Long road to safe maternal care
World Population Day is all about raising awareness about universal access to reproductive health services and building a world where every pregnancy is wanted and every childbirth is safe.
According to statistics from UNFPA, reproductive health problems remain the leading cause of ill health and death for women of childbearing age worldwide. Here are some terrifying statistics: 358,000 women die every year from pregnancy related causes. Some 222 million women in the developing world want to avoid or plan pregnancies but cannot to do so because of lack of safe, affordable and accessible methods of family planning. That is 222 million women who had no other choice but to give birth to a child when they didn't want. And meeting this need would result in 53 million fewer unintended pregnancies.
Nearly 800 women die everyday in the process of child birth from bleeding, infections, unsafe abortions, high blood pressure and obstructed labour; which are all highly preventable or treatable with adequate care and medicines.
Let the numbers sink in while I bring the issue closer to home. Maternal care is difficult to reach if you are poor and virtually non-existent if you are extreme poor. While working with an organisation that aims to reduce extreme poverty, I've met 14-year old mothers in Barisal, disabled mothers of large families in urban slums and too many women who have had miscarriages or lost children because of malnutrition and inadequate health care.
To portray the situation, I borrow from a research paper done by Nuzhat Chowdhury and Syed M. Ahmed, titled "Maternal care practices among the ultra poor households in rural Bangladesh," which explores the maternal care practices among the ultra poor in Bangladesh. Extreme poor women are marginalised compared to the national rural average in terms of accessing antenatal care (37% for ultra poor women and 60% national rural women), institutional delivery (5% from lowest wealth quintile and 15% national rural average), receiving iron supplementation during last pregnancy (53% for ultra poor and 55% national rural women), and use of contraceptive prevalence (63% for ultra poor and 80% ever-married women in Bangladesh). If anyone is need of quality reproductive health care, it's the extreme poor women of Bangladesh.
The following findings are based on the report from interviews with women in Kurigram. The respondents considered pregnancy as a common event and, aside from confirming the pregnancy, refrained from seeking antenatal care or medical advice.
This avoidance was due to a combination of financial constraints and traditional beliefs. On practices during childbirth, the women reported that most deliveries took place on the floor in the squatting posture and the attendants seldom washed their hands before delivering babies. Women avoided going to healthcare providers if they got ill after childbirth because they felt the process of pregnancy didn't really need additional medical intervention unless serious complications arose.
Even if the new mothers were in any pain or fell ill after delivery they didn't seek any medical help; mostly because they took the discomfort to be a natural symptom of the pregnancy, but many didn't go for check up because they were not even aware that post partum checkups were available. There is a dearth of information on maternal care practices of the marginalised women from ultra poor households in rural Bangladesh.
Ingrained traditional beliefs and superstitions can also shape practices related to pregnancy. As in many Bangladeshi homes, regardless of socio economic status, the elderly murobbi women in the family take control of the pregnancy dictating what, how, when, where and who, imposing restrictions based on their own experiences and superstitions.
For instance, eclipses are believed to effect pregnant women; the ladies reported staying at home or not lying on their own bed during eclipses. There is belief that cooking, cutting and twisting or eating certain things can lead to the child being born with a cleft palate or deformed features and so their movement and diet are controlled. A belief that the placenta could possibly choke the mother from the inside has lead to harmful practices to expel the placenta after delivery.
There have been cases where relatives massaged the abdomen of the mother, or gagged her with her hair or made her consume kerosene oil or onion juice to induce vomiting so that placenta comes out through abdominal contractions.
Monetary constraints, absence of knowledge about the necessity of services and restrictions on the movement of women were identified as reasons for not accessing antenatal care. The report also cites poor attitudes from healthcare staff such as using abusive language, denying services and assistance and lacking compassion in general as a reason for why women tend to avoid seeking healthcare. Women should feel free to share their problems, whatever they may be, with health care providers.
While it is already a priority of the government to address maternal healthcare and proper population control mechanisms, we need to do our part to make sure that the appropriate information is available to all parts of the country. The study iterates what we already know; that affluence and socio cultural factors play a significant role in maternal care practices, that dire poverty and social exclusion push mothers away from proper care during and after pregnancy.
This government is committed to achieving the Millennium Development Goals by 2015, but we have a long…long way to go. So to whoever is reading, be horrified by the aforementioned statistics, feel lucky that you have the knowledge and luxury to be horrified, and then do something about it, in whatever way you are able to.
The problems identified can be traced back to the lack of sufficient resources for healthcare in most parts of Bangladesh (which the government needs to address!) and the general lack of knowledge about the issue. We need to make sure that our mothers, daughters, nieces, maids, students, patients -- basically all the females in our lives -- are aware of the proper health care practices, and that the government is held accountable for facilitating those, so that no one has to have a child when they don't want one and no one has to fall ill or die from an unsafe childbirth.