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New programme empowers Bangladeshi families to make more informed health choices

© UNICEF/2010/Saikat
Chaity Tripura, 22, is one of many mothers in the Chittagong Hill Tracts region of Bangladesh who received support from a new UNICEF-supported programme.

By Nailmul Haq and Jesse Mawson

BANDARBAN, Bangladesh, 25 August 2010 – Chaity Tripura, 22, is the very 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, Ms. Tripura 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,’’ said the young mother.


Risk in remote areas

Ms. Tripura and her husband live in the remote Bangladeshi village of Changyai Tripura Para, some 8 km from the centre of Bandarban city. Populated largely by indigenous people, Bandarban makes up part of the country’s Chittagong Hill Tract region, which is characterized by dense green forests and unforgiving hills. While beautiful, the geographical isolation of this area makes delivering health services a challenge.

© UNICEF/2010/Saikat
Sumati (left), 25, is a trained Community Mobilizer (CM) in Bangladesh's Chittagong Hill Tracts region. She works to help improve maternal and child health in her local community.

“My hands and legs swelled up in the weeks before my daughter’s birth,” said Ms. Tripura. “I frequently fainted.”

Ms. Tripura’s in-laws grew so concerned about her condition that they eventually took her to the district hospital.

“I spent about 4000 taka [$57] to rent a vehicle and buy some medicine,” said Mr. Tripura, 25, who works growing fruits and spices. The amount is substantial here, but thanks to some good advice, the young husband had been saving money since his wife became pregnant.

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

Informed choices

Many mothers and families in remote areas of Bangladesh are now realizing that maternal and infant deaths can be prevented if early action is taken. This increased flow of information is due in large part to a programme known as ‘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 disseminates information via a network of Community Mobilizers (CMs) who track down newly married couples and register pregnant women and children under five years old. CMs also provide couples with counselling to build awareness, help identify danger signs during pregnancy, and emphasize the need for proper nutrition.

“The programme is designed to empower families to make informed choices about maternal and child health care,” explained Aung Chano Marma, the programme’s local district coordinator.

It is also contributing to helping Bangladesh meet the United Nations Millennium Development Goals target on improving maternal health. The MDGs, a set of internationally recognized targets for reducing poverty worldwide, call for reducing the maternal mortality ratio by three-quarters by the year 2015.

Changing attitudes

In order to achieve their aims, CMs must address many traditional beliefs about pregnancy and childbirth that remain 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,” said Sumati, a CM who has been advising Ms. Tripura since she was four months pregnant. “Unfortunately, traditional beliefs still prevent many families from seeking modern health care 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.”

To bring about a change in attitudes and practices, CMs work not only with families and individuals, but with entire communities through community support groups.

Community support group 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 immunization centres to ensure that newborns receive vaccinations.

“Our goal is to take an integrated approach,” said Ufo Sway Marma, a member of the support group in the village of Kuhalong. “If necessary, we arrange loans for poor families to ensure that pregnant women and newborns do not suffer.”



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