SEATTLE — Bangladesh has made notable progress in ensuring access to health care services throughout the country, especially with the help of community health workers. Maternal mortality rates have declined from 569 in 1990 to 176 per 100,000 live births in 2015 and neonatal mortality also fell from 64.1 in 1990 to 18.4 per 100,000 births in 2015. Given the importance of community health workers, the government, along with NGOs, has been training midwives to further reduce maternal mortality in Bangladesh over the next few years. Here are some additional statistics about maternal mortality rates in Bangladesh:
- As of 2012, there are 5.09 million pregnancies in the country each year, with only 3.26 million childbirths being attended by skilled health care workers.
- Only 41 percent of the existing health workforce is available for providing maternal and newborn health interventions.
There are several opportunities for midwife training in Bangladesh:
- In 2008, WHO provided technical assistance to develop a six-month post basic course curriculum, also known as the Certificate in Midwifery Program, along with a three-year diploma curriculum.
- UNFPA also provided additional technical and financial assistance. UNFPA and WHO have been supporting 20 training centers for the Certificate in Midwifery Program in the country.
- In September 2010, the Prime Minister of Bangladesh made headlines, announcing at the U.N. General Assembly Special Session that the country would train around 3,000 midwives by 2015. In order to reach this target, the government launched a three-year Diploma in Midwifery Program in 2013 under its 2011-2016 Health, Population and Nutrition Sector Development Program (HPNSDP).
- In 2010, 1,487 midwives were already certified under the Certificate in Midwifery Program.
- The government’s diploma program started with around 525 students across 20 nursing institutes and then expanded to 925 students in 38 institutes by 2016.
Developing Midwives Project
BRAC University (BRACU) also introduced its own three-year Diploma in Midwifery course under the Developing Midwives Project funded by the U.K. government in 2012. This marked the first initiative from the private sector to train midwives. The project aims to train around 1,200 midwives by 2021. It is free of cost and targets students from vulnerable and marginalized communities.
- The student demographic as of 2018 consists of around 256 students from farmer families, 238 from families that solely rely on small businesses, and some from families with small job holders such as support service holders, security guards, etc.
- The Developing Midwives Project is being implemented in seven academic sites across Dhaka, Sylhet, Mymensingh, Khulna, Dinajpur and Cox’s Bazar.
- Collaborating NGOs include Friends in Village Development Bangladesh (FIVDB) and Shimantik, Garo-Baptist Convention-Christian Health Project (GBC-CHP), Partners in Health and Development (PHD), World Mission Prayer League (LAMB Hospital) and Hope Foundation.
- Around 148 graduates from this program have been recruited by different organizations to work in refugee camps or health care centers. As of 2018, around 3,200 deliveries took place with the help of these graduates in the Rohingya refugee camps in Cox’s Bazar, giving an estimate of each midwife delivering about 25 babies between March-October 2018. This further signifies the importance of training midwives to reduce maternal mortality in Bangladesh.
Hope Foundation, which has been providing healthcare to deprived women and children around the country, including Rohingya individuals, has been deploying newly graduated midwives to the rural areas of Cox’s Bazar as the focal points for maternal health in those communities.
Approximately 90 percent of women usually give birth at home in Cox’s Bazar, without the assistance of any skilled healthcare worker, thus reflecting the necessity of trained midwives in the region. Trained midwives would also help raise awareness about the importance of antenatal and postnatal care, maternal malnutrition, etc.
Overall, training midwives to reduce maternal mortality in Bangladesh is an effective and important tool. Maternal mortality in the country is expected to decrease from 194 per 100,000 live births to 35 per 100,000 live births, while infant mortality is expected to drop from 52 per 1,000 to 12 per 1,000 live births with the help of these trained midwives, saving approximately 36,178 lives. Investing in midwives would bring about a return of 16.2 percent. It serves as a meaningful investment, especially in countries with high maternal and child mortality rates.
– Farihah Tasneem