Agile tricycle ambulances transport dais from the health centres to mothers in need and vice versa. Photo: UBINIG
Bangladesh has a high rate of maternal mortality—about 194 per 1,000 births in 2010—but this is steadily falling. And the Primate’s World Relief and Development Fund (PWRDF) is helping the developing country to reach its targeted reduction to 143 maternal deaths per 1,000 by 2015.
The leading causes of these deaths are hemorrhage, eclampsia (a condition of pregnancy arising from high blood pressure and leading to coma) and obstructed labour, visiting Bangladeshi speaker Parash Baral explained recently in an informal address at Anglican Church House in Toronto.
In Bangladesh only 20 per cent of pregnant women are delivered by mainstream medical professionals; more than 70 per cent of mothers seek care from traditional, unpaid birth attendants known as dais. “The dai is a highly respected and trusted member of the community,” said Baral, a project manager for the NGO UBINIG. “She will drop whatever she is doing and immediately go to a woman in need of care.”
The PWRDF is currently partnering with the Canadian International Development Agency (CIDA) and UBINIG to provide enhanced training for these attendants.
Speaking on April 17, Baral explained how PWRDF funding is providing better access to prenatal, neonatal and child health care in 15 selected districts from different areas of Bangladesh, each with it own culture, language, food and geographical conditions.
New training programs not only enhance the dais’ existing midwifery skills and knowledge of medicinal plants, but also enable them to provide nutritional counselling to improve the diets of mothers-to-be. “The dais are trained to understand problems faced by pregnant women and the signs of a problem pregnancy, as well as trained in nutrition and maternal and child health care,” said Zaida Bastos, a PWRDF program co-ordinator. The current training project involves 650 midwives selected out of 778.
Care is based in maternal health centres called daighors, which are constructed with start-to-finish input from local leaders and with locally available building materials, from bamboo to bricks and corrugated tin “The centres have to be built back from the road to ensure privacy and they have to have an open space in front for meetings,” said Baral.
Increasing numbers of villages are turning to the daighors for maternal and neonatal care, with some serving many more villages than originally intended.
The PWRDF project, which ends in 2015, is also funding the construction of fleet of ingenious tricycle ambulances to transport mothers in need of care to the women’s health centres, as well as several flat-bottomed boats to ferry the ambulances across Bangladesh’s many rivers. “Each river has unique currents and winds, and it can take a couple of hours to get across,” Baral said.
The PWRDF-CIDA-UBINIG project will serve 130 villages in the 15 districts. UBINIG (Unnayan Bikalper Nitinirdharoni Gobeshona) was established in 1984 in Dhaka as a research, policy and advocacy agency.