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Patwary M, Gop K. How community education led to empowerment and safe childbirth. HPHR. 2023;52. https://doi.org/10.54111/0001/ZZ06
In the village of Nodapara, in Brahamanbaria district in eastern Bangladesh, 19-year-old Sharifa Akter is a healthy mother of a robust five-month-old baby boy. An important decision she made during pregnancy may just have saved her life. Reducing maternal and neonatal mortality is a big part of the UN’s Sustainable Development Goal 3 (SDG 3), which requires nations to ensure healthy lives and promote well-being for all ages. While Bangladesh has seen a significant decline in maternal and infant mortality rates over the years, the struggle to further reduce maternal and neonatal deaths continues. Subgoal 3.1 (SDG 3.1) specifically calls on countries to reduce maternal mortality to less than 70 per 100,000 live births by 2030. At present, the maternal mortality ratio in Bangladesh is 173 per 100,000 live births, while under-5 mortality is 29.1 deaths per 1,000 live births, and the infant mortality rate is 24 deaths per 1,000 live births. 1 The key to addressing this challenge — especially in the more rural areas of the country — may lie in increasing awareness of and promoting community education on maternal health.
In the village of Nodapara, in Brahamanbaria district in eastern Bangladesh, 19-year-old Sharifa Akter is a healthy mother of a robust five-month-old baby boy. An important decision she made during pregnancy may just have saved her life.
Reducing maternal and neonatal mortality is a big part of the UN’s Sustainable Development Goal 3 (SDG 3), which requires nations to ensure healthy lives and promote well-being for all ages.
While Bangladesh has seen a significant decline in maternal and infant mortality rates over the years, the struggle to further reduce maternal and neonatal deaths continues. Subgoal 3.1 (SDG 3.1) specifically calls on countries to reduce maternal mortality to less than 70 per 100,000 live births by 2030. At present, the maternal mortality ratio in Bangladesh is 173 per 100,000 live births, while under-5 mortality is 29.1 deaths per 1,000 live births, and the infant mortality rate is 24 deaths per 1,000 live births.1
The key to addressing this challenge — especially in the more rural areas of the country — may lie in increasing awareness of and promoting community education on maternal health.
Antenatal care (ANC) is healthcare provided to mothers throughout their pregnancy. It includes health screenings, identifying risk factors, and providing health education to mothers.
The healthcare that a woman receives during pregnancy, at the time of delivery, and soon after giving birth is important for the survival and well-being of both the mother and the infant. This is why promoting facility-based delivery and ANC for pregnant women through community sensitization can contribute significantly to preventing and decreasing maternal mortality.
In Bangladesh, the percentage of women with four or more ANC visits during pregnancy is 47%, and the percentage of babies delivered in a health facility is 49%2 This only indicates that we still have a long, long way to go.
Sharifa is a homemaker who lives with her husband, Sohel Mia, a businessman. During the first five months of her pregnancy, Sharifa did not receive any medical check-ups or services as she and her family believed these would be costly. One day, she attended a courtyard health education session (under the ‘Working with Individuals, Families and Communities to improve ‘Maternal & Newborn Health in Bangladesh’ project”) conducted by BRAC, a Bangladesh-based NGO. The project strives to increase access to and utilization of health services, improve knowledge and capacities regarding maternal and newborn health and generate evidence for policy-level advocacy. The project also aims to promote the role of nurturing care, facility-based delivery, and community involvement in a safe pregnancy.
For Sharifa, this session turned out to be very useful as she learned about ANC and postnatal care (PNC), which is healthcare provided after the baby’s birth, as well as the importance of regular check-ups. In addition, she also learned about facility-based delivery and the free services that were available to her.
Sharifa also learned that community education on maternal health plays a significant role in preparing mothers for safe pregnancies. This ties in with one of the most vital strategies in reducing maternal and infant mortality rates, which is increasing ‘birth preparedness.’ The project urges mothers not to delay seeking care when needed and be open to receiving care during their pregnancy.
By engaging the community through discussion and dialogue, it is possible to cover more ground and inform more people on the subject faster, ultimately building a network that can pass on timely information about maternal and child health.
After returning from the courtyard health education session, Sharifa informed her husband about the free health services available at the nearest Community Clinic (government-run centers offering primary health care) and said that she wished to make use of them. While her husband was on board with her decision, her mother-in-law, unfortunately, was not. Sharifa’s mother-in-law insisted on home delivery, but Sharifa was determined to stick to her decision. Proactively, she reached out to community health worker, Moriam Begum, the facilitator of the courtyard session, for support in convincing her family of the benefits of availing facility-based antenatal and postnatal services.
Moriam went to Sharifa’s house and had a detailed discussion with the family on the importance of ANC services during pregnancy, having the delivery at the facility, and post-pregnancy aftercare. In addition, she explained the rights of a pregnant mother and the responsibilities of her family.
After the session with Moriam, the mood changed. Sharifa was able to successfully convince her family that a facility-based delivery combined with ANC and PNC services would be the safest course for both her and her baby.
She gave birth to a healthy baby boy at the Brahmanbaria Government hospital, which brings us back to the present, where she and her son are both in excellent health.
Beaming with joy, she said, “I felt very empowered and happy when I made my own decision about my delivery. Now, I can also guide my pregnant sister-in-law about the services and other important pregnancy-related issues.” (Sharifa, oral communication, July 2022)3.
The ‘Working with Individuals, Families and Communities (IFC)’ project in Brahmanbaria to improve ‘Maternal & Newborn Health in Bangladesh’ project is being implemented with financial and technical support from Enfants du Monde (EdM).
Monzur Morshed Patwary is a public health practitioner with over 11 years of professional experience in organizations such as BRAC, The Task Force for Global Health, and CDC Foundation. As a Senior Programme Manager at BRAC, he has led several large-scale projects involving COVID-19 response, maternal and child health, and digitalization of training for community health workers. Monzur represents Bangladesh on global platforms such as Paris WHO, Global Leadership Forum, and HPAIR Harvard Conference. Monzur completed his bachelors from the University of Minnesota-Twin Cities and the Hubert H. Humphrey fellowship from Emory University. He is also a PMI Certified Project Manager.
Konica Gop is a health practitioner with 6+ years of professional experience in project management, government/non-government partnership management, and donor liaison. As a Manager at BRAC, she is currently managing the Enfants du Monde- funded project involving maternal and child health in Brahmanbaria district in Bangladesh. Konica received her MS.C in Psychology from University of Rajshahi and a certificate on “Policy Options in Mental Health” from Swiss School of Public Health.
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