Tareen Rahman :
Recently statistics show that Bangladesh is on its way to achieving the Millenium Development Goals 5 (MDG 5) target of reducing maternal mortality. The target was to reduce the maternal mortality by the end of 2015 by three-quarters in Bangladesh.
Health and Family Welfare Ministry officials told our correspondent tthat the use of skilled birth attendants has improved over the past 15 years . Yet this number remains less than 20% as of 2007 and is especially low among poor, uneducated rural women.
According to government survey reports, the increasing numbers of skilled birth attendants, deploying them in teams in facilities, and improving access to them through messages on antenatal care to women, have the potential to reduce maternal mortality in Bangladesh.
The use of caesarean sections is increasing although not among the poor, uneducated rural women. Strengthening appropriate quality emergency obstetric care in rural areas remains the major challenge.
Strengthening other supportive services, including family planning and delayed first birth, menstrual regulation, and education of women, are also important for achieving MDG 5.
Government sources have declared that Bangladesh, with the third largest number of poor people in the world after China and India, signed onto achieving the Millennium Development Goals (MDGs) by 2015.
When queried, government spokesman told our correspondent that National policies and program implementation over the past decade and a half has helped follow through the commitment, specifically for MDG 5 (improving maternal health).
Beginning in 1994, the emergency obstetric care (EmOC) approach dominated with assistance from the United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), and the Averting Maternal Death and Disability program in the renovation and upgradation of existing facilities and training of facility staff.
With the development of the National Maternal Health Strategy in 2001, the approach broadened, building on the rights’ approach for safer motherhood and was incorporated into the ongoing Health and Population Sector Program (HPSP) and subsequently into the Health, Nutrition and Population Sector Program(HNPSP), the program that lay out the policies and program for government services.
Delivery of interventions was made through the one-stop essential services package (ESP) at the primary healthcare level with health and family-planning cadres unified under one management structure. While the ESP had five components, maternal health had the highest priority, with a focus on EmOC to reduce the maternal mortality ratio and basic obstetric care for the promotion of good practices and for the early detection of complications and appropriate referral.
Even when the Government moved away from the unified management structure and one-stop ESP in 2001, the focus remained the same.
To complement the facility approach to obstetric care, a skilled birth attendant strategy was initiated in 2001 with guidance from the World Health Organization (WHO) and UNFPA. The skilled birth attendants (SBAs) are to provide normal safe delivery in homes and referral to the EmOC sites.
The Government of Bangladesh (GoB) began training of community SBAs (CSBAs) for six months at the district level starting from the pool of 24,000 field-based female health and family-planning workers .
By the end of 2007, about 3,000 had been trained; a further 1,000 are to be trained yearly to achieve complete coverage, theoretically in a decade.
