When 19-year-old Shirin from a char village in Kurigram went into labour, her family expected a day of celebration. It was her first child. Like many young mothers in remote parts of Bangladesh, she had attended a few antenatal check-ups and everything appeared normal.
But as labour progressed through the night, complications began to develop. The nearest facility capable of managing obstetric emergencies was several hours away. There was no skilled provider nearby to identify the warning signs early.
The family initially hoped the delivery could happen safely at home. When the situation worsened, they scrambled to arrange transport. After a difficult journey, Shirin reached the nearest health facility, only to be referred onward because higher-level care was needed.
Doctors were eventually able to save her life. Her baby, however, did not survive.
Stories like Shirin’s unfold across Bangladesh every day. They represent one of the country’s most overlooked public health and development challenges.
As Parliament debated the national budget and the nation’s development priorities, one statistic demands urgent attention: every year, an estimated 63,000 babies in Bangladesh are stillborn; over 170 families every day experience this preventable heartbreak.
The country has earned global recognition for remarkable gains in maternal and child health over three decades: Reduced maternal and under-five mortality, expanded immunization, increased facility deliveries, and stronger primary care.
Yet progress has slowed. Maternal mortality remains above SDG targets, more than two-thirds of under-five deaths occur in the neonatal period, and stillbirth rates are among the highest in South Asia.
Stillbirths are a powerful indicator of health system performance. Most are preventable through timely antenatal care, skilled attendance, quality emergency obstetric and newborn care (EmONC), and strong referrals.
The impacts fall hardest on vulnerable women in chars, haors, hill tracts, coastal areas, and urban slums. Stillbirth is not only a health issue but one of equity, dignity, and economic loss. Families face high out-of-pocket costs (74% of total health expenditure nationally) while coping with grief, stigma, and pressure to conceive again quickly.
In the FY2026-27 national budget, the Ministry of Health and Family Welfare (MoHFW) has received a record allocation of approximately Tk 69,409 crore. This represents a significant increase and accounts for about 1.01–1.02% of GDP and roughly 7.4% of the total national budget.
While this substantial boost is a welcome and positive step toward addressing long-standing gaps in the health sector, it is insufficient to fully tackle the persistent challenges in maternal and newborn health.
Even at 1.01% of GDP, the allocation is far below WHO-recommended benchmarks of at least 5% of GDP in government health spending and 15% of the government budget.
Bangladesh faces acute human resource shortages, with only around 10-13 skilled health workers (doctors, nurses, and midwives) per 10,000 population -- well below WHO-recommended thresholds.
These shortages are particularly severe in rural and hard-to-reach areas, where many facilities still lack the capacity to provide 24/7 emergency obstetric and newborn care (EmONC).
Moreover, the existing system continues to struggle with quality and effectiveness. Historical data shows that the MoHFW has consistently under-utilized development budgets (often spending only 70–76% of allocated funds due to procurement delays, slow fund releases, and planning bottlenecks).
A large share of spending has gone toward recurrent costs rather than quality improvements in EmONC, referrals, or hard-to-reach services.
Development partners and NGOs working in remote areas (chars, haors, hill tracts) have made valuable contributions but often operate with fragmented, short-term projects that lack scale, coordination, and long-term integration with government systems, leaving critical gaps in 24/7 care, emergency transport, and equitable coverage.
Compounding these issues are low utilization rates of development funds, procurement delays, and chronic under-investment in quality-of-care improvements compared to infrastructure expansion. Together, these weaknesses significantly limit the health system’s ability to prevent stillbirths and achieve better maternal and newborn outcomes.
Bangladesh’s next gains in MNCH will come not from simply expanding infrastructure, but from prioritizing quality over quantity.
First, greater investment is required to strengthen quality MNCH services at primary and secondary-level facilities, where most women receive care. This means prioritizing skilled midwives and nurses, ensuring reliable supplies of essential drugs and equipment, establishing functional blood banks, and guaranteeing 24/7 emergency obstetric and newborn care (EmONC).
Second, the country must significantly improve referral and emergency transport systems, especially in hard-to-reach areas. No mother should lose her baby because an ambulance was unavailable, a referral was delayed, or appropriate care was hours away.
Third, primary healthcare and early risk identification need urgent bolstering. Community health workers and midwives should be equipped with better tools and training, including digital and AI-enabled solutions to detect high-risk pregnancies early, support the completion of recommended antenatal care visits, improve decision-making, and ensure continuity of care throughout pregnancy and childbirth.
At the same time, upstream factors such as child marriage, adolescent pregnancy, maternal malnutrition, and limited access to family planning must be addressed through coordinated multi-sectoral efforts.
Bangladesh can fast-track progress by building on proven global and regional experiences. The Every Newborn Action Plan (ENAP), a global framework launched by WHO and UNICEF in 2014, provides a roadmap with a target of 12 or fewer stillbirths per 1,000 total births by 2030.
Bangladesh has already aligned with ENAP and incorporated many of its elements into national strategies. However, despite this commitment, stillbirths remain a major challenge due to gaps in quality of care, timely referrals, and equitable coverage, particularly in hard-to-reach areas.
Stronger and more systematic implementation of ENAP principles has delivered prominent results elsewhere. Countries such as India (through its India Newborn Action Plan), Ghana, and Iran have made significant advances in newborn survival by scaling up quality care and measurement systems.
The Saving Mothers, Giving Life Initiative(SMGL) in Uganda and Zambia strengthened emergency obstetric care, referral systems, and data surveillance, achieving over 40% reductions in maternal mortality and notable declines in stillbirths in rural districts.
Community-based models using women’s groups and mHealth tools, successfully applied in parts of India, Pakistan, and sub-Saharan Africa, have also improved early risk detection and timely referrals.
Many of these approaches are well-suited for testing and scaling in Bangladesh’s hard-to-reach areas. A targeted pilot of SMGL-style interventions or expanded mHealth-supported community care in chars, haors, or hill tracts could generate valuable evidence for national scale-up while directly addressing geographic and equity barriers.
To ensure that increased investments deliver real results, the government should adopt a more strategic approach to resource allocation.
This includes shifting from traditional incremental budgeting to a need-based and performance-linked system that gives greater weight to vulnerable and hard-to-reach areas such as chars, haors, hill tracts, and coastal regions.
Special attention must be given to addressing the persistent human resource crisis. This means fast-tracking the recruitment and deployment of skilled midwives, nurses, and doctors, introducing strong incentives for rural postings, expanding training programs, and correcting the imbalanced doctor-nurse-midwife ratio.
Efficiency gains are equally critical. Reducing procurement delays, improving fund utilization rates, and strengthening stillbirth and perinatal death surveillance systems can help ensure that every taka spent translates into better outcomes on the ground.
Furthermore, MNCH efforts should be better integrated with other key sectors, particularly nutrition, education (to delay child marriage), and social protection programs. Leveraging partnerships with NGOs and the private sector can extend reach and bring innovation, especially in underserved communities.
Finally, the government should set clear, measurable MNCH and stillbirth reduction targets, while gradually raising overall health spending toward 1-2% of GDP.
These targets must be accompanied by stronger parliamentary oversight and accountability mechanisms.
Bangladesh knows what works from past successes in immunization and family planning. The question is whether we will commit the focused investments needed to finish the job.
Addressing stillbirths will strengthen the very systems that protect mothers, newborns, and families across the country. As budget priorities are finalized, let this issue take its rightful place in the national conversation. Investing here is an investment in human dignity, social equity, and Bangladesh’s brighter future.
Tamanna Ferdous is a public health professional, currently working as Director, Development Programme, SAJIDA Foundation.
