Tuesday, February 25, 2020 | ePaper

Midwifery & Training could be a change factor

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Rifat Zafreen :
Sokhina is at her advanced stage but it has been decided not to take her to hospital. So, Dai is her last resort. She is panicked and anxious thinking of her baby and her life. Traditional Dai is not a very safe idea in this situation of which most of our rural expecting mothers are to depend on. And it is one of the prime causes of maternal and neonatal death in our country while most of the rural mothers risk delivering their babies at home.
 Dais or traditional birth attendants are doing much harm than doing good and in the village life still the role of the Dais or quack doctors is not undermined completely though continuous awareness program of the government is going on in this regard. Under this circumstance, in place of Dais, skilled birth attendants and trained midwives are must to stop maternal and neonatal death in the country, which the government is trying to ensure.
Upazilla health complexes are not exactly always the next door for most of the rural people, also for those who are not connected with the few roads running through the village, of whom the only way of getting about places is to have a tight rope-walk across the thin ails (mound of earth separating one field from the other) in some cases.  72 per cent of child bearing women live in rural areas where healthcare access is limited or non-existent in many cases. Each year there are 50, 90,000 pregnancies and this is expected to increase by 20 per cent by 2030.  This would prove exceptionally difficult for a heavily pregnant mother, or one approaching labour. In this situation it is easily and reasonably preferred house births for them. Besides, strong, conservative and patriarchal traditions have made it difficult for the expecting mothers to go outside, much less to go to a hospital where there are male doctors. And thus most of the time the whole village are to depend on these traditional Dais.
To rescue these helpless mothers, government and other partner organisations have undertaken training programme named Community Skilled Birth Attendant (CSBA) for midwives to conduct skilled delivery at home.
Midwifery is relatively a new concept in Bangladesh. The traditional birth attendants commonly known as Dhatri though often are mixed up with Midwives, they are trained and skilled birth attendents. Midwifery is an honorable and distinguished profession. The increasing number of professional midwives has also contributed in the reduction of maternal and neonatal mortality rate in the country. In the last decade, being a rising star among the Least Developing Countries (LDCs) and aiming to become a Developing Country, Bangladesh has shown strong commitment to end preventable child and maternal deaths by 2030 to achieve the Sustainable Development Goals (SDG). To reach the goal the healthcare planners have prioritised antenatal and postnatal care, normal vaginal delivery, emergency obstetric care which directly links to quality maternal health services and so the country demands a huge supply of midwives to ensure healthy pregnancy for women and newborns.
An estimated 22000 midwives will be required to meet the national need. Prime Minister Sheikh Hasina committed at the UN General Assembly Special Session in September 2010 to train 3000 midwives by 2015. To fulfil the commitment of the  Prime Minister and to accelerate the production of midwives in the country, in January 2013, a three years direct entry Diploma in Midwifery Programme was introduced by the Government under the 2011-2016 Health, Population and Nutrition Sector Development Prrogramme (HPNSDP). Consequently, the set up a strong curriculaum, reformed the relevant Direcorate and the Regulatory body Bangladesh Nursing & Midwifery Council (BNMC) and created 3,000 posts for midwives to ensure health facilities.
The programme started with intake of 525 students in 20 nursing institutes and expanded, in phases to 925 students in 2016, across 38 institutes. Recently 1150 licensed Midwives are posted at Upazila Health Complexes. A post-basic course also started in 2010 under which 1,487 midwives have already been certified. Simultaneously with government, midwifery education has also been expanded by the private sector.
To help reach the goal of the counry along with different remarkable initiaves of the government in this regard, the most significant private sector initiative has been from BRACU which introduced a three years direct entry Diploma in Midwifery course in 2013 in partnership with 6 other NGOs working in different parts of the country. Funded by UK Government, the education initiative as part of the Developing Midwives Project (DMP) looks to create around 1.200 midwives by 2021.
Vulnerable students from disadvantaged and hard to reach areas have been provided free of cost education under this support from UK government. DMP promotes students from marginalised communities and low-income families.
These midwives are trained in the theoretical knowledge of anatomy, obstetrics, hygiene and first aid. Under this programme midwives learn all these subjects through apprenticeship. These midwives practice in their communities as skilled attendants with both of their practical knowledge and modern scientific expertise after completing this training.
This Midwifery Diploma Programme, facilitated by the James & Grant School of Public Health of BRAC University, is envisioned to complement government’s ongoing midwives training programme. Government has such many other programms across the country. Of these, some courses are short training sessions while others have lengthy diploma-level modules. But this is true; it is really very difficult to teach these courses to the semi literate and illiterate trainees mostly.
Only 41 per cent of the current health workforce is available to women to proride necessary maternal and newborn health interventions. Over the period 2012-2017, almost 80 per cent of live births worldwide occurred with the assistance of skilled health care personnel. Considering this factor it would be the most effective programme if midwifery is taught to the girls who have passed high-school, though Bangladesh Nursing Council has taken initiative to provide a government Diploma course in Midwifery to make sure that this branch of medical care can protect the pregnant mothers at the rural levels.  
Ministry of Health and Family welfare has recently reiterated its commitment to ensure of the total number half of the delivery must be attended by Skilled Birth Attendants (SBA) in the light of ‘Ending Preventable Child Death : Bangladesh Call for Action.’ It has also been committed to encompass the target of SBA up to 80 per cent birth coverage by 2020. Currently, one third (32 per cent PDHS 2011) of Bangladeshi women gave birth by the assistance of skilled birth attendant. Delivery by skilled birth attendant is a prerequisite to ensure safety of the maternal and newborns as it may not always be possible to rush a woman in labour, immediately to the hospital.
To ensure SBA as a health facility, MOH & FW has started the midwifery programme in the country and under this plan four midwives will be posted in each Upazilla Health Complex to ensure round the clock service provision for pregnant mothers. There will be 8 midwives at a district hospital and 12 in each medical college hospital to ensure delivery services.  
Mission of this Midwifery project is to provide quality health services to the most marginalized population in rural Bangladesh. In our perspective midwives can save life as Midwives are the first line of defense in the rural communities.
We can thus hope, very soon all of our pregnant mothers country wide will be taken care by the skilled birth attendants in place of traditional Dais during their crucial time.
In order to make these mothers along with their family members interested in skilled birth attendants and understand the importance of their services, media can play a very vital role in this case. School and college teachers also have a vital role to play to make the students and guardians aware of receiving the services of the trained midwives and skilled birth attendants. Our rural mothers and the people should be made aware of the importance of having a safe delivery for which skilled birth attendants are of no alternative. Safe delivery and so safety of the mother and newborn is must for having a healthy and lively generation for us.

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