Since the Covid-19 pandemic started spreading around the world at the beginning of this year, health workers in Bangladesh did not stop providing family planning and maternal health or pregnancy-related services. However, people have been strongly discouraged to conceive amid the pandemic for their own safety, experts have said. They have also emphasized ensuring family planning services to people amid the pandemic
Their take on the matter came forth during the latest edition of Bangla Tribune’s weekly Boithoki on October 3. Moderated by journalist Munni Saha, the virtual roundtable was aired live on private TV channel ATN News and on Bangla Tribune’s Facebook page
Int’l community, govts must achieve SDGs
Addressing the roundtable, former International Federation of Gynecology and Obstetrics (FIGO) president Prof Sir Sabaratnam Arulkumaran said all countries had pledged to contribute .7% of the GDP when the Family Planning 2020 program was formulated. However, some countries did not follow through.
These countries either contributed .2% or .4% citing either the coronavirus pandemic or economic recession, he said, stressing that the governments’ pledges and contributions were most important.
Prof Arulkumaran, also the adviser of the FIGO PPIUD Initiative, said most of the contribution, 60-70%, was made by different organizations such as UNFPA and USAID.
He opined that the international community and the governments will have to take responsibility to achieve the SDGs in this regard.
‘We decided quickly as WHO could not’
Dr Md Sharif, the director of Maternal and Child Health Services under the Directorate General of Family Planning (DGFP), said: “We were left dumbfounded with concerns over health [services] and livelihoods when the [novel] coronavirus started spreading. Still, led by the prime minister, the Health Ministry took some steps.
“When the World Health Organization and others were unable to decide what to do regarding the coronavirus, we decided to keep our hospitals open. Three major hospitals in Dhaka were kept operational.”
At the time, he said, the government also decided to turn Lalkuthi Ma O Shishu Kalyan Kendro into a hospital dedicated for Covid-19 patients. “We also decided to keep such hospitals for mothers and children in the district and upazila levels operational. While we managed to do that from day one, we could not keep the hospitals in union level open for the first 15 days.”
Dr Sharif added that the country’s health workers risked their lives to continue treating people as there was a shortage of PPE and masks at the beginning of the pandemic.
“At the beginning, we, including the Directorate General of Health Services [DGHS], also issued some circulars in a bid to raise awareness against conception amid the pandemic. We also provided safety equipment on time to ensure maternal health services,” he said.
Pandemic is not the time for pregnancy
Speaking at the Boithoki, Prof Sameena Chowdhury, the president of Obstetrical and Gynaecological Society of Bangladesh (OGSB), said they held an emergency executive committee meeting in mid-February when the coronavirus was raging through China’s Wuhan.
“In that meeting, we decided on how we will continue working and supporting the mothers under such circumstances.
“Right off the bat, we decided that we will provide services through telemedicine. Our members agreed. Then we distributed leaflets with some proposals, first of which was asking people to not get pregnant at this time,” she said.
Prof Sameena said they finalized their plan to respond to the situation by prioritizing this issue back then. At the time, it was hard for general people to access health services as everyone’s concentration was on saving people from the coronavirus — which also led to less priority to maternal health services.
“It has also seen that the pregnancy rate increases during any kind of crisis,” she added.
Telemedicine was the way
Prof Saleha Begum Chowdhury, the secretary-general of OGSB, said they worked jointly with the DGHS control room from the start.
“At the time, apart from alerting people that getting pregnant was not safe [amid the pandemic], we provided emergency services — including guidance to those who were already pregnant — and consultations through telemedicine every day.
“We also asked them [pregnant women] to contact us if they faced any kind of complications. We also guided them on when to go to the hospital,” she said.
Prof Saleha added that their organization had over 2,000 members — all of whom are trained professionals. “We made a collective effort when it came to providing health services.”
‘We knew coronavirus will not go away easily’
Prof Parveen Fatima, the national coordinator of the OGSB FIGO PPIUD Project, told the roundtable that they worked with many women who were getting impatient and suffering from anxiety as they were either getting older, had waited too long to conceive, or were unable to get pregnant.
“We do not know where Covid-19 [pandemic] will take the future generation. But, at the outset of the pandemic, we understood that the coronavirus will not go away easily considering the way it was spreading. So, we cannot sit idle too.
“That’s why we want all safety measures ensured, which will protect us from Covid-19, because we cannot stop treating people. Our main target is also to raise awareness,” said Prof Parveen.
Worldwide, 211 million pregnancies are estimated to occur every year and currently, more than 40% are unwanted pregnancies, she said. Of the 40% unwanted pregnancies, about 50% end with abortion, often in unsafe conditions that threaten the mother’s health and life.
About 16 million adolescent girls aged between 15 and 19 give birth every year, and one million are under 15. They are much more at risk of incurring fatal complications while giving birth than women over the age of 19, Prof Parveen added.
States must continue to ensure access to contraceptives and family planning even during Covid-19 pandemic, which is a human right protected by international law, she said quoting UN human rights experts. “If we want to avoid maternal deaths, it is essential to prevent unwanted pregnancies through access to contraception, safe abortion services, and quality post-abortion care.”
In 2015, FIGO proposed OGSB to work for the unmet need of contraception in Bangladesh as the institutional delivery increased from 17% in 2007 to 50% in 2017-18 and the unmet need was stagnant for a decade, she said.
There were women who wanted to limit their pregnancy and also were not using any modern method, which led to unintended pregnancy and maternal mortality. Moreover, 30% of women discontinued any method of contraception within a year.
PPIUD is a method which can provide immediate post-partum contraception benefit if inserted right after delivery. This gives the client immediate protection and also freedom from taking any daily methods for 10 to 12 years or until she wants another pregnancy. Also, PPIUD does not require the women to come back to the health facility regularly nor does it require buying any commodity — making it highly cost effective for the women.
Unwanted pregnancy may hike mortality rate
Joining the discussion, UNFPA’s Sexual and Reproductive Health Specialist Dr ASM Hasan said information and service were every citizen’s rights. “But we have seen that many people have been affected in many ways, including health, social and economic, due to this global pandemic.
“Many also had difficulty accessing family planning services or information. Because of which, the number of unwanted pregnancies may increase in Bangladesh like other countries.”
He feared that if unwanted pregnancies increase, it may lead to a rise in maternal and child mortality rate.
“It will have a huge impact on our overall healthcare system,” Dr Hasan added.
Opportunity for private practice
OGSB Vice President Prof Farhana Dewan said the coronavirus pandemic has given them the opportunity to practise privately in two ways.
“One is telemedicine. When we started, none of us left the house and they [patients] didn't come either.
“Currently, we are sharing a method, which we received during training, with those who need them after delivering [babies] nowadays. All in all, we are providing equal services through private practice,” said Prof Farhana, also the deputy national coordinator of the OGSB FIGO PPIUD Project.
Delivery at home going up
Public health expert Dr Abu Jamil Faisel, a member of the DGHS’ Covid-19 Public Health Advisory Committee, told the roundtable that the rate of child marriage in Bangladesh has gone up recently by 13%.
“These girls need to be taught about birth control so that they do not get pregnant. We also need to think more about giving birth control methods to the adults only.
“Those who got married at an early age are getting pregnant to prove that they can conceive, but these pregnant mothers are the ones who face many problems. Among them, the maternal mortality rate is also much higher,” he said.
The sexual and reproductive health specialist also added that because of the pandemic, the number of baby deliveries at home has significantly increased.
“Earlier, 50% deliveries had taken place at homes, but the rate is now about 70%,” he added.