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Bangladesh: The poorer the mother, the less likely she has access to skilled delivery support

Young woman holding child, standing next to livestock

Priyanka, 25, with her daughter Pollobi, 2 in the Rangpur District of northern Bangladesh. Photo: Sarah Easter/CARE

Priyanka, 25, with her daughter Pollobi, 2 in the Rangpur District of northern Bangladesh. Photo: Sarah Easter/CARE

When a baby is born in a rural village in northern Bangladesh, the mother puts honey in its mouth. The traditional reasoning is that this will help the baby learn how to "talk sweetly." As local mothers now understand, this tradition is not good for infants, who need mothers' milk, not sugar, in their first moments outside the womb.

“We… didn’t know how important it is to breastfeed the newborn with colostrum within the first hour,” says Asma Akter, 30, mother of Araf, seven months.

Colostrum, the first form of breastmilk, is nutrient-dense and high in antibodies and antioxidants to build a newborn baby’s immune system. It changes to breast milk within two to four days after the baby is born. Colostrum is thicker and more yellow than traditional breast milk.

In this small village, surrounded by rice fields and populated with many cows and goats, access to information about maternal and infant care was limited.

“I didn’t know about health check-ups for pregnant women,” says Priyanka, 25, mother of Pollobi, 2. “Many women died during their pregnancy or while giving birth. This was normal and a risk we all took. The women gave birth at their homes, now most of us go to the community clinic.”

Progress, but not enough of it

According to a study by the World Health Organization, Bangladesh has made progress in bringing down maternal mortality, from 441 deaths per 100,000 live births in 2000 to 123 deaths in 2020 — a rate that is still very high. The Sustainable Development Goal Target 3.1 stipulates reducing the maternal mortality rate to less than 70 deaths per 100,000 live births by 2030.

Most of the complications from which women die are preventable.

Access to maternal care and skilled birth attendants is believed to be of utmost importance in reducing maternal mortality — yet almost half of all births in Bangladesh still take place at home without the help of skilled birth attendants. The WHO study shows that only 30 percent of mothers who have had no previous education in comparison to 63 percent of mothers with secondary education had access to a skilled birth attendant. In addition, depending on how poor a woman is, the less likely she will have a skilled health professional at her side when she is giving birth. Only 32 percent of the poorest mothers in comparison to 86 percent of the richest have access to skilled delivery support.

Woman holding her daughter.
Photo: Sarah Easter/CARE

Priyanka was 16 when pregnant with her first child. She carried the baby for nine months when she fell into a hole in the water pump next to her house.

“After I fell, I kept silent,” she recalls, an absent gaze on her face. “I didn’t know what to do. My belly turned hard. I was so frightened. In the end, my baby was dead.” Since then, she has birthed two healthy children.

“When my first baby died, I cried a lot and had a [lot of] trauma,” she remembers. “I am happier now with my healthy other children. Pollobi is in good health and gained good weight.”

Eating well

Today, Priyanka regularly visits sessions for mothers and pregnant women run by Joint Action for Nutrition Outcome (JANO), a CARE project funded by the European Union and Austrian Development Cooperation. There, she is connected to other mothers and gains important knowledge on health, nutrition, and precautions she should take when pregnant.

“After coming to the JANO sessions, I learned how important it is to take precautions. If my baby didn’t move, I immediately went to the doctor for a check-up,” Priyanka says. “I also learned a lot about what to eat during pregnancy. My husband is a day labourer, he works in other people’s fields. It is hard to support our livelihood. Without the community garden from JANO, we only ate rice and potatoes. Now we also eat vegetables and fruits daily.”

When mothers are anemic, their babies are born malnourished. Close to one-third of children under five are affected by stunting in Bangladesh, which has implications for longer-term cognitive development and their future as adults. Poverty hinders access to the knowledge and services necessary for early childhood development, and this is reflected in poor households’ higher rates of stunting, wasting, and mortality.

Woman holding a small boy in front of a corn field.
Asma Akter, 30, with her son Araf (7 months) in front of a corn field in the Rangpur District of northern Bangladesh. Photo: Sarah Easter/CARE

Asma’s son Araf is still slightly malnourished. His mother regularly goes to the community clinic for a health check-up. Through JANO, she learned that she has access to the clinic and how important monthly check-ups are.

“I learned a lot about nutrition,.” she says. “We now have access to nutrition service and I now know how to feed Araf correctly.”

Before the JANO project started in this village, access to nutritious food was difficult. Food prices are rising. Four years ago the price for 1 kilo of potatoes was 7-8 Takas (about $0.07), now it is more than 20 Takas ($0.19). Additionally, most families didn’t know how to grow their own vegetables. Now, the JANO community and household gardens provide nutritious vegetables and fruit.


Young child being measured by community health worker.
Sofia, a community health worker, measures Araf to track his development. Photo: Sarah Easter/CARE

“We changed our way of cooking,” Asma says. “Before we just cooked what we had without thinking about a balanced diet.”

When she birthed her first son, she had complications during his delivery. “I didn’t know what I know today,” she recalls. “With Araf I didn’t have any complications. I am very happy that he is healthy and growing stronger every day.”

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