Safe Motherhood, Reducing Maternal Mortality and Morbidity

Bangladesh is one of the most densely populated countries in the world. The country has a population of about 140 million. Maternal Mortality Ratio remains high in Bangladesh at a ratio of 3.2. Only 13% deliveries are attended by skilled birth attendants, 92% deliveries take place at home and institutional delivery is only 8%. Major causes of maternal death are hemorrhage, eclampsia, puerperal sepsis and obstructed labour.

In Bangladesh every year about 3 million deliveries take place and around 12 thousand mothers die due to pregnancy related causes. On the other hand every year two hundred thousand mothers suffer from long-term ailments. Most of the causes can be prevented and treated by providing Emergency Obstetric Care during labour and follow up of postpartum period.

Developing capacity of the service providers in delivering high quality and effective reproductive health services is of great importance if UNFPA is to help to reduce maternal mortality and morbidity rates in the country. It does so by placing a strong focus upon institutional strengthening and capacity development.

UNFPA works closely with the Director General, Directorate General of Health Services (DGHS) , Directorate General of Family Planning, MOH&FW, Local Govt. Divisions of LGRD as well as the Medical Colleges and other training organizations in the public, NGO sector and allied medical professional associations.

Rural Poor:

UNFPA has been supporting the Directorate General of Family Planning in reducing maternal and child mortality as well as fertility rates in Bangladesh. Since the nineties 64 MCWCs have been upgraded and are playing a great role in delivering Emergency Obstetric Care (EOC) services effectively Doctors and Paramedics have been trained in EOC and the MCWCs equipped with modern medical equipment. About 50,000 deliveries and 5,000 Caesarean section are conducted annually in these MCWCs which contribute to a major percentage of the institutional deliveries in the country.. Through this project, the lives of thousand rural mothers are saved providing emergency obstetric care service during childbirth. This has proved as one of the successful programs of Ministry of Health and Family Welfare and widely appreciated by the community, the GOB and development partners.

In the 6th Country Programme, some new activities have been incorporated which includes Male services, Adolescent RH, Violence Against Women (VAW), RTI/STI case management, Post abortion care (PAC) and inter personal communication (IPC) training. The service providers were trained on these services and are making those available to the rural poor.


Urban Poor:

Bangladesh has one of the highest rates of growth of urban population. Rapid urbanization has resulted in vast intra-urban differentials in environment and health conditions, with those living in slums with the most acute and chronic hardships. Moreover, these slums are growing in huge numbers and shifting or expanding. Women and children are being particularly vulnerable in these areas.

Urban facts   - Urban pop. 23,39% of total population   - Urban growth rate 6% (National rate 1,5%)   - Population density in slum areas b 225.000persons/sq. km   - 1/3 of urban pop. have health problems   - Young people and adolescents comprise a large proportion of the slum population

   UNFPA has supported strategies to improve the Reproductive Health (RH) status of the urban poor through activities designed for capacity building in RH service delivery of City Corporations, Local Government Authorities and partner NGOs working in six City Corporations and six large districts of Bangladesh. The activities cover all the priority areas of Reproductive Health (RH) i.e. Safe motherhood, family planning, RTI/STI, etc.

• RH information and services to young
• Gender equality and equity
• Advocacy

Group meeting with RRCSS

Major activities   - provision of training on RH service delivery and management   - provision of medical, and surgical equipments and drugs to 25 Comprehensive Reproductive Health Care Centers (CRHCCs)   - Reproductive Health Care Centers (CRHCCs   - BCC activities at clinic and community level   - development and automation of Urban RH Management Information System (MIS)   - ensuring proper record keeping and reporting, and management of CDRS at CRHCCs   - ensuring quality assurance of service delivery at CRHCCs and piloting public-private-NGO partnership in Adolescent Reproductive Health (ARH) and other RH issues.

Deliveries at the centers have increased from 825 in 2001 to 12,472 in 2004. Some of the centers are even conducting more than 250 deliveries a month, however, on an average each center is carrying out 50-60 deliveries each month. Youth-friendly services are provided in the CRHCCs run by 14 partner NGOs. Planned activities for intensive BCC activities in slums have been initiated. Printed forms, registers and cards were supplied to CRHCCs. The centers are using Client Data Recording System (CDRS) software for recording client's data. Recently a Quality Assurance System and RH-MIS was developed and is being piloted in few centers.

Capacity Development for Reproductive Health:

UNFPA is continuing to strengthen the capacity of service providers in delivering Reproductive Health Services. Team training is being provided for doctors and nurses for comprehensive EmOC . Training on clinical contraception including Minilaparotomy, No-Scalpel Vasectomy (NSV) and HIV/AIDS, RTI/STI case management are being organized. Engender Health, Bangladesh Country Office is providing technical assistance on Clinical Contraception, HIV/AIDS and RTI/STI Case Management. The Curricula Review Committee of the MOHFW approved all the curricula developed by the project for its different training programmes.

Training of SBAs
The Government has taken a bold initiative to bring safe motherhood at the doorsteps of the women through a new cadre of health workers Skilled Birth Attendants (SBAs). Following a successful pilot project, supported by WHO, UNFPA and the Obstetric of Gynecological Society of Bangladesh (OGSB), training Family Welfare Assistant (FWA) and Female Health Assistant (FeHA) for 6 months in additional midwifery skills to become SBAs .The Government requested UNFPA to expand the SBA Training programme. WHO has developed the protocols and provided technical supports for the total programme.The implementing agency Directorate General of Health Services (DGHS) has expanded the training program in 24 districts. So far about 1400 FWAs and FeHAs from 24 districts completed the six months course.The Nursing Council has developed an accreditation body and process for certifying the SBAs. The provision of SBAs at the community level will serve as a pillar in meeting MDG goal 5.

Capacity Development for Reproductive Health:

Obstetric Fistula is a devastating pregnancy related disability and affects hundreds of women in Bangladesh. A bold initiative has been undertaken by UNFPA, BGD in strengthening the capacity of Government of Bangladesh to treat Vesico Vaginal Fistula (VVF). To address this issue, which has remained silent and hidden, UNFPA is assisting the government in strengthening services and developing capacity of the doctors and nurses in Dhaka Medical College Hospital since October, 2003. 44 Doctors and 21 Nurses of Dhaka Medical College and Hospital (DMCH) were trained on VVF. Existing facilities have been renovated to provide separate wards for fistula patients and a temporary Fistula Centre is established at DMCH. This will be the first of its kind in South Asia and is part of the global Fistula programme. UNFPA, Bangladesh received US$ 75,000 from the Fistula Trust Fund for additional activities as planned and a Rehabilitation Centre was opened. Four hundred (400) patients were operated successfully at the hospital from October 2003 to December 2005. UNFPA also funded the first ever situation analysis of fistula in the country, which estimated that at least 71,000 women are currently living with fistula in Bangladesh The aim is to develop capacity of the service providers in delivering high quality and effective fistula repair services in order to reduce maternal mortality and morbidity rates in the country.

Cervical Cancer Screening:

Cervical cancer is the second most common cancer among women of Bangladesh. To detect and prevent Cervical Cancer, a pilot project to "Train Health Providers on Cervical Cancer Screening based on VIA Test" is under taken in collaboration with Department of Obs/Gyn of BSMMU. Under this project, a total of 24 Doctors and 24 FWVs/Nurses from MCWCs and District Hospital have been trained so far. They are providing services for screening of Cervix for detection and primary treatment of cervical cancer and referring the VIA positive cases to the referral Hospitals


Fistula Patient Training & Rehabilitation Centre at DMCH, Dhaka