Bangladesh has made great strides in reducing maternal and newborn mortality but the death rates are still tragically high.
In Bangladesh 54 out of every 1,000 children die before their fifth birthday. Around half of these deaths are in the first month of life and, of those, approximately two-thirds occur before the baby is a week old.
Bangladesh is on track to achieve Millennium Development Goals (MDGs) 4 and 5 but too many mothers and babies still face terrible and unnecessary risks:
- the maternal mortality ratio is 194 per 100,000 live births
- the newborn mortality rate is around 32 per 1,000 live births.
There are two significant factors in these tragically high figures:
- around 85% of births in Bangladesh occur at home
- only around 18% of women giving birth have the support of a skilled attendant.
With support from the Big Lottery Fund (BIG), Women and Children First has been working in Bangladesh since 2002 in partnership with the Diabetic Association of Bangladesh's Perinatal Care Project (PCP) and University College London Institute for Global Health (IGH), to research the most effective ways of addressing these problems.
We and our partners worked in three districts, Bogra, Faridpur and Moulavibazar, to:
- mobilise communities
- strengthen health systems
- disseminate information and promote safe motherhood and essential newborn care.
Most recently, with funding from BIG, PCP modelled scaling up this work through a randomised control trial carried out in collaboration with the University College London Institute for Global Health and Women and Children First. This produced statistically significant evidence that this approach to community mobilisation reduces newborn mortality and is highly cost-effective. It has also identified the significant factors in the success of this type of intervention, so it can be expanded to reach more of the population.
The trial demonstrated that our low-cost interventions achieved:
- a 38% reduction in newborn death rates
- significant improvements in hygienic home delivery and maternal, newborn and child health practices
- a possible reduction of up to 27% in pregnancy-related deaths.
To achieve this, PCP worked with local communities to establish participatory women’s groups facilitated by women from the community. They received basic training on maternal and newborn health and participatory facilitation techniques, followed by regular supervision.
Different women’s groups chose to implement different strategies in order to improve their health, but these commonly included:
- establishing emergency funds
- arranging transport to health facilities
- disseminating key messages about safe motherhood and newborn care through community meetings and household visits.
The meetings empowered women to take action on the key factors that affect their health, by:
- engaging with the whole community
- improving access to, and the availability and quality of, health services.
The work of PCP grew rapidly, from 162 women’s groups in 2008, scaling up to over 800 groups in 2013, covering a population of a quarter of a million.
The work with women's groups was complemented by efforts to strengthen health services. This include:
- improving links between communities and health facilities and referral systems
- working with Community Health Committees and training doctors and Traditional Birth Attendants in essential newborn and maternal care
- establishing links between women’s group members and local authorities, committees and other Non-Governmental Organisations responsible for planning and delivering health care, to encourage them to implement best practice in maternal and newborn care.
Success Stories. Read about how a women's group works in practice to inform, empower and support its members and, through them, the wider community.
This guide describes an approach that has the potential to reduce maternal and newborn deaths, based on projects in India and Bangladesh.
Lancet report on the research to assess the effectiveness of a scaled-up development programme with women’s groups to address maternal and neonatal care in three rural districts of Bangladesh.
This moving film tells the personal stories of women who have benefited from being in a women’s group.
Research and funding
Women and Children's work in Bangladesh was funded by:
The research projects in India and Bangladesh were carried out by:
Women and Children First's partner organisation in Bangladesh is:
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BBC Radio 4 Appeal – Sunday 8th DecemberKathy Lette, bestselling author, writer, social commentator and Patron of Women and Children First, presents our BBC Radio 4 Christmas Appeal.
The Appeal will was broadcast on Radio 4 at 07.55 & 21.26 on Sunday 8 December 2013, repeated Thursday 12 December at 15.27. Please listen to the Radio 4 appeal or donate direct to us.