Birth attendants have been a part of Bangladesh's maternal health policy for twenty years, and are integral to the country's healthcare system. These skilled and heroic birth attendants are saving countless women and babies by supporting women during pregnancy, during delivery, and after that.
What Bangladesh's birth attendants do
A cross between a nurse and a doula, they are given several months of training before being tasked with guiding and supporting pregnant women. But their work isn’t just confined to helping with the delivery. They also make women get check-ups, blood tests, and screenings. They tell them which hospital to go to in case it’s a high-risk pregnancy. They even get them the right medication.
One of these skilled birth attendants is Nargis Akhter, who has overseen more than 400 deliveries in five years. She told AFP, “Every delivery is a new experience that I learn through myself. I do feel scared while doing deliveries many times, and I call on Allah in those times, because I have been in several tough situations during some deliveries. Being able to get them to a hospital on time is important to keep them healthy, so I am able to save the mother and the baby.”
Why birth attendants are important
Much like in many parts of rural South Asia, home births without medical assistance were very common in Bangladesh. AFP says, more than 30 percent of Bangladesh's women give birth without medical assistance, according to government data from 2022 Demographic and Health Survey. So, in the absence of professionals, there’s no one to help women safely give birth. That’s where birth attendants come in.
One of the mothers who benefited from their presence, Mafia Akhter, actually lost her first baby during a home birth where she had to deliver without a doctor present. But this time, she decided to go to a clinic and sought the help of Nargis Akhter, a birth attendant, whom Mafia credits for her child's survival.
She told AFP, “After my first child died, I felt if I don't go to the clinic this time, it could happen again, and if something goes wrong, I won't be able to bear it. My condition wasn't great in the beginning, but when Nargis told me to come and get a checkup here and prescribed medicines to me, I improved. Then I felt I should deliver my baby in the clinic, where my bleeding can be taken care of.”
Due to lack of education and awareness, women not only didn't know which hospital to go to and how, but also whether they need to see a doctor at all. Women like Nargis are supporting pregnant women by guiding them in that regard. Nargis told AFP: “During the checkup itself, we tell them that under no condition should they deliver at home.”
How maternal health in Bangladesh improved due to birth attendants
Over the past twenty years, improvements in Bangladesh's women's maternal health outcomes have coincided with the presence of birth attendants during deliveries. So, there has been a 70 per cent drop in maternal mortality in the past two decades, which is the same amount of time that birth attendants have been a part of this ecosystem.
A doctor and local health officer, Abdullahel Maruf, told AFP that the fact that women visit hospitals and clinics now, has helped make major headway in preventing maternal deaths: “If you see, last four or five years, maternal death was much more than it is now. And home delivery has been shifted to institutional delivery in some cases. Though the progress is not much in number, but it is significant,” adding, “Currently, maternal death is about 123 per lakh live birth, and per year we are achieving six per cent less maternal deaths.”
The roadblocks causing maternal deaths
Sayedur Rahman, a doctor who oversees Bangladesh's health ministry, told AFP that lack of funding is a huge problem: "We need resources to create a national ambulance network, recruit more anesthesiologists, open operating rooms. Our financial constraints will directly impact maternal and neonatal mortality rates."
Given the worldwide drop in healthcare expenditure on the part of several governments, the health of many is at risk. Women, who are marginalised in large sections of the world, often bear the brunt of this first, as do other marginalised communities. So, the birth attendants who are working to prevent this and protecting women's health at the grassroot level, shouldn’t remain unsung heroes, but be applauded for their contribution to society.
