04/02/26 Safe motherhood practices on roll in Habiganj Nurul Islam Hasib Senior Correspondent back from Habiganj (bdnews25.wapamp.com/Dhaka)In a remote village, some 30 kilometre away from the north- eastern Habiganj town, a mother gave birth to a healthy baby on Tuesday night while another died around same time. Rani Begum died during her sixth childbirth at home while Sanchita Rani Acharja delivered her baby at the Murakori Union Health and Family Welfare Centre. Murakori Union Parishad Chairman Mohammad Liakat Ali said the mother who died at home lived just 10 minutes away from the hospital. "But she would not come here. It's an age-old practice (not to deliver at hospital)," he said, "The mother died because of negligence." "But we tried to convince her mother-in-law (guardian)," the Chairman said. The local government representatives are being mobilised by the USAID's MaMoni Project that partnered with the government in Habiganj to promote safe motherhood, childbirth and population control. Despite its business-dominated economy, the district lags behind on various health indicators. The total fertility rate 3.6 is far more than the national average 2.5. The national contraceptive prevalence rate is about 61 percent while it is only 40 percent in Habiganj. The latest BDHS findings suggest that at least 85 percent women deliver at home in the entire Sylhet division while nationally the rate is 76 percent. "Even a year ago, it (the Health and Family Welfare Centre) was an abandoned building," the Chairman said showing a picture to bdnews24.com taken at the time when the renovation work had started. After the renovation, it looks like a branch of a posh private facility. Staff members have quarters on the premises of the tidy Centre that offers round-the-clock normal delivery services, apart from other maternal and neonatal care. Such union health and family welfare centres have been renovated in the district and staff have been appointed by MaMoni Project against the vacant posts to maintain a 24-hour operation. Chairman of adjacent Shibpasha Union Parishad Md Tofsir Mia said delivering at home was like maintaining family status here. "They cannot even think that they will come out for giving birth. It's like losing one's prestige." The Chairman said social stigma and religious belief held them back. But through its unique feature, the project mobilises people at the very root level, so that they could avail those government services. When the Murakori centre was being renovated, the project managers were not sure whether women would come there. But because of community mobilisation, it has recorded over 150 childbirths in the last 10 months and the number is swelling fast. But questions remain about the continuation of the services once the project winds up and the management is handed over to the government. "We are showing the way how government facilities can be utilised," Dr Md Mohiuddin Choudhury, Field Manager of the project, said and added they had motivated 20 to 25- member team in every village to mobilise people at the community level to avail free government services. "Once they send an expectant mother to a facility for check- ups, our paramedics can convince them well enough to turn up again," he said. On a visit to a meeting of community volunteers on Thursday at a village of Shibpasha, where small boats were the only means of transportation, women could be seen gathered at a home braving rains. They were giving their account of number of expectant mothers, number of newborns, deaths, immunisation status and more other such information they collected from their areas to their leader. They collect information going door to door in their bid to motivate expectant mothers to visit the facilities. Team leaders would then go to the respective Union Health and Family Welfare Centre (UHFWC) with those data once a month where the government staff would collate those to send to the central authority in Dhaka. A Family Welfare Assistant of Tulla UHFWC Mohila Akhter said they could send more accurate information now than before to the central authority. "Earlier, we would go door to door for collecting those which was difficult for us two staff members. Now the volunteers come to us with all those statistics," she said. As most of the villages are surrounded by water and boats are the only means of transportation, the government health staff usually do not visit the field. Based on the partnership, paramedics have been appointed by MaMoni in vacant posts and they are being carried by a specially designed "Water Ambulance" to the field. The ambulance has a separate patient's bed, nurses' corner, water supply, toilet and washbasin with necessary medicines and equipment needed for check-ups. It is also meant to bring patients, especially critical cases, without having to depend on scheduled passenger boats. A mother Surma Begum at Noagaon under Baniachang recalled how she delivered her third baby onboard a health centre. It takes 30 minutes on an engine boat to go to the village from Baniachong. "I delivered my child mid-way to the hospital. Apa (a paramedic) managed everything and then we came back," she recollected with the baby in her lap. Line Director of the government's Primary Healthcare (PHC) Dr Syed Abu Jafar Md. Musa told bdnews24.com because of strong monitoring and supervision, these 'small-scale' pilot projects worked better. "But the government has to oversee the whole country which sometimes may not work well because of resource constraints." But he hoped the Habiganj model will continue functioning well even after hand-over of charge to them as community would become "demand-driven" by that time. "The activities will create demand in the community, and once people demand, you have to fulfil," he said. A headmaster of Noagaon Government Primary School Shikha Rani Das is also optimistic. "People here are not aware. They go for many children. They don't believe in birth control. But things will change soon as an increased number of girls are coming to the schools now," she told bdnews24.com showing her school's record. But the traditional birth attendants (TBAs) are disappointed. The mother Sanchita said they tried to convince her so that she did not visit the hospital. "It's (attending births at home) their earning so they don't want to lose it." Octogenarian Gendhu of the village, who himself worked as a TBA, believes there is no need for hospitals as she delivered her eight offspring at home. "Allah did it well." Paramedics at the Murakori Centre said the mother died as forced exertions by the TBA during placenta (which attaches the unborn baby inside the womb with the mother) removal and incomplete removal triggered bleeding after childbirth. "We are training them (TBAs) so that at least they avoid harmful practices," the project manager said.
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