A rising number of pregnant women in rural Bangladesh are choosing hospital deliveries for their children as they do not trust home deliveries by midwives to be safe.
Traditionally, women in rural parts of the country have preferred home deliveries over hospital deliveries, but this trend appears to be shifting as more women become aware of the risks associated with childbirth and the pressing need for midwives with proper training.
According to the Bangladesh Bureau of Statistics (BBS), 47% of women still get their children delivered at home, but only 3% of midwives are properly trained.
Dr Gulshan Ara, a gynecology and obstetrics specialist and surgeon, told Dhaka Tribune: “Home delivery by an unskilled hand poses many immediate and long-term risks to both the baby and the mother. Obstruction in delivery occurs in many cases, or the delivery is done without determining the position of the baby. This may tear the uterus and colon or cause other injuries to the mother and baby by placing extra pressure on them.”
Uterine prolapse is one of the long-term problems that may develop from improper childbirth, she added.
The risks associated with childbirth at home can be reduced by training more midwives, but initiatives to address the issue in the country have so far focused on promoting hospital deliveries. One such initiative is the Gender Mainstreaming in Maternal & Child Health and Nutrition Project of World Vision Bangladesh, funded by the Korea International Cooperation Agency (KOICA).
Dhaka TribuneThe project commenced its operations in March 2021 and will continue to run till December of 2023. It aims to improve the nutritional status of children under the age of five and reduce the prevalence of diseases among them, in addition to promoting hospital deliveries.
According to Project Manager Jaganmay Prajesh Biswas, the initiatives taken to promote hospital delivery under the project include timed and targeted counseling, timely antenatal check-ups and birth planning, and referring pregnant women to hospitals through community clinics. The project is also looking to raise awareness among men to help them play a greater role in pregnancies.
One of the project areas is Dabar union of Kaharole upazila in Dinajpur.
“In the last one and a half years, we have found massive changes in this area. Our baseline evaluation found the institutional (hospital) delivery rate to be 56.1% at the start of the project. The rate rose to 81% by July 2021, and to 84% by June 2022,” Biswas said.
Pijush Kumar Roy, health care provider at the Kamor community clinic in Dabar, said: “Even five years ago, rural women here did not come for regular checkups when they were pregnant. Now, they are showing interest.”
He added that about 5% of the women in the village had been referred to district hospitals with uterine prolapse. The total population of the village is 21,941, of whom 10,852 are females.
While visiting the clinic with her 23-year-old daughter-in-law recently, Gheya Rani, 55, told this correspondent: “I have been suffering from uterine prolapse for a long time. Recently, my daughter-in-law Lipi told me she was facing the same problem, so I brought her here.”
Most of the women visiting the clinic were between the ages of 22 and 35. About 30% of them were pregnant for the first time.
Sumita Rani Roy, who was seven months pregnant, said her mother-in-law and sister-in-law had both lost children during home delivery.
“We women don't want to give birth with risks anymore. So I am planning for delivery at the hospital. Many women here are having normal delivery at the hospital,” she added.
The Bangladesh National Strategy for Maternal Health (BNSMH) 2017-2030 was taken up by the government with the aim of improving maternal care. According to a government study, institutional delivery has increased by 50% since the strategy was adopted.