Giving birth at home taking lives of mother, child

Mosammat Alfa Begum (22) is more of a ‘fool’ to most of the locals. In her in-laws’ words, Alfa is so ‘stupid’ that she didn’t recognise the usual physical signs at the time of giving birth. Since the delivery was not on time, her child died.

During a visit to remote Shimultair Char area in Chaluabari union of Sariakandi upazila in Bogura on 17 April, this correspondent talked to Alfa and her in laws. In response to a query, Alfa’s sister-in-law Mosammat Rabeya Begum admitted that Alfa was never taken to see a physician while she was pregnant.

It had taken one and a half hours to reach Shimultair Char village in a remote Char area crossing the Jamuna river on an engine-operated boat. About 100 families live in the village. Locals say that issues like child marriage and getting pregnant at an early age are quite normal there.

Giving birth naturally at home is indeed the only hope there. If there is any complication during the delivery, they have to go to Sonatala or Sariakandi upazila health complex after one and a half to two hours of journey.

About twenty days before the death of Alfa’s child, SAAF champion women football team member Razia Sultana (21) died from excessive bleeding after giving birth at her home in Lakshminathpur of Kaliganj upazila in Satkhira in the early morning on 14 March.

The incident of her death, dragged issues such as high rate of giving birth at home, unawareness of pregnant women and their families, lack of government initiatives and negligence in seeking prenatal care at least four times under fresh light throughout the country.  

Under such condition of maternal and neonatal death, the safe motherhood day was observed on Tuesday, 28 May with the goal of raising awareness. The theme for the day this year is ‘Give birth in hospitals, save lives of mother and child’.

According to the report titled, ‘Key Findings of BBS Sample Vital Statistics 2023’ published by Bangladesh Bureau of Statistics (BBS) in March this year, the rate of giving birth at home is still around 33 per cent.

Meanwhile, the rate of receiving prenatal care four times or more is only 39 per cent. As many 20 newborns aged less than a month are dying against 1,000 live births, while 136 mothers are dying from 100,000 (1 lakh) live births.

As per United Nations’ Sustainable Development Goals (SDG), there’s a goal of bringing down maternal death to 70 in every 100,000 (1 lakh) and neonatal death to 12 in every 1,000 birth within 2030.

According to the Directorate General of Health Services (DGHS) data, there have been 1,760 neonatal and 242 maternal deaths in a total of 586 government hospitals including upazila health complex, medical college hospitals and district level hospitals from January to March of 2024.

There were 6,980 neonatal and 875 maternal deaths in 2023 with 10,553 neonatal and 800 maternal deaths registered in 2022.

Alfa, her sister-in-law and brother-in-law were speaking sitting in a tiny tin shade with fence walls. Alfa Begum is not an articulate speaker. Her sister-in-law Rabeya said that Alfa is a person with intellectual disabilities and her brother Md Sultan Sheikh has speech disability. This was her first pregnancy and a doula helped her giving birth.

Blaming her sister-in-law, Rabeya said that Alfa couldn’t respond physically while giving birth. When her labour pain was intensifying, she kept standing up again and again. When asked why they didn’t take her to the hospital during delivery, Rabeya said, “That was a mistake.”

Chaluabari Union Parishad chairman Md Tajul Islam told Prothom Alo that the people of the village are not that much aware about prenatal care of the expecting mothers. Whenever they require critical medical treatment, they have to reach the upazila health complex either by boats or in horse-drawn carts and auto rickshaws taking a long alternate route.

Head of the gynaecology department at Dhaka Medical College Hospital, Shikha Ganguly told Prothom Alo that it requires at least four times of prenatal care to reduce the life risk for the mother and the child. Every single pregnancy is unique. So, it cannot be predicted what the situation will be in any particular case before the delivery. That’s why it’s really risky to give birth at home.

There are 3,288 union health and family welfare centres on the union level that are operated under the directorate general of family planning with 60 mother and child welfare centres in the district, 12 in upazilas and 147 in different unions. However, none of these has a gynaecologist or anesthetist in them.

Program manager at the directorate general of family planning, Md Manjur Hossain told Prothom Alo that the government is working to make people motivated in visiting healthcare centres, aware in seeking prenatal care four times and to deal with the infrastructural lacking.