Promoting Child Rights

Photo Courtesy: The Guardian

Midwifery
Traditional ‘dai’ is gradually replaced by skilled attendant

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Zyma Islam                          

Photo Courtesy: The Guardian

Photo Courtesy: The Guardian

ZAHIDA  Ishrat Khan who had recently completed her undergraduate studies in Public Health recalled her experience of working as an intern in the field of maternal health in a small village in Raozan of Chittagong.
“As someone who grew up in the city, I was surprised to see that most of the mothers risked delivering their children at home. My initial reaction towards the ‘dai’ or traditional birth attendant(ABAs)  was that they may be doing more harm than good. However once I started getting to know the village life better, I realized that the role played by TBAs and quack-doctors is not to be undermined,” she said.
In fact, if anything, the public health scenario would be a lot worse if they were not there, she surmised.
“The Upazila  Health Complex was not exactly next-door for most of these people.  Also, for those who are not connected to the few roads running through the village, the only way of getting about places is to tight-rope-walk across the thin ails(mound of earth) separating one field from the other. This would prove exceptionally difficult for a heavily pregnant mother, or one approaching labor. It is understandable why they preferred home-births,” said Zahida.
Besides, she said, strong, conservative, patriarchal traditions made it difficult for expecting mother to go outside, much less go to a hospital where there are male doctors.
Zahida maintained that what she saw, showed that the whole village depends on TBAs and quack-doctors, the way townsfolk depend on their local hospitals.
However, government and other partners have undertaken training programme for “Community Skilled Birth Attendant (C-SBA)” to conduct skilled delivery at home and more than 7000 of them have been trained.
Dr Ushyang Chowdhury from Sylhet, is the program coordinator of a Brac University-run diploma program in midwifery at a center in Pollogram, at Khadimnagar.
“There is a need to have midwives trained in the theoretical knowledge of anatomy, obstetrics, hygiene and first aid. Whatever they learn they learn through apprenticeship,” she said.
She maintained these midwives will practice in their communities as skilled attendants who have both practical knowledge and modern scientific expertise.
The midwifery diploma program, facilitated by the James P. Grant School of Public Health of Brac University is envisioned to complement   government’s ongoing midwive training program  to train 3000 midwives by 2015.
Suraiya Begum, registrar of Bangladesh Nursing Council, who coordinate the nationwide midwive training program, has  said that there are many such programs being offered across the country, although the exact number could not be obtained.
“Some of these courses are short training sessions, while others have lengthy diploma-level modules,” she said.
However, she said, it becomes very difficult to train women who are semi literate, or illiterate.
“Considering that factor, it is most effective if we can teach midwifery to girls who have passed high-school,” said Suraiya.
A government diploma course in midwifery by the Bangladesh Nursing Council, has taken the initiative to make sure that this branch of medical care can permeate into the rural levels.
The course offers teachings in physiology, medicine and minor surgery, among others.
“Choosing a TBA  is a risky choice – it is difficult to assess their level and depth of training,” added Suraiya.
Monica Fong, stated that training is needed to make sure that midwives can recognize beforehand, what cases of pregnancy might need emergency caesarean intervention,
“This is especially important considering the fact that it may not be possible to rush a woman in labor, immediately to a hospital,” she added.
Delivery by Skilled Birth Attendant is a prerequisite to ensure maternal and newborn’s. To this effect, Ministry of Health and Family Welfare has recently reiterated its commitment to ensure half of the deliver’s to be attended by a Skilled Birth Attendant ( SBA) by 2016 in the declaration ceremony of “ Ending Preventable Child Death : Bangladesh Call for Action’. Prof AFM Ruhal Haque, Honorable Minister, MOH and FW has made this declaration on July 21, 2013 which also encompassed the target of SBA up to 80 percent birth coverage by the year 2020. Currently, one third (32 %, BDHS 2011) of Bangladeshi women gave birth by the assistance of Skilled Birth Attendant. It is important to note that majority of those delivery had taken place at health facility ( 29 percent). To fulfill this commitment the declaration has figured out the major strategic approach for ensuring round the clock delivery service from health facilities equipped with necessary equipment, delivery room & beds and most importantly availability of  skilled birth attendant.  To ensure SBA at health facilities, the MOH&FW has started the midwifery programme in this country in order to realize what the Prime Minister’s had said at the General Assembly of the UN in 2010 where she committed to the development and deployment of 3000 midwives by 2015. Four Midwives will be posted in each Upazila Health Complex to ensure round the clock service provision. There will be 8 midwives at a District hospital and 12 in each Medical college hospital to ensure round the clock  delivery services from those facilities as well.
Till date, 710 certified midwives have been trained in this country.  Government has initiated two pronged strategies to increase the number of midwives in Bangladesh : six month long  “skill-up” short training of existing nurse-midwives, and (b) three-year direct-entry Diploma in Midwifery programme through Bangladesh Nursing Council. This diploma course has commenced in December 2012 with 525 students in 20 training sites (nursing colleges and institutions) where scarcity of nursing or midwifery instructors and nursing and midwifery lecturers is acute. Nonetheless, creation of the posts for midwives is under process. Expeditation of this process is necessary to ensure already trained midwives to retain competencies and offer quality pregnancy, delivery and postpartum period.

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