Bangladesh

Background

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.

These statistics are gradually improving, and Bangladesh is on track to achieve Millennium Development Goals (MDGs) 4 and 5 . However, there is no room for complacency as the maternal mortality ratio is still 194 per 100,000 live births and the newborn mortality rate is around 32 per 1,000 live births.

A significant factor in these tragically high figures is the fact that around 85% of births in Bangladesh occur at home and only around 18% of women giving birth have the support of a skilled attendant.

Working in partnership

With support from the Big Lottery Fund, 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). We and our partners work in three districts – Bogra, Faridpur and Moulavibazar – disseminating information and promoting safe motherhood and essential newborn care, mobilising communities and strengthening health systems.

To achieve this The Perinatal Care Project works with local communities to establish participatory women’s groups. The monthly meetings are run by PCP facilitators – women from the local community who have received basic training on maternal and newborn health and participatory facilitation techniques, followed by regular supervision.

Different women’s groups choose to implement different strategies in order to improve their health, but these commonly include:

• Establishing emergency funds
• Arranging transport
• Disseminating key messages about safe motherhood and newborn care through community meetings and household visits.

The meetings empower women to take action on the key factors that affect their health, by engaging with the whole community and by improving access to, and the availability and quality of, existing health services.

Because of the shortage of professionally trained birth attendants, Traditional Birth Attendants continue to play a major role in the community. To help save lives in Bangladesh, we need to work with TBAs and support them in playing the most effective role they can. They are not an alternative to professionally trained staff, but can play a vital complementary role in keeping mothers and babies alive.

Foundations for the future

The work of PCP has grown rapidly, from 162 women’s groups in 2008, to over 800 groups today, covering a population of a quarter of a million people. Now we are:

• Targeting more pregnant women
• Addressing health problems faced by women and under-fives
• Preparing to start training traditional birth attendants (TBAs) and doctors.

Most recently, working closely with University College London and Women and Children First (UK), PCP has produced strong evidence that this approach to community mobilisation reduces newborn mortality. 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.

Women and Children First has been assisting PCP in developing advocacy strategies, and has developed a Good Practice Guide based on the experience of Ekjut – one of our partner organisations in India – and PCP in facilitating women’s groups.