Shetu Rani Mandal (40) has been a resident of Nandipara in Khilgaon of the capital city for long. She has two daughters and a son. Her husband works as a painter. For long Shetu Rani has been taking Sukhi, the free birth control pill supplied by the government. She would take one packet every month for free from the family welfare visitor. However, over the past six or seven months she has had to pay Tk 20 for the packet to the non-government organisation designated to provide the government service. She wants to know why, of all a sudden, she has to pay for the birth control pill.
Two other women who were standing with Shetu Rani, told this correspondent that they too were having to pay for the government oral birth control pill and condoms. They said, they even had to pay Tk 50 for the three-month short term birth control injections.
A visit to the area and talking to the women and adolescent girls there, revealed that the government's free birth control services, girl's TT shots, infant's vaccines were now all having to be paid for. They even had to pay up to 16 times higher for otherwise inexpensive birth registration.
These women and girls had come to attend a meeting arranged by ActionAid Bangladesh on 28 November at the Sher-e-Bangla Ideal Institute in Nandipara. They directly confronted the local people's representatives and government officials at this 'Service Provider Organisations and Public Hearing Meeting 2022'. The women and girls voiced their grievances over not getting free government services, having to pay extra costs for certain services and other problems of the area.
Retired family welfare assistant Sheuli Akhter, her replacement Tasnuva and the people's representatives presented their narratives. Sheuli Akhter said she had provided free birth control services for 31 years. Why were they being charged now? Tasnuva said she had called a woman to give her a free injection at the Nandipara government primary school. But the non-government organisation (NGO) people were not pleased with her presence there.
Nandipara is located in ward 74 of Dhaka South City Corporation. The ward councillor Md Azizul Huq said he had become extremely angry when he once saw the people having to pay for the services.
Charges even for vaccines
The government runs a free TT vaccine programme to administer four doses to protect girls over 15 from tetanus. When Khushi Islam of Nandipara was a young girl in 2016, she received four doses of the vaccine free of charge. But the parents of the young girl Trishna Rani (16) of the same area last November had to pay Tk 100 to get a card so she could avail the vaccine. She has had to pay Tk 50 for the first dose.
Two mothers, Kanika Rani Mandal and Ayesha Akhter, said they had to pay to get their children immunized.
They are angry about birth registration too. Kanika said she had to pay Tk 800 to get the birth of her four-year-old daughter registered. Shetu Rani paid Tk 500 to get her 5-year-old son’s birth registration. But the actual government birth registration fee is Tk 25 for under-five-year-olds and Tk 50 for children over 5. And there are no charges if the registration is done within 45 days of birth.
This year ActionAid, through the NGO Spriha, carried out a social survey of gender sensitive public services in Nandipara. The report revealed that free vaccines for infants and young girls had to be bought with money and so many poor families did not immunize their children in time. There were no health centres to provide adolescent girls with reproductive health and counseling services or for prenatal and neonatal health care for women. The government hospital, Mugda Medical College Hospital, was 7km away. Expectant mothers had to go to private hospitals in Bashabo and Bonosri for delivery and that cost between Tk 20,000 to Tk 30,000.
What the officials say
Speaking to Prothom Alo about the unavailability of free birth control services, Md Niazur, line director of the family planning directorate’s Field Services Delivery Unit, said, there is inequity in this free service in the cities. In Dhaka, three specialised hospitals of the directorate provide this service. Other than that, the city corporation provides service.
The health department of Dhaka City Corporation provides primary health care in the urban area through NGOs. These organisations say they provide ‘various services’ and take money for this.
Chief health officer of Dhaka North City Corporation (DNCC), Brigadier General Mohammad Jobaidur Rahman, told Prothom Alo, NGOs have been given this responsibility due to a lack of workforce. There is no provision to charge for birth control services. In order to cover overheads costs of transport, delivery and such, they can charge a minimum fee, not more than Tk 50.
The NGOs provide marginal services in the Dhaka wards 1, 2, 3, 12, 74 and 75. Project manager of such an NGO in the Khilgaon zone, Nazmun Nahar, claimed that there were no charges imposed for free services. She told Prothom Alo, women and young girls were given certain additional services and service charge was taken for these.
The ActionAid Bangladesh report provided certain recommendations to resolve the existing problems. These included ensuring healthcare for expectant mothers, lactating mothers and adolescent girls, free vaccinations, not charging extra for birth registration, raising awareness concerning social allowance and training for youth development, and ensuring government action to resolve water crisis in the localities.