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Midwifery transforms childbirth risks in Bangladesh

  • Published at 02:13 am May 14th, 2018
Midwifery transforms childbirth risks in Bangladesh

A generation ago, Bangladesh was considered one of the riskiest places in the world in which to give birth. 

That bleak picture has improved significantly thanks to the prioritization of effective interventions for maternal and newborn health by the Ministry of Health and Family Welfare (MoHFW), with support from Unicef and other partners.

“During the 1990s, few people had access to delivery in health facilities or under trained midwives, but the scenario has changed,” Subhash Chandra Sarkar, additional secretary (Nursing and Midwifery) of MoHFW, said. 

In 1990, over 241,000 newborns died across the country while the neonatal mortality rate was also staggeringly high, at 65 deaths per 1,000 live births.

By 2016, the death toll had been reduced to 62,000 while the mortality rate had fallen by two-thirds, to the current rate of 20.1. 

“The quality of the health service sector has improved,” Subhash Chandra Sarkar said. “Most deliveries are now aided by trained midwives or done at health facilities (and) midwives undergo a three-year diploma training now.”

Subhash said the next recruitment round of these diploma-holding midwives will take place in a few months. “We hope that this will help Bangladesh reduce the current death rate of newborns,” he said.

The figures for Bangladesh compare favourably to other low-income countries, where the average is just over 20 deaths per 1,000 births. Among its South Asian neighbours, India has 25.4 deaths per 1000 births and Pakistan has 45.6 deaths. India accounts for almost a fourth of global child deaths and Pakistan accounts for a tenth, while Bangladesh accounts for just 2 percent child deaths worldwide, according to Unicef’s Every Child Alive report published earlier this year.

Despite Bangladesh meeting UN Millennium Development Goal (MGD) 4 on reducing infant mortality, there is still much work to be done. Earlier this year, a Unicef report ranked Bangladesh at No.8 in the world in terms of the total number of newborn deaths per country in 2016. 

“Though Bangladesh is among the top 10 countries still, what we have to recognize is that we have improved a lot,” ShaminaSharmin, a newborn health specialist with Unicef, said. 

“Bangladesh has set an example by implementing the National Neonatal Health Strategy to reduce the newborn death rate (by 4% every year).”

The Unicef report said nine out of ten (88%) neonatal deaths in Bangladesh were attributable to one of four causes: birth asphyxia, prematurity or low birth weight, sepsis, or meningitis.

ShaminaSharmin said a lack of basic awareness in communities is a major obstacle to making further improvements to the mortality rate.

“All reasons behind newborn deaths are preventable,” she said. “Many (new parents) do not know that they cannot take their newborn for a shower for the first 72 hours of their birth. They also do not know the five danger signs during pregnancy or childbirth, or even where to go if they see any of the five dangerous signs.”

Shamina said Unicef is working on television dramas and public service ads to raise more awareness on these issues.

“For a long time Unicef has been working with the government advocating developing protocol, policy, strategy and providing technical support by training health service providers along with updating new technology,” she said. 

For its part, MoHFW has introduced Special Newborn Care Units (SCANUs) in 44 districts to provide specialized care for ill newborns in public hospitals. 

The service will be expanded in the remaining 20 districts over the coming years.

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