Deiji, from Lakshminagar Char, married Rahim from a nearby village in Rajshahi. She gave birth within a year to a stillborn child and also died at the hands of an unskilled village midwife.
According to the doctor, she was in poor physical condition and had died due to lack of proper care in pregnancy.
Kalpana of Tiktiki para, a char village in Rajshahi, fell sick in pregnancy and died giving birth to her third child at home. She was first brought to an unskilled village doctor and Kobiraj. She suffered extreme convulsions and was not taken to the hospital in time, where she died.
Like Kalpana and Deiji, hundreds of women and children die without proper care in char areas like Lakshminagar Char in Rajshahi, Char Sindorna and Nayarhat, in Hatibandha upazila of Lalmonirhat, the char areas of Netrokona, and elsewhere all across the country.
Most women and children in char areas are deprived of health services due to lack of hospitals and local Shastho (health) complexes. They can’t even go to the Sadar Hospital far from the villages of char areas, because there is nothing to be found by way of transport. People in char areas have to go miles on foot over muddy roads to reach the Sadar Hospital.
Though the government has taken some initiatives to provide medical care facilities, no one wants to go to the char areas to provide healthcare. "We cannot go to the Sadar Hospital which is too far away, so we have to depend on the local Kobiraj or unskilled midwives," they complain.
“Maternal and child mortality continues to be a problem because of poor roads and transport to far away hospitals in our remote localities,” said Sadekul Islam of Char Sindurna.
“Only because of transport problems we have to depend on unskilled midwives. Pregnant women cannot go to the Sadar hospital walking through muddy roads over long distances. So she gave birth to a dead child at home and herself died suffering extreme convulsions on her way to the hospital,” Taslima's husband added.
Maternal mortality is high in Netrokona
The neonatal death rate of children under 28 days of age, is the highest in Netrokona.
Due to lack of manpower, medical services are hampered at Netrokona Sadar Hospital. There are 58 Union Health Family Welfare Centers in 86 unions of the district, but due to a manpower crisis and poor facilities, 28 unions still lack access to health services.
According to Netrokona upazila records, there are 5,507 children between the ages of one and two months. 66,086 are from zero to one year, and 3,30,435 are from zero to 5 years. The upazila has 6,35,759 women ages 15 to 49, and there are 4,49,322 House holds (HH) in the upazila .
Netrokona upazila civil surgeon Tajul Islam says Netrokona is a neglected area and that they are campaigning for institutional delivery. However, there is a risk of death in pregnancy at a young age and it would be better if antenatal (during pregnancy) counseling and checkups are done more often.
To reduce maternal mortality in the district, Netrokona Family Planning Department emphasized three tasks. The main activities of this department are to improve the quality of health services for mothers and children at the community level. In most areas of Netrokona, service recipients and services have both gone up at community clinics, compared to previous years. Mothers far away from health services are being brought to medical facilities by truck.
An intervention called 'mother assembly' is being organized to increase health awareness and services at the community level, whereby pregnant mothers gain access to initial and basic pregnancy services such as blood group diagnosis, hemoglobin examination, blood sugar screening, and counseling.
Following registration with ‘mother assembly’ , mothers are monitored. If a pregnant and at risk mother is found, she is referred to the hospital immediately. This 'mother assembly' has seen an overwhelming response at the community intervention level. Of the 222 mother assemblies, 32 were held in community centers where 19,875 mothers have been given pregnancy services.
At present, the program is directly implemented by the Health and Family Planning Department.
An effective referral system has also been introduced to bring down maternal and infant mortality and to improve the quality of services. In the program, mothers and children under five who are at risk, are referred to upazila and district hospitals from the community level, to ensure advanced services. In the referral system, direct financial assistance is given to mothers and children under five years of age.
Netrokona Family Planning Department Deputy Director Motiur Rahman said: “There is a government commitment to safeguarding motherhood. It is possible to fulfill this commitment only if everyone works together in concert. For the prevention of maternal death, registration, antenatal care (ANC), and institutional delivery are important. If these services are effectively delivered, it would reduce the mother and child mortality rate to some extent.”
“Awareness training has started in the five remote upazilas of Kalmakanda, Madan, Mahonganj, Khaliajuri, and Durgapur, jointly organized by Care Bangladesh and the government. At the same time, promotion and awareness of institutional delivery is ongoing. Lists of pregnant mothers in each union are provided to field workers with instructions over mobile phones,” he added.
According to the Bangladesh Demographic and Health Survey (2014) 5,270 mothers died giving birth to 31,00,000 children every year. In other words, for every 600 neonatal births, one mother dies.
Only 42% of child deliveries are done by trained nurses. The remaining 58% of the deliveries are done by unskilled midwives and relatives, the survey said.
According to the latest government survey, the maternal mortality rate in Bangladesh is 176 per one lakh live child births.
Dr Nurun Nahar Begum Rosy, program manager of the Clinical Contraception Services Delivery Program of the Directorate General of Family Planning, said: “Though the government has a lot of initiatives to bring down child and maternal mortality, char areas are yet to develop. There is no data on how many children are born in the char areas and what the mortality rate for women and children is. ”