Providing Quality Reproductive Health Services to Women in Bangladesh

MANIKGANJ, Bangladesh—This bustling farming community, 70 kilometres south of Dhaka, is a town of narrow dirt lanes, clogged with humanity and every conceivable form of transport, from rickshaws and bullock carts to tricycles, motorcycles and battered pick-up trucks loaded with bawling goats. At the end of a quiet cul-de-sac off the main road is a nondescript two-story concrete building—the local Mother and Child Welfare Centre. Though it resembles hundreds of others in this overcrowded nation of 146 million people, this is no ordinary health clinic.

"Thanks to UNFPA’s assistance this clinic is now a centre of excellence for the entire country," points out Dr. Syeda Akhter Tahmina, the centre’s petite head doctor.

“What makes this centre different from most is that we offer a complete array of maternal and child health services under one roof,” says Dr. Tahmina. “We provide comprehensive reproductive health and family planning information and services, including emergency obstetric care, testing and treatment of STIs [sexually transmitted infections], and HIV/AIDS prevention and counselling. We even cater to the needs of married adolescents, a group bypassed by services in the majority of health centres.”

The centre, one of nine in the entire country, has two full time doctors, three paramedics, two nurses and support staff. The facility also boasts a fully stocked pharmacy, including a range of modern contraceptives supplied by UNFPA.

With UNFPA assistance, 25 Mother and Child Welfare Centres in major urban areas, largely in Dhaka and Chittigong, have improved their outreach and service delivery, providing better quality services oriented to women and children. One of the government's primary health targets during the current UNFPA programme cycle (2003-2005) is to provide the same high-quality mix of services available in Manikganj in at least one clinic in each of the country’s 64 districts. By the end of 2005, the government anticipates that this goal will have been reached. 

Still, much remains to be done. Most health centres, especially in rural areas, offer only rudimentary health exams, are plagued by shortages of contraceptives, have no counsellors and are not equipped to handle obstetric emergencies.

Though the country’s total fertility rate has dropped from over six children per woman in the 1970s to just under four today, maternal mortality remains unacceptably high at 320 deaths per 100,000 live births. A high proportion of deaths are attributed to a lack of emergency obstetric services and trained personnel.

In a breezy second floor recovery room, Hamida Akhter has just given birth to her second child, a healthy baby boy. “I wouldn’t even consider giving birth at another clinic,” states Hamida with finality. “This facility caters to the needs of women and children and if I had a difficult delivery I know they have the skill to perform a C-section.”

Hamida admits that this is likely to be her last child. “I was taking contraceptives, in the form of injectables, between pregnancies,” she says shyly. “This was a planned pregnancy, not an accidental one. Both my husband and I agree that two children are enough. We want to be able to educate both of them and give them a bright future. So now I will probably start using a long-term contraceptive like Norplant.”

Currently, 54 per cent of women in Bangladesh practise family planning, an increase of nearly 50 per cent in three decades (a 10 per cent increase from the period 1994-2004). In 2002, the government was providing 16 per cent of the public sector contraceptive requirements, with the bulk supplied by donors, principally USAID and UNFPA. In 2003, the Ministry of Health and Family Welfare increased its budget for contraceptives in a concerted drive for greater self-reliance in the provision of family planning services.

“Before this centre upgraded its services, women with complicated pregnancies had to go to a hospital in Dhaka to get proper medical attention,” points out Hamida. “Some of them didn’t make it in time. One of her primary school classmates, who married at 15 and got pregnant at 16, bled to death on a back of a horse cart on the way to the hospital. “If she had access to these services, she would still be alive today,” sighs Hamida.

Dr. Tahmina agrees. “We get 50-60 clients a day here,” she observes. “They come from all over this region because they know we offer quality services designed for women and children. Not one woman has died in this centre from complications.”

Downstairs, a receptionist screens all clients before they see one of the doctors or nurses. In the waiting room, women with newborn babies watch a video on breastfeeding. “We take every opportunity to educate women on reproductive health and baby care,” says Dr. Tahmina. “We also advise them on proper diets during pregnancy and personal hygiene.”

Dr. Tahmina admits that without UNFPA assistance, which provided training for staff on provision of better quality reproductive health services and counselling, as well as equipment, "we would not be able to provide this level of service to women and children."

The centre’s comprehensive approach to mother and child care has earned it widespread recognition. The Ministry of Health and Family Welfare is using the Manikganj Mother and Child Welfare Centre as a “proving ground” for the delivery of gender-sensitive services.

“This centre and eight more like it, made possible by UNFPA assistance, are now so successful that they are being used as reference points for the delivery of quality reproductive health services, family planning and child care,” points out Suneeta Mukherjee, UNFPA Representative in Bangladesh. “We are helping to institute genuine advances in maternal and child health care in this country.” [see UNFPA Office in Bangladesh]

Providing women and men with the means to voluntarily plan their families, within the context of comprehensive reproductive health services, is central to UNFPA’s mandate and the achievement of the goals set forth in the Programme of Action adopted by 174 countries at the International Conference on Population and Development (ICPD) in 1994. These goals are also considered critical for the Government's target of reducing the total fertility rate to 2.2 children per women, a goal that will not be reached for at least another decade.

With UNFPA assistance, the Government is concentrating its efforts in three key areas: diversifying contraceptive methods; ensuring safe deliveries by providing emergency obstetric services; and improving the quality of reproductive health care for women and men.

" I feel safe here, because I know that the staff are well trained and have the proper equipment to deal with emergencies. "

--Hamida, client at the Manikganj Center

Providing quality, affordable reproductive health services, including family planning to women and men, also contributes directly to the attainment of four of the eight Millennium Development Goals (MDGs) agreed to by all nations in 2000. These include: Goal 3, Promote Gender Equality and Empower Women; Goal 4, Reduce Child Mortality; Goal 5, Improve Maternal Health; and Goal 6, Combat HIV/AIDS, Malaria and other Diseases.

For women like Hamida, who have never heard of ICPD or the MDGs, the Manikganj Centre represents nothing less than life—for themselves and their babies. “I feel safe here,” she says. “Because I know that the staff are well trained and have the proper equipment to deal with emergencies.”

“The best testimony to our work is our clients,” adds Dr. Tahmina. “They keep coming back and bringing more women from their communities with them.”

UNFPA has played a pivotal role in persuading the Government of Bangladesh to allocate more resources, both human and financial, to the health sector. The Government is even launching a comprehensive population policy. Concludes Ms. Mukherjee, “UNFPA has been instrumental in engendering a real reproductive health revolution in this country."

—Don Hinrichsen