Dhaka, 15th September 2011: You’re a Bangladeshi woman, about to give birth to your first child in a remote area. Your mother gave birth to you at home, as did her mother to her. Generations of women all giving birth at home, usually without medical expertise. It’s easy to see why tradition would dictate that you do the same. But giving birth without a skilled attendant there can be a risky business, sometimes with disastrous consequences for the mother’s health.
Or you’re a newly married young woman, living with your husband you barely know and his mother – your new mother-in-law – at their family compound near Dhaka. You go into labour at home but it’s taking too long, way too long. You want to go to hospital but your mother-in-law doesn’t believe hospitals are a good place to give birth – in the market last week she heard about a woman who knew a woman who went to the hospital to have her baby and she died. If her daughter-in-law is going to die, she may as well do it in the comfort of her own home.
Rumour and tradition are barriers to maternal health
So you don’t get to go to hospital and have the reassurance of having a skilled birth attendant overseeing your labour, even though you’re scared and you desperately want to, and you’re begging your husband to take you, but he can’t cross his mother.
According to Sabina Faiz Rashid, a medical anthropologist living and working in Bangladesh, getting women out of the home and into the hospital to give birth is the key to cutting the maternal mortality in the country. She says that tradition, rumour and familial power relations are the main barriers to this happening.
In 2008, an estimated 358,000 women died in pregnancy and childbirth; around 1,000 women each day. Some of the main causes of maternal death are haemorrhage, sepsis (infection), high blood pressure (eclampsia) and obstructed labour. Have any of these happen to you while giving birth at home and the prognosis is usually pretty grim.
Improving access to services is key
Evidence shows that more lives could be saved if women had access to skilled attendance while delivering, and emergency obstetric care on hand in case anything goes wrong. Both of these recommendations are fundamental to achieving MDGs 4 and 5, yet only 58% of all deliveries are attended by skilled health providers, dropping to as low as four percent in some developing countries. In Bangladesh 85% of births are at home, and only 18% of all births are attended by a skilled professional. These disparities in healthcare provision are reflected in maternity mortality statistics: a woman’s lifetime risk of dying during pregnancy, giving birth or shortly afterwards is 1 in 20 in some parts of the world, compared to less than 1 in 5,000 in the US, Canada, UK, Australia and most of Europe.
An innovative voucher scheme is just one way the Marie Stopes Clinic Society improves maternal health in three underserved regions of Bangladesh. Our volunteers identify which women would benefit most from the scheme, then each woman gets a voucher card, entitling them to at least two ante-natal check-ups, one hospital admittance during their pregnancy, a hospital delivery (either normal delivery and caesarean section) and any medicine or treatment they need, and one post-natal check-up. Women are also given vouchers for travel to and from the clinic.
It’s amazing to see how some small pieces of paper can overcome the pernicious double influence of tradition and ill-informed market rumour.
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