Why mothers are dying, and what we can do about it
“My mother-in-law insisted that the delivery be at home, as that is how most women deliver babies in our community. I went into labour late at night, and the traditional birth attendant gave up at around 3am. The pain was immense, I thought I would not make it to dawn. Somebody from the neighbourhood called a BRAC community health worker and informed about the emergency.
The next thing I remember was being assisted onto a van by a lady in a white apron with a BRAC logo on it. I think I passed out in the middle from pain. Then I woke up on a bed in a BRAC delivery centre. I looked around, the lady in the white apron was holding onto my hand and telling me ‘it is going to be fine, we have trained birth attendants here, they know how to deliver your baby. There is nothing to fear.’ Not long after that, I gave birth to my baby boy. Holding him in my arms was the most beautiful moment of my life, and it would not have been possible without the lady in the white apron.”
Rupali Begum, 25, resident of a slum in Dhamalkot, Dhaka, was saved by Shipra Rani Mridha, a BRAC community health worker.
Giving birth to a new life is meant to be one of the most beautiful life experiences. However, unfortunately, for many mothers across Bangladesh, that is far from reality.
Each year, approximately 7,700 mothers die in Bangladesh while giving birth. That is 7,700 families and approximately 30,800 people directly affected every year.
Some 830 women die every single day across the globe due to pregnancy and childbirth-related complications. This is higher than the number of people killed annually by natural disasters. The crucial question remaining in 2019 -- why are we still failing to save our mothers?
BRAC health, nutrition, and population program has been working to safeguard maternal and child health in Bangladesh since the 1980s. Here are the three major challenges to ensuring safe motherhood, based on our decades of on-ground experience and knowledge generated in collaboration with partners.
Delay in decision-making
Many families, like Rupali Begum, choose traditional birth attendants and home deliveries over skilled help and specialized facilities. In many cases, the mother is taken to the facility when it is too late. Many people do not know about the life-threatening risks of giving birth at home without skilled help. Superstition can complicate matters further and people are not able to identify the danger signs that may lead to a complicated delivery.
People are yet not used to the idea of seeking specialized support and consultation throughout pregnancy, they miss danger signs and seek specialized help too late in the pregnancy.
Delay in transfer from home to facility
After the decision has been made about taking the mother to the clinic, the next challenge is arranging safe, appropriate transportation. Transportation is hard in many remote areas in Bangladesh at any time, but the fact that a woman may go into labour during odd hours of the night makes it even more difficult.
The delay in transportation increases the risk to the mother and they are often beyond the scope of help by the time they reach the clinic.
Delay in service
Patients often do not get attended to immediately after reaching clinics. At the stage when every minute is expensive for the mother, they have to go through paperwork and wait until staff get the facility ready.
What are we doing to change the status quo?
BRAC health, nutrition, and population program takes a holistic approach to tackling the three killer delays. We ensure regular check-ups of pregnant women in the community and provide primary health care with a special focus on the following maternal and child health areas.
Our community health workers ensure antenatal and post-natal care for mothers, provide health and nutrition counselling, and educate mothers about the five crucial pregnancy danger signs. They identify initial complications, ensure proper care, and either give it directly or ensure it is provided through health facilities.
During home visits, family members of pregnant women are oriented about the risks of giving birth without skilled help at home, and about the importance of specialists and facility-based delivery. This helps in reducing the resistance towards skilled help, reducing the delay in decision-making.
During routine household visits, community health workers provide information about nearby hospitals, clinics, delivery centres, and phone numbers of nearby drivers who can take people to facilities at the time of need.
When a mother in her area goes into labour, family members immediately contact the community health worker. She accompanies the mother from home to the appropriate facility, ensuring the delay in transfer from home to facility is reduced.
To tackle the third delay (in service), BRAC establishes maternity centres and deploys referral staff in health facilities. Our 47 maternity centres across the country offer respectful maternity care round the clock to people from underserved communities.
These centres, completely run by midwives, exemplify safe delivery practices, and rates of c-section rates (10.9%) are much lower than the national average (24%). Referral staff work as a crucial linking point between the community and the facilities in emergencies, ensuring that the service is initiated as soon after the patient reaches the clinic as possible, including notifying clinic authorities to prepare beforehand while the patient is on her way.
We care about safe motherhood, for every mother. From identification of pregnancy to the birth of children and then postnatal care; we literally stand by mothers throughout every stage of this crucial phase of their lives. BRAC health, nutrition, and population program is constantly testing new approaches and engaging key partners to decrease the three killer Ds further.
Tanjila Mazumder Drishti is Senior Manager, and Morseda Chowdhury is Associate Director at BRAC’s health, nutrition, and population program.