Rifat Zafreen :
Sokhina is at her advanced stage but it has been decided not to take her to hospital. So midwife is her last resort. She is panicked and anxious thinking of her baby and her life. Traditional ‘dai’ is not a very safe idea in this situation of which most of our rural expecting mothers are to depend. And it is one of the prime causes of maternal and neonatal death in our country while most of the rural mothers risk delivering their babies at home.
‘Dai’ or traditional birth attendants are doing much harm than doing good and in the village life still the role of ‘dai’ or quack doctors is not undermined. In this situation in place of ‘dai’, skilled birth attendant with skill and trained midwives are must to stop maternal and neonatal death in the country.
Upazilla Health Complexes are not exactly always the next door for most of the rural people, also for those who are not connected with the few roads running through the village, of whom the only way of getting about places is to have a tight rope-walk across the thin ails (mound of earth separating one field from the other). This would prove exceptionally difficult for a heavily pregnant mother, or one approaching labour. In this situation it is easily and reasonably preferred house births for them.
Besides, strong, conservative and patriarchal traditions have made it difficult for the expecting mothers to go outside, much less to go to a hospital where there are male doctors. And thus most of the time the whole village depends on these traditional ‘dais’.
To rescue these helpless mothers, government and other partners have undertaken training programme named Community Skilled Birth Attendant (CSBA) for midwives to conduct skilled delivery at home and more than 700 of them have so far been trained up. These midwives are trained in the theoretical knowledge of anatomy, obstetrics, hygiene and first aid. Under this programme midwives learn all these subjects through apprenticeship. These midwives practice in their communities as skilled attendants with both of their practical knowledge and modern scientific expertise after completing this training.
This midwifery diploma programme, facilitated by the James & Grant School of Public Health of BRAC University, is envisioned to complement government’s ongoing midwives training programme to train 3,000 midwives by 2015.
Government has such many other programms across the country. Of these, some courses are short training sessions while others have lengthy diploma-level modules. But this is true, it is really very difficult to teach these courses to the semi literate and illiterate trainees.
Considering this factor it would be most effective if midwifery is taught to the girls who have passed high-school. Bangladesh Nursing Council has taken initiative to provide a government diploma course in midwifery to make sure that this branch of medical care can protect the pregnant mothers at the rural levels.
Ministry of Health and Family welfare has recently reiterated its commitment to ensure half of the delivery’s to be attended by Skilled Birth Attendants (SBA) by 2016 in the declaration ceremony of ‘Ending Preventable Child Death : Bangladesh Call for Action.’ Under this declaration it has also been committed to encompass the target of SBA up to 80 percent birth coverage by 2020. Currently, one third (32 percent PDHS 2011) of Bangladeshi women gave birth by the assistance of skilled birth attendant. Delivery by skilled birth attendant is a prerequisite to ensure maternal and newborn’s safety as it may not always be possible to rush a woman in labour, immediately to a hospital.
To ensue SBA as a health facility, MOH & FW has started the midwifery programme in the country. Under this plan four midwives will be posted in each Upazilla Health Complex to ensure round the clock service provision for pregnant mothers. There will be 8 midwives at a District hospital and 12 in each medical college hospital to ensure delivery services.
We can thus hope, very soon our pregnant mothers will be taken care by the skilled birth attendants in place of traditional ‘dai’ during their crucial time. In order to make these mothers along with their family members interested in skilled birth attendants and understand the importance of their service, media can play a very vital role in this case. They should be made aware of the importance of having a safe delivery for which skilled birth attendants are of no alternative and it is must for having a healthy and lively generation for us.
PID-UNICEF Feature
