.

He says that they arrange transport, mobilize funds to send a pregnant woman to health facilities when any emergencies related to childbirth arise. They also counsel families when they find casesof negligence towards pregnant women.

 "It works like magic. No trouble maker in the family can avoid us, we convince them that they must extend help to the pregnant woman for the betterment of their families," he says.

Considering the need of the community, now the committee is thinking of raising a common fund to handle any such emergencies.

And how this campaign works, becomes clearer when Mohammad Nurul Haque, another member of the committee, says he donated a piece of land in 2009 on which this Community Clinic was built.

"I am a simple person but when I understood how serious the issue is, I donated this land," he says with pride.

Bilkis Begum, a teacher of a nearby government primary school and also a member of the committee, says: "Now, fewer women die of pregnancy-related complications". "We stand by them when they need any support. People are more aware now. Unlike before, they now understand what is good for them and what they should do," she argues.

Mohammad Abdul Ahad, another member of the committee and a village doctor, says he gets less patients with severe pregnancy related problems. “They usually visit better quality doctors in the sub-district hospital. In my locality, I have not heard of any death from pregnancy-related complications in recent months," he says.

Awareness triggers changes in care-seeking behaviour:

As Bangladesh is striving to reach the Millennium Development Goal 5, which stipulates 50 percent reduction in maternal deaths by 2015, the nation is making progress, thanks to various interventions and community awareness through programmes like MNCS.

The latest Bangladesh Maternal Mortality and Health Service has found that maternal deaths in Bangladesh fell from 322 per 100,000 in 2001 to 194 in 2010, a 40 percent decline in nine years.

"This is a great achievement, and it has been possible for the increased level of awareness of the community,” Dr.  Asutush Das, chief of a state-run 31-bed hospital in nearby Derai sub-district, says the community engagement in the programme is playing a pivotalrole in reducing deaths related to pregnancy.

In the tiny Jatrapasha village, 60-year-old Amaya Ghosh is more confident than before to help deliver her in-law's second baby. "I helped many women in my area to deliver kids at home. But with the hands-on training, I am more confident to do my job in a better way this time," she says.

"I have been working as a midwife in my village without any proper training for years. I had no knowledge of modern ways of handling the mother and the baby. But now, I am confident enough. I will teach my grand parents how to handle such cases in a proper way," a delighted Amaya Ghosh says.

"We don't wait and waste time when we understand that someone should be sent to the hospital," she continues.  "Earlier, we used to keep a mother in a dark room, we used to carry out the delivery on the floor, even during the winter. We used to keep all windows and doors closed. But now I know it was absolutely wrong," she says.

Change of perception is evident in villages as knowledge and awareness are transmitted through this programme. The project is implemented with the financial and technical support of AusAid and UNICEF and implemented by the Government of Bangladesh.



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