N.S.M Muzzammel Huq :
Safe motherhood is normally considered as an approach and measures covering concept and conditions for ensuring women receive the appropriate services in connection with pregnancy, child birth and the post natal period, including family planning and emergency obstetric care. The basic principles of safe motherhood are neither new nor controversial. These are considered as the six pillars of safe motherhood. Family Planning, Antenatal care, Obstetric care, Post natal Care, Post abortion care and STD/HIV/AIDS control are the six pillars very important and neede for Safe Motherhood.
Ensuring safety of a mother begins from the early age-adolescent age. Proper health care, nutrition and menstrual management and in case of complicacies, proper medicare is necessary for a future mother. A girl grows up and at the age of 19 years she becomes fit for married life. In the previous days, even now a days too, child marriages are considered as one of the major health hazards causing maternal and child mortality in Bangladesh. Due to governments health care program, services and massive awareness campaign, this mortality rate has gone a downward trend but still much left to do to reach the desired level.
Ensuring safe motherhood is very much related with family planning of married couples. The newly married couple should have the information and services to plan the timing, number and spacing of pregnancies after their marriage. This will, to a great extent, ensure their safe motherhood objective keeping mother and child in a good health.
Then comes Antenatal care- which requires providing vitamin supplements, vaccinations, screening of risk factors in order to prevent complications where possible, and to ensure that complications of pregnancy are detected and treated early. For obstetric care the birth attendants must have the knowledge, skills and equipment to perform a clean and safe delivery. They must ensure emergency care for high risk pregnancies and complications for women at any cost. For ensuring post partum care to mother and baby, including lactation assistance, provision of family planning services and managing danger signs are very much important. Abortion of early pregnant women is identified as a health problem and this should be detected early and treated appropriately and related reproductive health care and proper family planning methods should be suggested as needed.
Finally to prevent Sexually Transmitted Diseases (STD)/HIV/AIDS); screening, prevention and management of transmission to baby, to assess the future risk of infection, voluntary counseling and testing and encouragement are necessary. It will be appropriate to expand services to address mother to child transmission.
We know global Safe Motherhood initiative was launched in 1987. Governments and international agencies committed to reduce maternal deaths. Since then much have been launched and most effective interventions focused on prediction and prevention of obstetric complication to trying to manage them appropriately.
It is worldwide acknowledged that almost all maternal deaths could be prevented with appropriate care. It is essential that all women are cared for by professional hands like: midwife, nurse or doctor with skill during the most dangerous period during and immediately after childbirth. Besides, it is necessary to ensure deliveries to be conducted hygienically and with accepted medical practices preventing complications that are caused or exacerbated by poor care. Prompt identification of complications and management by taking appropriate treatment is also necessary. Providing high quality, culturally appropriate and considerate care, ensuring cover follow up, services covering antenatal and post partum care as well as family planning, post abortion care and treatment of sexually transmitted infections must be ensured.
The issue ‘Safe Motherhood’ is important because, this benefits not only the woman, but also the health of newborns and children and the well being of the entire household, society and nation. Bangladesh is a country with one of the highest population density with more than 1000 people living per square kilometer. Two thirds of the population (62.6%) live in the rural areas and rest in the urban and semi urban areas (37%). The population growth rate is 1.35% (2015) and it is estimated that more than 85% of deliveries still are conducted at home and the majority of births are attended by untrained birth attendants, relatives or neighbors who are not medically trained.
Now maternal death rate in the world is 216 per 100,000 live births. Every year 30-32 lacs mother become pregnant and 12,000 mothers die in our country and every day the number of death is 15 out of 1000. In 1974 the maternal death rate was 574, now it is reduced to 176. By 2030 the rate is targeted to reduce at below 70. Added to this the age of the pregnant mother at the age of 15 is increasing and they are having more risk.
If a mother dies within 42 days of her delivery that is called maternal death. The main reasons of this death are lack of communication with hospitals, child marriage, lack of education, superstition, absence of required number of doctors and adequate primary facilities and logistics.
Haemorrhage and acclampcia are mainly responsible for half of the deaths, 7% die due to abortion complicacies and rest for different reasons. Due to widespread poverty children and mothers suffer from moderate to severe malnutrition mdit is also for our country.
Bangladesh has held a long standing commitment to improving maternal and child health. The country has made significant improvements in the health of women and children and already achieved Millennium Development Goals (MDGs) and has been marching forward to reduce maternal mortality rate at <70 by 2030 (SDGs). So the situation has improved compared to earlier times.
The Honorable Prime Minister of Bangladesh has declared the ‘Safe Motherhood Day’ in 1967 or 1997. This day is now being observed from the grassroots level covering the entire country. Gradually the people are becoming aware and sensitized about the benefits of safe motherhood, safe delivery and care after delivery. But we have to improve our service of delivery system, logistics and infrastructures to cover the hard to reach people and disadvantaged groups.
Measures like ‘ensure safe motherhood awareness campaign’ for Safe Motherhood should continue with information messages on delivery. Hospitals, Clinics, Community Clinics Union Health and Family Welfare Centers should provide essential care services in this regard. Role of Midwives and their presence in the labor room must be ensured and also followed up. Health workers of community clinic can campaign right message for safe delivery issues. Early marriage and early pregnancy should be discouraged. Prevention of hemorrhage, maintenance of surgical equipment and supply of essential medicines are required. Laboratory facilities at clinics, hospitals preservation of medicines, free ambulance service should be provided. Adequate budget allocation for improvement of maternal care standard, training of midwives, health workers should be ensured. Appointment of doctors, nurses and supporting manpower is also essential. Role of media in communicating relevant messages can create awareness and help reduce maternal death and child mortality rate. For ensuring safe motherhood Priority should be given to improving adolescent health and focusing on mainstreaming nutrition interventions is needed to reduce malnutrition.
Bangladesh has entered into the phase of developing country towards achieving the dream of a developed nation by 2041. National initiatives in different sectors are directed towards this end. In health and family planning sector implementation of best practices of Safe Motherhood giving importance and priority on adolescent girls is very much needed to discourag early marriage. This strategy can help us achieve our cherished goal as a healthy mother can ensure a healthy child and so a healthy future generation.
(PID Article)
